PT HEXAGONAL INTI

REKAYASA
Menara Bidakara 2, Annex Building Lt 4 Jl. Gatot Subroto, Kav 71 – 73, RT08 / RW 08
Menteng Dalam, Kec. Tebet, Kota Jakarta Selatan DKI Jakarta, Indonesia 12870
Telp : +62 823 853 030 99, Website : www.hexagonalintirekayasa.com

SERVICE REPORT
xxxx/HIE-SR/IV-24

Job Type : Service Inspection Installation Commissioning Other

Name of Ship : PO Number :

IMO Number : Place :
Call Sign : Date :
Ship Owner : Page (s) : 2 (two)

A. Equipment Details

Brand / Type Serial Num. / Drawing Num. Description Comments

B. On Site Finding / Report / Conclusion

C. Probable Root Cause

D. Repair as Directed

Sign
 PT HEXAGONAL INTI
REKAYASA
Menara Bidakara 2, Annex Building Lt 4 Jl. Gatot Subroto, Kav 71 – 73, RT08 / RW 08
Menteng Dalam, Kec. Tebet, Kota Jakarta Selatan DKI Jakarta, Indonesia 12870
Telp : +62 823 853 030 99, Website : www.hexagonalintirekayasa.com

E. Necessary Action and Recommendation

F. Part Needed

No. Part Name Part Number Qty Information

G. Job Status

Unit ok, ready for operation

Unit has deficiencies but ready for operation
Unit is not ready for operation

H. Outstanding Items

Ship Owner PIC HIE Technician

(………….……………………….)

Name, Signature, and Company Stamp Sign

PT HEXAGONAL INTI
REKAYASA
Menara Bidakara 2, Annex Building Lt 4 Jl. Gatot Subroto, Kav 71 – 73, RT08 / RW 08
Menteng Dalam, Kec. Tebet, Kota Jakarta Selatan DKI Jakarta, Indonesia 12870
Telp : +62 823 853 030 99, Website : www.hexagonalintirekayasa.com

(………….……………………….)

Sign