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(H.
Pr HYllRDRAYR ADIi PERICASA
GERINDA
INSPECTION STANDARD
(CAL/OSHA 29 CFR 1910)
Location
Capacity
: "f'C.
Serial Number : ~v,o!,.;. ?Ofl-
lnspectlondate: 01,
Perlode : t
ioo I'-"\
~-z.)

No I INSPECTION ITEM STANDARDS

INSPECTION METHOD

VISUAL I FUNCTION I
INSPECTION RESULT
COMPLY I NOT COMPLY
REASON FOR NOT COMPlY

1 side handle

wheel guard
availlable (tersedia)
v
--
2 not crack (tidak retak)
V
3 wheel lock nut not crack,tight (baut tidak retak,rapat)
V
4 wrench availlable (tersedia)
V
5 spidle lock button work (berfungsi)

6 switch work (berfungsi)

7 power cord not scratch,insullated (tidak sobek,terisolasi)

8 motor no spark (tidak ada percikan)

-- engan standar
--
9 !wheel

10 Ibody machine V
--
not greased,oil (tidak ada grease,oli)

INSPECTION STATUS: ~PASS ~REJECT [:]HOLD

SPft&AL NOTE_f_ROM INSPECTOR :

,~
·-

INSPECTION BY APPROVED BY •
i=
Name and Signature
~1
 Location : <r., ~,
GERINDA
cfri,
Capacity
Serial Number : \-VI~ 0Jt+ (oc.~
PT H'tDRaRlml IIDHI PERKASR
INSPECTION STANDARD Inspection date: o-; 1~ -n.oJA.
(CAL/OSHA 29 CFR 1910) Perlode : \

No I INSPECTtON ITEM STANDARDS

INSPECTION METHOD
VISUAL I FUNCTION I
INSPECTION RESULT
COMPLY I NOTCOMPLY
REASON FOR NOT COMPLY

1 side handle availlable (tersedia)

2 wheel guard not crack {tidak retak)

-
wheel lock nut not crack,tight (baut tidak retak,rapat)
3

4 wrench availlable (tersedia)

5 spidle lock button work {berfungsi)

I
•
6

I 7
switch

power cord
work (berfungsi)

not scratch,insullated (tidak sobek,terisolasi)

no spark (tidak ada percikan)

J
,_/
8 motor
engan standar
9 wheel
not greased,oil (tidak ada grease,oli)
10 body machine

INSPECTION STATUS: [i2JPASS

S_PEOAL NOTE FROM INSPECTOR :

INSPECTION BY APPROVED BY

Name
 '

Location : tr-~\
GERINDA Capacity
Serial Number : \\_,\t,C,Y-,\ \?QA lo6 £--
P1' HYIRJRATA AIH Pal<RsA INSPECTION STANDARD Inspection date: Cl, Sa.v'luC-t, ~.,_,"',
(CAL/OSHA 29 CFR 1910) Periode \
No INSPECTION METHOD INSPECTION RESULT
•SPECTION ITEM STANDARDS REASON FOR NOT COMPLY
VISUAL I FUNCTION I COMPLY I NOT-COMPLY
1 side handle availlable (tersedia)
V
2 wheel guard not crack (tidak retak) J
3 wheel lock nut not crack,tight (baut tidak retak,rapat) , v
4 wrench availlable (tersedia) V
5 spidle lock button work (berfungsi} V
6 switch work (berfungsi)
'1'
7 power cord not scratch,insullated (tidak sobek,terisolasi)
- r--
V ,
8

9
motor
--
lwheel
no spark (tidak ada percikan)
as manufacturing standard {sesuai dengan standar
v
--
10 I body machine
abrjkan
not greased,oil (tidak ada grease,oli) V
--
INSPECTION STATUS : lv!PASs c=]REJECT C=:JHOLD
SPEOAL NQTE FROM INSPECTOR :

t
INSPECTION BY APPROVED BY

Name and Signature

...
N~=
.,___
 Location : ~- \1.i~,:
GERINDA Capacity
Serial Number : \'\\\µ1\.1,,\ '?VA 1,oat-t

PT HYDRDRAYA RDHI PERl<ASA

IN-sP-ECTION STANDARD Inspection date: c~ ~Of'UW\ ~-r--.,
_ ___ ___ (CAL/OSHA 29 CFR 1910) Perlode ~,

No I INSPECTION ITEM STANDARDS

INSPECTION METHOD
VISUAL
INSPECTION RESULT
I FUNCTION I COMPLY I NOT COMPLY
REASON FOR NOT COMPLY

1 lside handle availlable (tersedia) V

2 lwheel guard not crack (tidak retak)

3 wheel lock nut not crack,tight (baut tidak retak,rapat) v

..,/
4 wrench availlable (tersedia)

5 sp-idle lock button

--
work (berfungsi)
v
6 switch work (berfungsi) J
7 power cord not scratch,insullated (tidak sobek,terisolasi) ..J

8 motor no spark (tidak ada percikan) V

engan standar -.)
9 wheel

10 lbody machine not greased,oil (tidak ada grease,oli) V

INSPECTION STATUS:
. ~PASS C]REJECT CJHOLD

SPECIAL NOTE FROM INSPECTOR :

INSPECTION BY APPROVED BY

1=
Name and Signature Name and Signature