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Form No. S.2.13A.001/FRM

PT KALIMANTAN PRIMA PERSADA

TECHNICAL SERVICE REPORT

REPORT NO. : WO NUMBER. : :
REPORT DATE : DELIVERY DATE :

CODE NUMBER MACHINE MAKER MACHINE MODEL MACHINE S/N ENGINE MODEL ENGINE NUMBER

APPLICATION ENVIRONMENT OPERATION PAY LOAD (KG) * __________ OLIE MADE **________
LOC_______________ COND________________ CODE UNIT_____ MATERIAL CARRI* _________ OLIE CLASS **________
WORK_____________ _ OPER TABLE____ SPEED(KM/HRS) ___________ OLIE VISC ** ________
CARAC________________
TROUBLE TROUBLE DATE HM
KM

NUMBER OF MAIN PART CAUSING THE PROBLEM PART NAME COMP./PART GORUP LIFE TIME

CAUSED
DETAIL OF
FAILURE

CORRECTION MADE CORRECTION DATE MAN HOUR

LEVEL WORKING PARTNER, NAME & LEVEL SUPERVISOR NAME :

SIGN
SIGN

NOTE : *) = Only for whell type, ** filled when it’s need for analysis

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