PT WIDI JAYA ANGGUN

TOOLS & EQUIPMENT INSPECTION CHECKLIST

VEHICLE TYPE TRANSPORTER

Subjects □ Mini Bus / Bus □ Dump Truck □ Truck □ Trailer □ Truck Mixer □ Track Carrier

Result Column ( ): Yes/Good, Acceptable, (X): Not/Bad, Not to use, (NA) : Not applicable
EQUIPMENT CARRY-IN CERTIFICATE
Type : Police No. :
Machine No : Certificate No :
Serial No. : Certificate Validity :
Capacity : Operator Name :
Manufacturer : Operator License :
Subcontractor : Operator License Validity :
Date of Inspection : Validity of Inspection :
Place of Inspection : Type of Inspection High Risk / 3
Monthly
Month
This form must be completed by the operator and company user before entering the equipment to be operated in the
site project area, and at any time of setting location. All equipment condition must meet to the Safety Regulation and
GTU Management Plan

No Check Item Check Points Result Remarks

1 Carrier Body/Frame Damage, Deformation
2 Flat Bed / Box (for Box & Trailler) Damage, Deformation
3 Wheels and Spare wheel Tire pressure, Abrasion
4 Handle/Power Steering Operability, Play, Breakage
5 Handle Transmission Operability, Play,
6 Foot/Hand Brakes Operating Check, Play
7 Clutch/lever/Pedals Operating Check
8 Engine Condition Starting, Sound, Vibration
9 Battery/Wiring Liquid vol., Aging, Terminal
10 Engine Oil/Filter/Piping Oil vol., Smudge, Leakage
11 Fuel Tank/Pump/Filter/Piping Leakage, Breakage, Plugging
12 Radiator/Pump/Fan Belt Water vol., Leakage, Damage
13 Transmission/Torque Converter Oil Vol., Leakage, Smudge
14 Muffler/Flame Arrestor Exhaust color, Sound, Missing
15 Lamps & Rotary Lamp Head/Tail Lamp
16 Signal Lights Trafficator, Brake Light
17 Horn/Reverse Alarm Function check
18 Indicator Fuel, Speed, Temp. meters
19 Wiper/Washers/Mirrors Function, Breakage
20 Door Latches/Locks Defect, Missing

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Form/3/Vehicle Type Transporter
 PT WIDI JAYA ANGGUN

TOOLS & EQUIPMENT INSPECTION CHECKLIST

VEHICLE TYPE TRANSPORTER

21 Seat Belts Breakage, Missing,

22 Fire Extinguisher Function
23 First Aid Kit Box Missing
24 Tools Kit & Jack Missing, Function check
25 GPS / G-Track System Function
26 Carry-in Certification Possession
27 Safety Cone (for HV) 2 EA, reflector light, Rain coat
28 Personal Protective Equipment PPE Mandatory, Body Vest
29 Safety Sign / Sticker Driving Safely, Safe Distance, Emergency
Contact Number

General Comment:

Inspection Result:
NOT SAFE to Operate SAFE to Operate

Inspected By: Reviewed By Approved By:

Mechanic / Driver HSE SPV

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Form/3/Vehicle Type Transporter