Doc No :

S-000-1654-400-F.12
Pembangunan Aviation Fuel System & DPP Rev :
Kulon Progo Project Date :

□CARRY-IN/□MONTHLY EQUIPMENT INSPECTION CHECKLIST

[ELECTRIC DISTRIBUTION BOARD]

Type of Equipment : CARRY-IN CERTIFICATE

Equipment No. : Permit No. :
Capacity : Date :
Manufacturer : Approved by :
Subcontractor : Reviewed by :
Date of Deployment : Inspection shall be carried out at carry-in
Month of Inspection : and at least once a month

[Subjects] □ Electric Distribution Board □ Kabel Distributor

[Result Column]  : Yes/Good, Acceptable, X: Not/Bad, Not to use, NA: Not applicable.

No. Check Item Check Points Result Remarks

Electric Distribution Board
a Appearance/Structure Weather-proof, Door w/ Lock
b Earth Leakage Circuit Breaker Function, Capacity
c Frame (Body) Earth Resistance, Damage, Missing
d Switches/Switch covers Breakage, Missing
e Socket/Outlet Breakage
f Light for night, dim location Breakage, Missing
g Pilot Lamp Breakage, Missing
h Cable Termination Secure, No exposed
i Installation Location, Access
j User’s Tag for Each Circuit Indication
k Doors Lockable/Breakage
l Fire Extinguisher Provision
m Warning Sign for Elec. Shock Display
n Responsible Person’s Name Display

Subcontractor/Supplier JGC INDONESIA

Approved by : Safety Manager :

Reviewed by : Reviewer :

Page 1 of 2
 Doc No :
S-000-1654-400-F.12
Pembangunan Aviation Fuel System & DPP Rev :
Kulon Progo Project Date :

Inspected by : Inspector :

Date : Date :

Page 2 of 2