HR-GA -005- FORM -PIKB .
18
No. Revisi : 0
Tgl Terbit : 01 September 2018
Pemeriksaan / Inspeksi Kendaraan Bermotor
Vehicle Inspection
PT.DRAGON
Date / Tanggal : 10/31/2018
Police No / No Polisi : B 9079 BEN
Odometer / Kilometer : 205357
Vehicle Type / Jenis Kendaraan : MITSUBISHI FUSO
Condition Condition
G B N G B N
1 Driver's Licence / SIM √ 17 Hand Brake / Rem Tangan √
2 STNK √ 18 Footbrake / Rem Kaki √
43 First Aid Kit / P3K √ 19 Cabin Mirror / Kaca Spion Dalam √
45 Front Plate / Plat No. Depan √ 20 Cuter Mirror / Kaca Spion √
Rear Plat / Plat No. Belakang √ Right/ Kanan √
5 Inspection Book / Buku KIR √ Left / Kiri √
6 Spare Tire / Ban Cadangan √ 21 Jack / Dongkrak √
7 Head Light or High Beam / Lampu Besar Jauh 22 Tire Wrech / Kunci Roda √
Right/ Kanan √ 23 Fan Belt / Tali Kipas √
13 Left / Kiri √ 24 Triangle / Segitiga Pengaman √
8
14
Head Light or Low Beam / Lampu Besar Dekat 25 Engine Oil / Oli Mesin √
Right/ Kanan √ 26 Radiator Cooling Water / Air Radiator √
Left / Kiri √ 27 Brake Oil / Minyak Rem √
9 Front Flaser light / Lampu Besar Depan 28 Wirsheild Wiper Water / Air Pembersih Kaca √
Right/ Kanan √ 29 Battray Liquid / Air Bateray √
Left / Kiri √ 30 Air Conditioner / AC √
10 Rear Flaser light / Lampu Tanda Belok Belakang 31 Tire Pressure tester / Pengukur Tekanan Ban √
Right/ Kanan √ 32 Tire Pressure / Tekanan Ban √
Left / Kiri √ Front Right & Left / Depan Kanan & Kiri √
11 Brake Or Stop light / Lampu Rem Back Right & Left / Depan Kanan & Kiri √
Right/ Kanan √ 33 Rekorder Tape / Tape Rekorder √
Left / Kiri √
12 Beck Up Light / Lampu Mundur Others / Lain - Lain
Right/ Kanan √
Left / Kiri √
13 Vehilce No Light / Lampu Plat No √
14 Hazard Light / Lampu Bahaya √
15 Horn / Klakson √
16 Safety Belt / Sabuk Pengaman √
Front / Depan √
Back / Belakang √
Side / Samping √
Inspection / Pemeriksaan : OPAN SOPIAN
The check / Tanggal Periksa : 10/31/2018
Inspected by / Diawasi Oleh, User / Driver Information / Keterangan
G : Good / Baik
B : Bad / Jelek
N : Not Available/ tdk ada
HR-GA -005- FORM -PIKB .18
No. Revisi : 0
Tgl Terbit : 01 September 2018
Pemeriksaan / Inspeksi Kendaraan Bermotor
Vehicle Inspection
PT.DRAGON
Date / Tanggal : 11/29/2018
Police No / No Polisi : F 6011 HY
Odometer / Kilometer : 9291
Vehicle Type / Jenis Kendaraan : MOTOR SUPRA FIT S
Condition Condition
G B N G B N
1 Driver's Licence / SIM 17 Hand Brake / Rem Tangan √
2 STNK √ 18 Footbrake / Rem Kaki √
34 First Aid Kit / P3K √ 19 Cabin Mirror / Kaca Spion Dalam √
54 Front Plate / Plat No. Depan √ 20 Cuter Mirror / Kaca Spion √
Rear Plat / Plat No. Belakang √ Right/ Kanan √
5 Inspection Book / Buku KIR √ Left / Kiri √
6 Spare Tire / Ban Cadangan √ 21 Jack / Dongkrak √
7 Head Light or High Beam / Lampu Besar Jauh 22 Tire Wrech / Kunci Roda √
Right/ Kanan √ 23 Fan Belt / Tali Kipas √
13 Left / Kiri 24 Triangle / Segitiga Pengaman √
8 Head Light or Low Beam / Lampu Besar Dekat
14 25 Engine Oil / Oli Mesin √
Right/ Kanan √ 26 Radiator Cooling Water / Air Radiator √
Left / Kiri 27 Brake Oil / Minyak Rem √
9 Front Flaser light / Lampu Besar Depan 28 Wirsheild Wiper Water / Air Pembersih Kaca √
Right/ Kanan √ 29 Battray Liquid / Air Bateray √
Left / Kiri 30 Air Conditioner / AC √
10 Rear Flaser light / Lampu Tanda Belok Belakang 31 Tire Pressure tester / Pengukur Tekanan Ban √
Right/ Kanan √ 32 Tire Pressure / Tekanan Ban √
Left / Kiri √ Front Right & Left / Depan Kanan & Kiri √
11 Brake Or Stop light / Lampu Rem Back Right & Left / Depan Kanan & Kiri √
Right/ Kanan √ 33 Rekorder Tape / Tape Rekorder √
Left / Kiri
12 Beck Up Light / Lampu Mundur Others / Lain - Lain
Right/ Kanan √
Left / Kiri √
13 Vehilce No Light / Lampu Plat No √
14 Hazard Light / Lampu Bahaya √
15 Horn / Klakson √
16 Safety Belt / Sabuk Pengaman √
Front / Depan √
Back / Belakang √
Side / Samping √
Inspection / Pemeriksaan : OPAN SOPIAN
The check / Tanggal Periksa : 11/29/2018
Inspected by / Diawasi Oleh, User / Driver Information / Keterangan
G : Good / Baik
B : Bad / Jelek
N : Not Available/ tdk ada
HR-GA -005- FORM -PIKB .18
No. Revisi : 0
Tgl Terbit : 01 September 2018
Pemeriksaan / Inspeksi Kendaraan Bermotor
Vehicle Inspection
PT.DRAGON
Date / Tanggal :
Police No / No Polisi :
Odometer / Kilometer :
Vehicle Type / Jenis Kendaraan :
Condition Condition
G B N G B N
1 Driver's Licence / SIM 17 Hand Brake / Rem Tangan
2 STNK 18 Footbrake / Rem Kaki
34 First Aid Kit / P3K 19 Cabin Mirror / Kaca Spion Dalam
54 Front Plate / Plat No. Depan 20 Cuter Mirror / Kaca Spion
Rear Plat / Plat No. Belakang Right/ Kanan
5 Inspection Book / Buku KIR Left / Kiri
6 Spare Tire / Ban Cadangan 21 Jack / Dongkrak
7 Head Light or High Beam / Lampu Besar Jauh 22 Tire Wrech / Kunci Roda
Right/ Kanan 23 Fan Belt / Tali Kipas
13 Left / Kiri 24 Triangle / Segitiga Pengaman
8
14
Head Light or Low Beam / Lampu Besar Dekat 25 Engine Oil / Oli Mesin
Right/ Kanan 26 Radiator Cooling Water / Air Radiator
Left / Kiri 27 Brake Oil / Minyak Rem
9 Front Flaser light / Lampu Besar Depan 28 Wirsheild Wiper Water / Air Pembersih Kaca
Right/ Kanan 29 Battray Liquid / Air Bateray
Left / Kiri 30 Air Conditioner / AC
10 Rear Flaser light / Lampu Tanda Belok Belakang 31 Tire Pressure tester / Pengukur Tekanan Ban
Right/ Kanan 32 Tire Pressure / Tekanan Ban
Left / Kiri Front Right & Left / Depan Kanan & Kiri
11 Brake Or Stop light / Lampu Rem Back Right & Left / Depan Kanan & Kiri
Right/ Kanan 33 Rekorder Tape / Tape Rekorder
Left / Kiri
12 Beck Up Light / Lampu Mundur Others / Lain - Lain
Right/ Kanan
Left / Kiri
13 Vehilce No Light / Lampu Plat No
14 Hazard Light / Lampu Bahaya
15 Horn / Klakson
16 Safety Belt / Sabuk Pengaman
Front / Depan
Back / Belakang
Side / Samping
Inspection / Pemeriksaan :
The check / Tanggal Periksa :
Inspected by / Diawasi Oleh, User / Driver Information / Keterangan
G : Good / Baik
B : Bad / Jelek
N : Not Available/ tdk ada
HR-GA -005- FORM -PIKB .18
No. Revisi : 0
Tgl Terbit : 01 September 2018
Vehicle Inspection
:
Police No / No Polisi :
Odometer / Kilometer :
Vehicle Type / Jenis Kendaraan :
Condition
G B N
1 Driver's Licence / SIM 17
2 STNK 18
3 First Aid Kit / P3K 19
4
4 Front Plate / Plat No. Depan 20
5
Rear Plat / Plat No. Belakang
5 Inspection Book / Buku KIR
6 Spare Tire / Ban Cadangan 21
7 Head Light or High Beam / Lampu Besar Jauh 22
Right/ Kanan 23
Left / Kiri 24
13
8 Head Light or Low Beam / Lampu Besar Dekat 25
14
Right/ Kanan 26
Left / Kiri 27
9 Front Flaser light / Lampu Besar Depan 28
Right/ Kanan 29
Left / Kiri 30
10 Rear Flaser light / Lampu Tanda Belok Belakang 31
Right/ Kanan 32
Left / Kiri
11 Brake Or Stop light / Lampu Rem
Right/ Kanan 33
Left / Kiri
12 Beck Up Light / Lampu Mundur
Right/ Kanan
Left / Kiri
13 Vehilce No Light / Lampu Plat No
14 Hazard Light / Lampu Bahaya
15 Horn / Klakson
16 Safety Belt / Sabuk Pengaman
Front / Depan
Back / Belakang
Side / Samping
Inspection / Pemeriksaan :
The check / Tanggal Periksa :
Inspected by / Diawasi Oleh, User / Driver
HR-GA -007- FORM -DPOM .18
No. Revisi : 0
Tgl Terbit : 01 September 2018
hicle Inspection Data Pem
Tanggal
No
Stock Awal
7/23/2018
1 7/28/2018
2 9/1/2018
3 9/1/2018
Condition 4 9/26/2018
5 10/22/2018
G B N 6 11/10/2018
7 11/17/2018
Hand Brake / Rem Tangan 8 11/21/2018
9 11/22/2018
Footbrake / Rem Kaki 10 11/27/2018
11
Cabin Mirror / Kaca Spion Dalam 12
13
Cuter Mirror / Kaca Spion 14
15
Right/ Kanan 16
17
Left / Kiri 18
19
Jack / Dongkrak 20
21
Tire Wrech / Kunci Roda 22
23
Fan Belt / Tali Kipas 24
25
Triangle / Segitiga Pengaman 26
27
Engine Oil / Oli Mesin 28
29
Radiator Cooling Water / Air Radiator 30
31
Brake Oil / Minyak Rem 32
Total
Wirsheild Wiper Water / Air Pembersih Kaca Dragon Ciawi
###
Battray Liquid / Air Bateray
Dibuat
Air Conditioner / AC Staff GA
Tire Pressure tester / Pengukur Tekanan Ban
Tire Pressure / Tekanan Ban Haryanto
Front Right & Left / Depan Kanan & Kiri
Back Right & Left / Depan Kanan & Kiri
Rekorder Tape / Tape Rekorder
Others / Lain - Lain
Information / Keterangan
G : Good / Baik
B : Bad / Jelek
N : Not Available/ tdk ada
R-GA -007- FORM -DPOM .18
o. Revisi : 0
gl Terbit : 01 September 2018
Data Pemakaian Oli Mesin
Plat Mobil Nama Sopir Penambahan Pemakaian Sisa Saldo Satuan
200
forklift no 3 Basri 7 193.0 Liter
fuso B 9079 BEN wahyudin 12 181.0 Liter
fuso B 9079 BEN wahyudin 12 169.0 Liter
forklift no 5 Rahmat 7 162.0 Liter
forklift no 4 Ivan Supriatna 7 155.0 Liter
forklift no 5 Rahmat 7 148.0 Liter
forklift no 2 Cadangan 5 143.0 Liter
forklift no 3 Basri 5 138.0 Liter
forklift no 1 Cadangan 5 133.0 Liter
forklift no 5 Rahmat 5 128.0 Liter
wings box B 9256 CCG wahyudin 18 110.0 Liter
110.0 Liter
110.0 Liter
110.0 Liter
110.0 Liter
110.0 Liter
110.0 Liter
110.0 Liter
110.0 Liter
110.0 Liter
110.0 Liter
110.0 Liter
110.0 Liter
110.0 Liter
110.0 Liter
110.0 Liter
110.0 Liter
110.0 Liter
110.0 Liter
110.0 Liter
110.0 Liter
110.0 Liter
0.0 90.0 110.0 Liter
Menyetujui Mengetahui Mengetahui
Manager HRGA General Manager Senior Manager HRD
Agus Triono Hendri Irawan Supriyadi S.H
