PT.

DEPRIWANGGA OM
PROJECT ROAD MAINTENANCE
MEDCO BANGKANAI

MONTHLY INSPECTION CHECK LIST

MOTOR GRADER
Date of Inspection 05/06/2024
Serial Number DWOM-MG-03
Model SEM 915

NO DESCRIPTION GOOD FAIR POOR N/A REMARKS

1 Kelengkapan Surat ✓
SIO / SIM ✓
SILO ✓ Exd. 2023
2 Sistem Pengereman ✓
Rem ✓
Rem Parkir ✓
Rem Holding ✓
3 Lampu ✓ Rusak
Lampu Belakang ✓
Lampu Utama ✓ Rusak terkena ranting
Lampu Rem ✓
4 Safety devices ✓
Lampu Rotary ✓ Rusak di lighter
Alarm Mundur ✓
Safety Belt ✓
Klakson ✓
Spion ✓
5 Safety Kit ✓
APAR ✓
P3K ✓
6 Blade ✓
Pisau Blade ✓
Cylinder Blade ✓
Ripper ✓
 Pisau Ripper ✓
Cylinder Ripper ✓
7 Mobile Devices ✓
Roda Depan ✓ Kurang dari 3mm
Roda Belakang ✓ Kuarng dari 3mm
8 Oil, fuel, lubricant ✓
Pelumas Engine ✓
Pelumas Hidrolic ✓
Oil leaks ✓ Kebocoran pada turbo
Radiator Coolant ✓
Grease ✓ Kurang preventif
Battery ✓
9 Panel ✓
10 Kondisi Cabin ✓ Kotor
Canopy ✓
Kebersihan ✓ Kotor
11 Utility ✓ Tidak proper
Kaca Kabin ✓
Operator Acces ✓
12 Pin / Bolt ✓
13 Filter Fuel ✓
Filter Oli Mesin ✓
Filter Water Separator ✓
Air Cleaner ✓

Inspected by : Inspected by :
Name Fajar Name

Position Hse Position

Sign Sign

Acknowledge by :
Name Hadid

Position Spv

Sign