PT GRACIA DIKATAMAS

DUMP TRUCK AND TRUCK INSPECTION CHECK LIST

Product Identification : Company :

Model No : Contract No :
Engine No : Date of Inspection :
Frame No : Location of Inspc :

No. ITEM CHECKED / BAGIAN YANG DIPERIKSA Remarks

A DRIVER INFORMATION / Informasi Pengemudi

1 Name of Driver / Nama Supir

2 Driver Licence Number / No SIM Pengemudi

3 Class of Driving Licence / Jenis SIM

4 Expire Licence / Masa Berlaku SIM

B VEHICLE INFORMATION / Informasi Kendaraan

1 Licence Plate / Nomor Polisi

2 STNK Valid to / Masa Berlaku STNK

3 BUBKB / KIR Valid to ( Only for Pic-Up vehicle )

4 Type of Vehicle-Merk /Tipe Kendaraan - Merek

5 Year of Built / Tahun pembuatan

ITEM CHECKED Availability Condition
No. Remarks
BAGIAN YANG DIPERIKSA Yes No Good Fair Poor
Ada Tidak Bagus Kurang Jelek

C VEHICLE CONDITION / Kondisi Kendaraan

1 Km Driven / Kilometer tempuh

2 Glass / Kaca:

2.1 Windshield / Kaca depan

2.2 Rear Window / Kaca belakang

2.3 Side Window / Kaca samping

Windshield wiper / karet pembersih kaca depan

3 Mirror / Spion

3.1 Side / Samping

- Left / Kiri

- Right / Kanan

4 Light / Lampu

4.1 Head / Depan

4.2 Tail / Belakang

4.3 Parking / Parkir

4.4 Indicator - Sign / Signal

4.5 Break / Rem

5 Door Condition / Kondisi pintu

6 Type of Tire / Tipe Ban

6.1 Mud Type / Type Mud

6.1.1 Front / Depan

6.1.2 Rear / Belakang

7 Valve Tire Cap / Penutup lubang angin ban

8 Gas / fuel tank door / lid - Gas / Penutup tanki bahan bakar
 ITEM CHECKED Availability Condition
No. Remarks
BAGIAN YANG DIPERIKSA Yes No Good Fair Poor
Ada Tidak Bagus Kurang Jelek

9 Fuel tank, any leak ? / Tanki bahan bakar, ada kebocoran?

10 Engine / Mesin

11 Exhaust / Knalpot

12 Accu / Aki Electric System

13 Horn / Klakson

14 Safety belt / Sabuk pengaman

15 Speedometer / Speedometer
16 Break / Rem
17 Fuel indicator / Indikator bahan bakar

18 Single Rear Axle Configuration / Poros belakang tunggal

19 Gear Pump : Power take off PTO / roda gigi pompa

20 Bed Capacity : 4M3 - 8 Ton / Kapasitas Muat

21 Nut & Bolt Tire

22 V-Belt Engine / V belt mesin

23 Hydraulic System / Sistem hidrolik

24 Transmission System / Sistim transmisi

25 Fire Extinguisher / Racun api

26 Manufacture’s Tool Kit / Perkakas

27 Vehicle Jack / Dongkrak

28 15 m 0.5” wire rope, c/w shackles / Tali kawat 15 m 0,5"

29 Safety Triangle / Segitiga pengaman

30 First Aid / P3K

31 Safety PPE driver

Note : 1
2
3
- Mechanical findings :

- Overall condition : GOOD FAIR POOR

- Conclusion : 1. Meet / Not meet contract spec.
2. Meet contract spec but on condition (specify) :

Inspected by,