Ref : BB-COJO-BPMJ-A-00183
INSPECTION AND TEST PLANT
PERSONAL QUALIFICATION
SCHEDULE MANDAY
PROCEDURE OF SCISSOR LIFT CERTIFICATION
CHECK LIST
DISNAKER CERTIFICATION
OF
8 UNITS SCISSOR LIFT
( List Attched )
USER : EKO BERSAUDARA
PJIT : PT. SUCOFINDO
Prepared by : Reviewed by :
PT. Eko Bersaudara PT. SUCOFINDO
Verified by :
DISNAKER
RE-CERTIFICATION WORK SCHEDULE & MANDAYS INSPECTOR
OWNER : PT. EKO BERSAUDARA
DESCRIPTION : SCISSOR LIFT DISNAKER RECERTIFICATION
LOCATION : TANGGERANG, BANTEN
MARET 2010
NO. ACTIVITY REMARK
1 2 3 4 5 6 7 8 9 10 11 12
1. Review & Verify Document 4 Days
2. Visual Inspection & NDT 1 Days
3. Recommendation of Repair 3 Days
4. Functional Test & Load Test 1 Days
5. Reporting 3 Days
INSPECTION AND TEST PLAN Scissor Lift
Owner/User : PT. Eko Bersaudara AR : Approval Required R : Review of Document
PJK3 RIKSA UJI : Avit AI : Actual Inspection V : Verification
NDT Comp. : PT. Sucofindo W : Witness Inspection P : Provide
Location : Tanggerang, Banten
NO ACTIVITY VERIFIED DOCUMENT ACCEPTANCE CRITERIA INSPECTION LEVEL
OWNER PJK3 RIKSA UJI REGULATION
1 DOCUMENT REVIEW
New Scissor Lift Certification
- Design, Fabrication, Installation & - Permen 08/Men/2020 P R -
1 Drawing and Manual Book Scissor Lift
Inspection Procedure & Document - ANSI/SAIA A92.6
- ASME B 30. 23 P R -
2 Installation and Maintenance Procedure
- Scissor Lift Manufacturer Data Report -
Manufactured Data Record, Owner Spec.
& Scissor Lift Manual P R -
3 Load Chart Scissor Lift
P R -
4 NDT Procedure and Other Supporting Certificate
Scissor Lift Existing ( Recertification-Annual certification )
1 Log Book - Design, Fabrication, Installation & - Inspection Procedure P R -
Inspection Procedure & Document - ANSI/SAIA A92.6 P
- ANSI/SAIA A92.6
2 Maintenance History
- Scissor Lift Manufacturer Data Report - ASME B 30. 23 P R -
3 Previous Inspection Report
P R -
INSPECTION AND TEST PLAN Scissor Lift
Owner/User : PT. Eko Bersaudara AR : Approval Required R : Review of Document
PJK3 RIKSA UJI : Avit AI : Actual Inspection V : Verification
NDT Comp. : PT. Scufindo W : Witness Inspection P : Provide
Location : Tanggerang, Banten
NO ACTIVITY VERIFIED DOCUMENT ACCEPTANCE CRITERIA INSPECTION LEVEL
OWNER PJK3 RIKSA UJI REGULATION
2 PHYSICAL Scissor Lift INSPECTION (PCI)
1 Design & Construction - Inspection Procedure - Inspection Procedure P AI -
2 Platform Control - ANSI/SAIA A92.6 P AI -
3 Hydraulic Component - ASME B 30. 23 P AI -
P
4 Mechanical System P AI -
3 DIMENSION CHECK
1 Design & Construction - Inspection Procedure - Inspection Procedure P AI -
2 Platform & Hand Rail - ANSI/SAIA A92.6 P AI -
3 Hydraulic System - ASME B 30. 23 P AI -
4 Wheel & Brake P AI -
4 NON DESTRUCTIVE TESTING
1 NDT on Critical Area - NDT Procedure and Mapping 0 AWS V P AI -
'- AWS D1.1
5 FUNCTIONAL TESTING
1 Hoisting and Travelling Mechanism - Inspection Procedure - Inspection Procedure P AI -
2 Safety Devices and Indicators - Functional Testing Procedure - ANSI/SAIA A92.6 P AI -
3 Platform Control P AI -
INSPECTION AND TEST PLAN Scissor Lift
Owner/User : PT. Eko Bersaudara AR : Approval Required R : Review of Document
PJK3 RIKSA UJI : Avit AI : Actual Inspection V : Verification
NDT Comp. : PT. Scufindo W : Witness Inspection P : Provide
Location : Tanggerang, Banten
NO ACTIVITY VERIFIED DOCUMENT ACCEPTANCE CRITERIA INSPECTION LEVEL
OWNER PJK3 RIKSA UJI REGULATION
6 NON CONFORMANCE RECORD
1 Scissor Lift NCR Report - Inpection Procedure - ANSI/SAIA A92.6 AR AR -
- Manufacturer Document
7 LOAD TESTING (If Required)
1 Load Testing Execution - Inspection Procedure - Inspection Procedure P V W
- ANSI/SAIA A92.6
8 AFTER LOAD TEST
1 Hoisting and Traveling Mechanism - Inspection Procedure - Inspection Procedure P AI -
2 Structure - NDT Procedure - NDT Procedure P AI -
9 REPORTING
1 Scissor Lift Inspection Report - Inspection Report - Inspection Procedure - P -
2 Inspection Certificate - Certificate of Inspection V P V
- Regulation - Permen 08/Men/2020 V P AR
Avit Owner/ User
( ) ( )
QUALIFICATION OF PERSONNEL
SCISSOR LIFT DISNAKER CERTIFICATION
Owner : PT. EKO BERSAUDARA
Description : SCISSOR LIFT DISNAKER CERTIFICATION
Location : Tanggerang, Banten.
No. Name Company Qualification
1. BAGUS EKO SAMBO PT. EKO BERSAUDARA K3 (Umum), POP, POU
2. AVIT PT. SUCOFINDO AK3U, AK3 PAPA, NDT Level2
3 AGUNG JAYA PT. EKO BERSAUDARA OPERATOR PESAWAT ANGKAT
PENGAWAS KETENAGAKERJAAN
4 ARIF BUDI DISNAKER
SPESIALS K3
Remark
