Page 1 of 2

SANDBLASTER PRE-MOB INSPECTION REPORT

Applies to Sand Blasting Equipment

Equip. No. : Type : Model : Brand :

Serial No. : Service Date :

Inspected by : Date : Location : Owner :

d
oo
d
Description to be Checked Remarks

/A
oo

N
G

o
N
Equipment Documentation
1 Today's Pre-Trip Inspection Original Copy Available on Unit
2 Original Manufacturer Name Plate Year of Manufacture
3 Original or a Copy of Operation Manual Book Matches Unit Type and Series
4 SOP - Standard Operating Procedure Based on OEM Operation Manual Book
5 Company ID Number, Company Logo Correct Size, Minimum 10 Cm Height, Visible
6 K3/P3A2 - Depnaker Certification Expired :
Air Receiver Tank Original Manufacturer Name Plate Intact Not Modified and Certified with ASME or
7
Equivalent Genuine Reference Number

Mandatory Safety Inspections and Devices

1 Automatic Overpressure Safety Release Valve Test Function
2 Quick Change Air Hose Couplers Connector and Clamps must be SAFETY WIRED
3 Air Manifold Discharge Check Valve Test Function
4 Trailer Towing Ring -Towing Connecting Devices Not Bent, No Fatigue Cracks

5 Trailer Wheels and Tires, Wheel Condition, No Broken-Missing Lug Nuts, Tread Depth Minimum 3mm

Trailer Suspension System, Springs, Brakes

6 No Loose Axle Mount Bolts, No Worn Out Spring Bushings and Pins All U-Bolts Tight, No Cracks,
Parking Brake Functional
Safety Covers and Guards All Covers in Place, Not Loose, None Missing, Not Modified, Remain
8
within OEM Specs

9 Safety Stand Legs Not Bent, Not Unsafe or in Danger of Collapsing

10 Safety Cable or hose connector No rust good condition, function test

Main Unit
1 Sand Pot
2 Coupler and Hose All Coupler and hose in good condition no damage
3 Connection and Extentension All Connection in good condition no damage
4 Fitting and Clamps All Fitting and Clamp in good condition no damage

5 Valve All valves in good condition no damage

Frame and Body

1 Body Condition Good Paint and General Appearance, No Excess Damage, No Rust
2 Covers Hinges Inspect Latches for Safety Holding Brackets, Can NOT Pinch Fingers

Servicing and Maintenance

1 Maintenance Schedule - PM and PdM Service Records Available
 Page 2 of 2

SANDBLASTER PRE-MOB INSPECTION REPORT

Applies to Sand Blasting Equipment

Equip. No. : Type : Model : Brand :

Serial No. : Service Date :

Inspected by : Date : Location : Owner :

d
oo
d
Description to be Checked Remarks

/A
oo

N
G

o
N
Others
1
2
3

Comments
Good = Good condition, able to be operated
in all PHKT areas
No Good = Broken, Malfunction, Repair or
Replace
N/A = Not Applicable

Inspected by: Checked by Acknowledged by PHKT The undersigned hereby accept and agree
that this equipment is "OK" and safe for
operation. Menerima dan Menyetujui
bahwa Alat ini sudah "OK" dan aman
untuk dioperasikan.

SIGNATURE, Date

PT. Catur Elang Perkasa

Contractor's Name