No.

FM-BAS-PLANT-016

FORM Tgl. Terbit 01-08-2018

UNIT CONDITION REPORT MAIN EQUIPMENTS Revisi 01 (21-01-2020)

Halaman 12 Halaman

PROJECT ID : Kutai Energi MODEL : Double Cab Triton HDX DATE : 29 Aug 2023
UNIT ID : BC137 S/N : MMBJNKL30MH-029160 SMU : 77994 KM
Perhatian
Caution
* Cuci unit yang bersih sebelum pelaksanaan inspeksi
Clean up the unit before inspection
* Parkirkan unit pada tempat rata dengan aman
Park the unit on flat area safely
* Yakinkan anda sudah memasang Danger atau Service Tag pada unit
Make sure you already use Danger or Service Tag on the unit
* Aktifkan parking brake
Ensure parking brake is "ON"
* Yakinkan bahwa unit yang akan diinspeksi dalam kondisi aman
Ensure the machine in safe condition to inspect
* Lampirkan form ini dengan hasil pemeriksaan ECM Engine & ECM Transmission

BACKLOG STATUS

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Description Remark WO No.

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B

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ENGINE & RELATED SYSTEM

POWER TRAIN
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Description Remark WO No.

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B

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W

OPERATOR STATION

Page 1 of 8
HYDRAULIC SYSTEM

MAIN FRAME

UNDERCARRIAGE

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ou

Description Remark WO No.

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TIRE & RIM

WORK TOOL

STANDARD EQUIPMENT ATTACHEMENT

BACKLOG REMARK

Page 2 of 8
 PICTURE TAKEN FROM BACKLOG STATUS
Picture Comment

Tampak engine dari sisi kiri

Tampak engine dari sisi belakang

Tampak engine dari sisi kanan

1. Terdapat jelaga sisa pembakaran dan Si

2. Terdapat material Fe, Cr dari crankshaft, ring
piston. Cu, AI dari bearing crankshaft

Backlog Prepared By: Aknowledged By:

Name : M. Bayu Setiawan Name : Syaiful Ali Maskur

Siganture : Siganture :
Date : 29 Aug 2023 Date : 29 Aug 2023

Page 3 of 8
 COMPONENT HISTORY
Last Done
No Component Description Current Comp. Life
SMU Date Comp. Fitted
ENGINE GP
TURBOCHARGER
TURBOCHARGER
FUEL TRANSFER PUMP
UNIT INJECTOR GP
RADIATOR GP
WATER PUMP
BATTERIES
ALTERNATOR
HARDNESS
ELECTRIC STARTING MOTOR
AIR COMPRESSOR GP
TRANSMISSION
TRANSMISSION PUMP
TORQUE CONVERTER
PUMP DRIVE GP
DIFFERENTIAL
AXLE HOUSING ASSEMBLY
FINAL DRIVE, BRAKE AND WHEEL
FINAL DRIVE, BRAKE AND WHEEL
WHEEL BEARING FRONT
WHEEL BEARING FRONT
BRAKE GROUP ( SERVICE BRAKE )
BRAKE GROUP ( SERVICE BRAKE )
BRAKE LINES & VALVE
AIR DRYER
STEERING CYLINDER
STEERING CYLINDER
STEERING LINKAGE & LINES
STEERING PUMP
STEERING COLUMN
STEERING METERING PUMP
SECONDARY STEERING PUMP
HYDRAULIC CONTROL VALVE
IMPLEMENT PUMP
LIFT/HOIST CYLINDER
LIFT/HOIST CYLINDER
SUSPENSION CYLINDER FRONT
SUSPENSION CYLINDER FRONT
SUSPENSION CYLINDER REAR
SUSPENSION CYLINDER REAR
DUMP BODY

Page 4 of 8
 EQUIPMENT HEALTH
INSPECTION RATING & SOS RESULT
Last Inspection Rating Date:
Last Sample Taken Date: 17 Agustus 2023
Inspection Result
No Component Description Remark
P2 P1 Last
1 Engine V Engine blowby

Page 5 of 8
SOS RESULT TRENDING GRAPH
No Picture / Graph Remark

Page 6 of 8
CTS REPORT
Inspection Date:
Component Hour on Wear Surface % Worn
Position Remark
Description Left Right Left Right
Links
Bushing Internal
External
Shoes
Idlers Front
Rear
Carrier Rollers Front
Pos#2
Pos#3
Track Rollers Front
Pos#2
Pos#3
Pos#4
Pos#5
Pos#6
Pos#7
Pos#8
Pos#9
Sprocket
Remark

TIRE INSPECTION REPORT

Inspection Date:
Tire Serial RTD
Merk/Brand Tread Pattern Life Damaged Description Note
Position Number 1 2 Avg
1
2
3
4
5
6
7
8
9
10
Remark

Page 7 of 8
EQUIPMENT HEALTH REMARK

TECHNICAL ANALSYIS SUMMARY & RECOMMENDATION

Compartement Recommendation

Prepared By: Aknowledged By:

Name : M. Bayu Setiawan Name : Syaiful Ali Maskur

Siganture : Siganture :
Date : 29 Aug 2023 Date : 29 Aug 2023

Page 8 of 8