PT.

BAK
FIRE EXTINGUISHER INSPECTION

No. Form : BAK-HSE-013 Rev : 00

ITEM TO BE CHECK
NO DATE DESCRIPTION CYLINDER NOZZLE PRESSURE PIN LOCK HANDLE LOCATION REMARKS
OK NO OK NO OK NO OK NO OK NO
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20

……………………… , ……………………20….
Prepared & Checked By, Acknowledge & Approve By,
………………………………………… …………………………………………
 PT. BAK PT. BAK
FIRE EXTINGUISHER INSPECTION FIRE EXTINGUISHER INSPECTION
No. Form: BAK-HSE-006A Rev : 00 No. Form: BAK-HSE-006A Rev : 00
Tahun: Tahun:
Fire Extingusher Number Inspected By, Fire Extingusher Number Inspected By,
Month Tab Nozz Pres Pin Hand Date Name & Sign Month Tab Nozz Pres Pin Hand Date Name & Sign
July July
August August
September September
October October
November November
December December

PT. BAK PT. BAK

FIRE EXTINGUISHER INSPECTION FIRE EXTINGUISHER INSPECTION
No. Form: BAK-HSE-006A Rev : 00 No. Form: BAK-HSE-006A Rev : 00
Tahun: Tahun:
Fire Extingusher Number Inspected By, Fire Extingusher Number Inspected By,
Month Tab Nozz Pres Pin Hand Date Name & Sign Month Tab Nozz Pres Pin Hand Date Name & Sign
July July
August August
September September
October October
November November
December December
 PT. BAK PT. BAK
FIRE EXTINGUISHER INSPECTION FIRE EXTINGUISHER INSPECTION

Fire Extingusher Number Inspected By, Fire Extingusher Number Inspected By,
Week Tab Nozz Pres Pin Hand Month Name & Sign Week Tab Nozz Pres Pin Hand Month Name & Sign
I I
II II
III III
IV IV
V V
I I
II II
III III
IV IV
V V

PT. BAK PT. BAK

FIRE EXTINGUISHER INSPECTION FIRE EXTINGUISHER INSPECTION

Fire Extingusher Number Inspected By, Fire Extingusher Number Inspected By,
Week Tab Nozz Pres Pin Hand Month Name & Sign Week Tab Nozz Pres Pin Hand Month Name & Sign
I I
II II
III III
IV IV
V V
I I
II II
III III
IV IV
V V