Form Ref. No.
BPI-HSEM-002/23
BAUER PRATAMA INDONESIA
CHECKLIST PEMERIKSAAN KENDARAAN
INSPECTION CHECKLIST FOR VEHICLE
MOBILISASI DI LAPANGAN
MINGGUAN / WEEKLY
ON SITE
WEEK NO._______ DARI/FROM ______SAMPAI/TO________
MOBILIZATION
(Beri tanda cek pada kotak yang tepat / Please tick appropriate box)
JENIS KENDARAAN
TYPE OF VEHICLE PANTHER PICK UP
NO. KENDARAAN
VEHICLE NO B 9312 FT
PERUSAHAAN
COMPANY BAUER PRATAMA INDONESIA
PROYEK
PROJECT JALAN TOL SEMARANG - SOLO
TANGGAL PEMERIKSAAN
INSPECTED DATE / / 2011
PEMERIKSAAN BERIKUT
NEXT INSPECTION / / 2011
ITEM PEMERIKSAAN HASIL KETERANGAN
NO
CHECK ITEMS RESULT REMARKS
Rem dalam kondisi yang bagus? (Pedal rem, rem tangan)
a
Brake in good condition? (Brake pedal, hand brake)
Indikator? (meter bahan bakar, meter kecepatan, suhu)
b
Indicators? (fuel meter, speed meter, temperature)
Apakah mesin menyala dengan halus? Dan tidak ada suara
c abnormal? Is
the engine started smoothly? And no abnormal sound?
Minyak pelumas (volume oli, kebocoran)
d
Lubricant oil (oil volume, leakage)
Peralatan pendingin (volume air, keregangan sabuk, penutupan
core)
e
Cooling devices (water volume, tension of belts,blocking of
cores)
f Kaca spion / Rear view mirrors
g Lampu depan / Head lights
h Lampu cadangan / Back-up lights
i Lampu belakang / Tail lights
j Lampu berhenti / Stop lights
k Kelakson / Horn
Tidak ada kebocoran dalam sistem bahan bakar
l
No leaks in fuel system?
Tak ada kebocoran atau kerusakan dlm muffler pembuangan
m
No leaks or damage in exhaust muffler?
n Roda (tekanan, pengikisan) / Tires (pressure, abrasion)
Sabuk pengaman (rusak, hilang)
o
Seat belt (damage, missing)
Diperiksa oleh /
Inspected by : Andriyana / Ginanjar / Pata Bin Manik TTD / Signature:
(Nama / Name)
Nama Perusahaan /
Company Name : Bauer Pratama Indonesia
Disaksikan oleh /
Witnessed by : ALEXANDER L / AGUNG S TTD / Signature:
(Nama / Name)
Dated: Rev.0 Prepared by:
Form Ref. No. BPI-HSEM-002/23
Tanggal / Date :
Dated: Rev.0 Prepared by:
Form Ref. No. BPI-HSEM-002/23
BAUER PRATAMA INDONESIA
CHECKLIST PEMERIKSAAN KENDARAAN
INSPECTION CHECKLIST FOR VEHICLE
MOBILISASI DI LAPANGAN
MINGGUAN / WEEKLY
ON SITE
WEEK NO._______ DARI/FROM ______SAMPAI/TO________
MOBILIZATION
(Beri tanda cek pada kotak yang tepat / Please tick appropriate box)
JENIS KENDARAAN
TYPE OF VEHICLE PANTHER WEGAN
NO. KENDARAAN
VEHICLE NO B 8942 AF
PERUSAHAAN
COMPANY BAUER PRATAMA INDONESIA
PROYEK
PROJECT JALAN TOL SEMARANG - SOLO
TANGGAL PEMERIKSAAN
INSPECTED DATE / / 2011
PEMERIKSAAN BERIKUT
NEXT INSPECTION / / 2011
ITEM PEMERIKSAAN HASIL KETERANGAN
NO
CHECK ITEMS RESULT REMARKS
Rem dalam kondisi yang bagus? (Pedal rem, rem tangan)
a
Brake in good condition? (Brake pedal, hand brake)
Indikator? (meter bahan bakar, meter kecepatan, suhu)
b
Indicators? (fuel meter, speed meter, temperature)
Apakah mesin menyala dengan halus? Dan tidak ada suara
c abnormal? Is
the engine started smoothly? And no abnormal sound?
Minyak pelumas (volume oli, kebocoran)
d
Lubricant oil (oil volume, leakage)
Peralatan pendingin (volume air, keregangan sabuk, penutupan
core)
e
Cooling devices (water volume, tension of belts,blocking of
cores)
f Kaca spion / Rear view mirrors
g Lampu depan / Head lights
h Lampu cadangan / Back-up lights
i Lampu belakang / Tail lights
j Lampu berhenti / Stop lights
k Kelakson / Horn
Tidak ada kebocoran dalam sistem bahan bakar
l
No leaks in fuel system?
Tak ada kebocoran atau kerusakan dlm muffler pembuangan
m
No leaks or damage in exhaust muffler?
n Roda (tekanan, pengikisan) / Tires (pressure, abrasion)
Sabuk pengaman (rusak, hilang)
o
Seat belt (damage, missing)
Diperiksa oleh /
Inspected by : Andriyana / Ginanjar / Pata Bin Manik TTD / Signature:
(Nama / Name)
Nama Perusahaan /
Company Name : Bauer Pratama Indonesia
Disaksikan oleh /
Witnessed by : ALEXANDER L / AGUNG S TTD / Signature:
(Nama / Name)
Dated: Rev.0 Prepared by:
Form Ref. No. BPI-HSEM-002/23
Tanggal / Date :
Dated: Rev.0 Prepared by:
Form Ref. No. BPI-HSEM-002/23
BAUER PRATAMA INDONESIA
CHECKLIST PEMERIKSAAN KENDARAAN
INSPECTION CHECKLIST FOR VEHICLE
MOBILISASI DI LAPANGAN
√ MOBILIZATION
ON SITE
MINGGUAN / WEEKLY
WEEK NO._______ DARI/FROM ______SAMPAI/TO________
(Beri tanda cek pada kotak yang tepat / Please tick appropriate box)
JENIS KENDARAAN
TYPE OF VEHICLE
NO. KENDARAAN
VEHICLE NO
PERUSAHAAN
COMPANY BAUER PRATAMA INDONESIA
PROYEK
PROJECT 2310 KADU SIRUNG UNDERPASS
TANGGAL PEMERIKSAAN
INSPECTED DATE / / 2024
PEMERIKSAAN BERIKUT
NEXT INSPECTION / / 2024
ITEM PEMERIKSAAN HASIL KETERANGAN
NO
CHECK ITEMS RESULT REMARKS
Rem dalam kondisi yang bagus? (Pedal rem, rem tangan)
a
Brake in good condition? (Brake pedal, hand brake)
Indikator? (meter bahan bakar, meter kecepatan, suhu)
b
Indicators? (fuel meter, speed meter, temperature)
Apakah mesin menyala dengan halus? Dan tidak ada suara
c abnormal? Is
the engine started smoothly? And no abnormal sound?
Minyak pelumas (volume oli, kebocoran)
d
Lubricant oil (oil volume, leakage)
Peralatan pendingin (volume air, keregangan sabuk, penutupan
core)
e
Cooling devices (water volume, tension of belts,blocking of
cores)
f Kaca spion / Rear view mirrors
g Lampu depan / Head lights
h Lampu cadangan / Back-up lights
i Lampu belakang / Tail lights
j Lampu berhenti / Stop lights
k Kelakson / Horn
Tidak ada kebocoran dalam sistem bahan bakar
l
No leaks in fuel system?
Tak ada kebocoran atau kerusakan dlm muffler pembuangan
m
No leaks or damage in exhaust muffler?
n Roda (tekanan, pengikisan) / Tires (pressure, abrasion)
Sabuk pengaman (rusak, hilang)
o
Seat belt (damage, missing)
Diperiksa oleh /
Inspected by : TTD / Signature:
(Nama / Name)
Nama Perusahaan /
Company Name : Bauer Pratama Indonesia
Disaksikan oleh /
Witnessed by : TTD / Signature:
(Nama / Name)
Tanggal / Date :
Dated: Rev.0 Prepared by:AL
BAUER PRATAMA INDONESIA VEHICLE INSPECTION CHECKLIST
Vehicle Data Note
Vehicle Type OK
Production Year X Not OK
Police Number NA Not Available
User
Inspected By Recommendation
Workshop Pass
Address Fail
Date of Inspection
Item Area Description Front Front Rear Rear Back Spare
Right Left Right Left
1 Wheels Tyre Tread
Wheels & Nuts
2 Lights Head Lamp High
Head Lamp Low
Parking
Rear
Brake
Indicator
3 Doors Operation
Mirror Bonnet Mirror
4 Seating Seat Belts
5 Brakes Foot Operation Brake Pedal Mechanism
Windscreen Glass Wipers Wahers
Interior Dashboard Horn First Aid Box
Fire Extinguisher
Steering Wheel Play Steering Mechanism (linkage & joints)
Exhaust System Leaks Air Emission
Body Body Panels Bumper Suspension mechanism
Structure/corrosion fuel tank/lines
Rear Tray for Seat Available Firmly Tightened
Multipurpose Use Cover Steel Structured Well Covered
Document STNK Validity :……………………………………………………
KIR Validity :……………………………………………………
SILO Validity :……………………………………………………
HSE Rep Mechanic Rep
Sign : Sign :
Name : Name :
ON CHECKLIST
Not Available
ommendation
Wheel bearings
Comments
Sun Visor
Suspension mechanism
Firmly Tightened
Well Covered
………………………………………….
………………………………………….
………………………………………….
