02/MAU-MR/R0

CHECK LIST INSTRUKSI KERJA

(WORK INSTRUCTIONS CHECK LIST) Nomor Urut
:
SEBELUM PEMBESIAN PILE CAP (Serial Number)
(BEFORE IRONING OF PILE CAP)
Nomor Referensi Gambar
PROYEK [ Kode ] : (Drawings Reference number) :

LOKASI (LOCATION): : Revisi (Revision) :

Beri tanda (Mark) √ yang sesuai (Appropriate) Inspeksi I (Inspection I) Inspeksi II* (Inspection II) Inspeksi III* (Inspection III)
ITEM PEMERIKSAAN Ya Tidak Tidak disyaratkan Ya Tidak Tidak disyaratkan Ya Tidak Tidak disyaratkan
No
(WORK ITEM) (Yes) (No) (Not Required) (Yes) (No) (Not Required) (Yes) (No) (Not Required)
Shop drawing tersedia
1 (Shop Drawing is Available)
Cutting list & bending list sesuai Shop Drawing
2 (Cutting list and bending list is
accordance with shop drawing)
Alat tersedia dan layak pakai
3
(Tools are available and suitable to be used)
- Bar cutter
- Bar bending
- Gunting besi manual (Manual iron scissors)
- Gegep (Tweezers)
- Alat bantu (Aids)
Fabrikasi sesuai Cutting list & bending list
4 (Fabrication is accordance with cutting and
bending list)
- Diameter besi beton (Diameter of concrete iron)
- Jumlah & ukuran potongan (The number and size of the pieces)
- Jumlah & ukuran tekukan (The number and size of bending)
- Jumlah & dimensi sengkang (The number and dimensions of
the cross bar)
Material kawat beton tersedia
5
(Concrete wire material is available)
Besi sambungan/stek/overlap min 40 D
6
(Iron connecting / cuttings / overlap min 40 D

APD yang digunakan lengkap dan sesuai dengan potensi bahaya

yang ditimbulkan
7
(PPE that is used are complete and in
accordance with potential hazard that is posed)

Mengidentifikasi potensi bahaya yang timbul serta cara

8 pengendaliannya
(Identify the hazard that arise and how to control it)

Lokasi Inspeksi (Inspection Location) : Tanggal inspeksi (Date of Inspection) Tanggal inspeksi (Date of Inspection) Tanggal inspeksi (Date of Inspection)

Yang membuat (Created by) Yang membuat (Created by) Yang membuat (Created by)

Supervisor Supervisor Supervisor

Alat Inspeksi (Inspection Tools) : Mengetahui (Approved by) Mengetahui (Approved by) Mengetahui (Approved by)

Quality Control Quality Control Quality Control

Catatan (Note) : Rekomendasi (Recommendation) Rekomendasi (Recommendation) Rekomendasi (Recommendation)

Perhatian (Attention): Penanggung jawab

1 Utamakan Keselamatan Kerja (Safety First) (Responsible person)
2 Pakailah safety helmet (Used Safety Helmet)
3 Pakailah safety shoes (Used Safety Shoes)
4 Pakailah safety belt (Used Safety Belt)
5 Jagalah kebersihan lingkungan (Keep it Clean) Production Manager
 02/MAU-MR/R0
CHECK LIST INSTRUKSI KERJA
(WORK INSTRUCTIONS CHECK LIST) Nomor Urut :
SEBELUM BEKISTING PILE CAP (Serial Number)
(BEFORE FORMWORKING OF PILE CAP)
PROYEK [ Kode ] : Nomor Referensi Gambar :
LOKASI (LOCATION): : Revisi (Revision) :
Beri tanda (Mark) √ yang sesuai (Appropriate) Inspeksi I (Inspection I) Inspeksi II* (Inspection II) Inspeksi III* (Inspection III)
ITEM PEMERIKSAAN Ya Tidak Tidak disyaratkan Ya Tidak Tidak disyaratkan Ya Tidak Tidak disyaratkan
No
(WORK ITEM) (Yes) (No) (Not Required) (Yes) (No) (Not Required) (Yes) (No) (Not Required)
Shop drawing tersedia
1
(Shop drawing is available)

Galian pile cap dan Lantai kerja sesuai Elevasi Shop

2 Drawing (Excavated pile cap and
floor work in accordance with shop drawing elevation)

Lantai kerja & elevasinya

3
(Work floor and its elevation)
Pabrikasi sesuai shop drawing
4
(Fabrication is accordance with shop drawing)
Kebersihan bekisting
5
(The sanitation of formwork)
Pelapisan bekisting dengan mold oil
6
(Formwork coating with mold oil)
Alat bantu tersedia
7
(Tools are available)

APD yang digunakan lengkap dan sesuai dengan potensi

bahaya yang ditimbulkan
8
(PPE that is used are complete
and in accordance with potential hazard that is posed)
Mengidentifikasi potensi bahaya yang timbul serta cara
pengendaliannya
9
(Identify the hazard that arise and how to
control it)

Lokasi Inspeksi (Inspection Location) : Tanggal inspeksi (Date of Inspection) Tanggal inspeksi (Date of Inspection) Tanggal inspeksi (Date of Inspection)

Yang membuat (Created by) Yang membuat (Created by) Yang membuat (Created by)

Supervisor Supervisor Supervisor

Alat Inspeksi (Inspection Tools) : Mengetahui (Approved by) Mengetahui (Approved by) Mengetahui (Approved by)

Quality Control Quality Control Quality Control

Catatan (Note) : Rekomendasi (Recommendation) Rekomendasi (Recommendation) Rekomendasi (Recommendation)

Perhatian (Attention): Penanggung jawab

1 Utamakan Keselamatan Kerja (Safety First) (Responsible person)
2 Pakailah safety helmet (Used Safety Helmet)
3 Pakailah safety shoes (Used Safety Shoes)
4 Pakailah safety belt (Used Safety Belt)
5 Jagalah kebersihan lingkungan (Keep it Clean) Production Manager

*) Kolom Inspeksi II dan III digunakan apabila ada pekerjaan yang tidak memenuhi syarat ( ada Ketidaksesuaian Produk)
 02/MAU-M
CHECK LIST INSTRUKSI KERJA
(WORK INSTRUCTIONS CHECK LIST) Nomor Urut :
SEBELUM BEKISTING BATAKO (Serial Number)
(BEFORE FORMWORKING OF BRICK)
Nomor Referensi Gambar
PROYEK [ Kode ] : (Drawings Reference number) :

LOKASI (LOCATION): : Revisi (Revision) :

Beri tanda (Mark) √ yang sesuai (Appropriate) Inspeksi I (Inspection I) Inspeksi II* (Inspection II) Inspeksi III*
ITEM PEMERIKSAAN Ya Tidak Tidak disyaratkan Ya Tidak Tidak disyaratkan Ya Tidak
No
(WORK ITEM) (Yes) (No) (Not Required) (Yes) (No) (Not Required) (Yes) (No)
Shop drawing tersedia
1
(Shop drawing is available)
Galian pile cap sesuai Shop Drawing
2
(Excavated pile cap is in accordance with shop drawing)
Pemadatan tanah
3
(Soil compaction)
Elevasi lantai kerja sesuai shop drawing
4 (Work floor elevation is accordance with
shop drawing)
Tarikan benang elevasi top pile cap
5
(Thread pull of cap top elevation)
Alat bantu tersedia
6
(Tools are available)

APD yang digunakan lengkap dan sesuai dengan potensi

bahaya yang ditimbulkan
7
(PPE that is used are complete and
in accordance with potential hazard that is posed)
Mengidentifikasi potensi bahaya yang timbul serta cara
pengendaliannya
8
(Identify the hazard that arise and how to control
it)

Lokasi Inspeksi (Inspection Location) : Tanggal inspeksi (Date of Inspection) Tanggal inspeksi (Date of Inspection) Tanggal inspeksi (Date of Inspec

Yang membuat (Created by) Yang membuat (Created by) Yang membuat (Created b

Supervisor Supervisor Supervisor

Alat Inspeksi (Inspection Tools) : Mengetahui (Approved by) Mengetahui (Approved by) Mengetahui (Approved by)

Quality Control Quality Control Quality Control

Catatan (Note) : Rekomendasi (Recommendation) Rekomendasi (Recommendation) Rekomendasi (Recommend

Perhatian (Attention): Penanggung jawab

1 Utamakan Keselamatan Kerja (Safety First) (Responsible person)
2 Pakailah safety helmet (Used Safety Helmet)
3 Pakailah safety shoes (Used Safety Shoes)
4 Pakailah safety belt (Used Safety Belt)
5 Jagalah kebersihan lingkungan (Keep it Clean) Production Manager

*) Kolom Inspeksi II dan III digunakan apabila ada pekerjaan yang tidak memenuhi syarat ( ada Ketidaksesuaian Produk)
 02/MAU-MR/R0

nspeksi III* (Inspection III)

Tidak disyaratkan
(Not Required)

ggal inspeksi (Date of Inspection)

ng membuat (Created by)

Supervisor
ngetahui (Approved by)

Quality Control
komendasi (Recommendation)
 02/MAU-MR/R0
CHECK LIST INSTRUKSI KERJA
(WORK INSTRUCTIONS CHECK LIST) Nomor Urut :
SEBELUM PENGECORAN PILE CAP (Serial Number)
(BEFORE PILE CAP CASTING)
Nomor Referensi Gambar
PROYEK [ Kode ] : (Drawings Reference number) :

LOKASI (LOCATION): : Revisi (Revision) :

Beri tanda (Mark) √ yang sesuai (Appropriate) Inspeksi I (Inspection I) Inspeksi II* (Inspection II) Inspeksi III* (Inspection III)
ITEM PEMERIKSAAN Ya Tidak Tidak disyaratkan Ya Tidak Tidak disyaratkan Ya Tidak Tidak disyaratkan
No
(WORK ITEM) (Yes) (No) (Not Required) (Yes) (No) (Not Required) (Yes) (No) (Not Required)
Shop drawing tersedia
1
(Shop drawing is available)
Spesifikasi mutu beton
2
( Mix Design)
Nilai slump test beton sesuai Mix Design
3 (Slump test value of the concrete is accordance with
mix design)
Benda Uji Kubus beton sesuai BPP
4 (Test material of concrete cube is accordance with
BPP)
Peralatan cor tersedia dan layak pakai :
5 (Cast equipments are available and
suitable to be used, such as )
- Kompressor / cleaning bucket
- Vibrator
- Bucket
- Tremie (kalau diperlukan) (If needed)
- Concrete pump (jika diperlukan) (If needed)
- Alat bantu (Aids)
Marking elevasi top cor rencana
6
(Marking the top elevation of cast plan)
Bidang pengecoran dibersihkan
7
(Casting field was cleared)
Material curing compound/karung cukup tersedia
8
(Material of curing compound / sack is available)

APD yang digunakan lengkap dan sesuai dengan potensi bahaya

yang ditimbulkan
9
(PPE that is used are complete and in
accordance with potential hazard that is posed)

Mengidentifikasi potensi bahaya yang timbul serta cara

10 pengendaliannya
(Identify the hazard that arise and how to control it)

Lokasi Inspeksi (Inspection Location) : Tanggal inspeksi (Date of Inspection) Tanggal inspeksi (Date of Inspection) Tanggal inspeksi (Date of Inspection)

Yang membuat (Created by) Yang membuat (Created by) Yang membuat (Created by)

Supervisor Supervisor Supervisor

Alat Inspeksi (Inspection Tools) : Mengetahui (Approved by) Mengetahui (Approved by) Mengetahui (Approved by)

Quality Control Quality Control Quality Control

Catatan (Note) : Rekomendasi (Recommendation) Rekomendasi (Recommendation) Rekomendasi (Recommendation)

Perhatian (Attention): Penanggung jawab

1 Utamakan Keselamatan Kerja (Safety First) (Responsible person)
2 Pakailah safety helmet (Used Safety Helmet)
3 Pakailah safety shoes (Used Safety Shoes)
4 Pakailah safety belt (Used Safety Belt)
5 Jagalah kebersihan lingkungan (Keep it Clean) Production Manager

*) Kolom Inspeksi II dan III digunakan apabila ada pekerjaan yang tidak memenuhi syarat ( ada Ketidaksesuaian Produk)
(Inspection columns II and III are used when there are work that do not qualify (there Incompatibility Products))