Form : BK1/QHSSE/QHSSE/W/014
No. Dokumen :
FORM CHECKLIST PEMERIKSAAN
No. Revisi :
GENERATOR SET
Tanggal :
Satuan Kerja :
Proyek :
Equipment Description :
Manufacture : Tag Number :
Merk / Brand : Lokasi Pemeriksaan :
Jenis Pemeriksaan *) : Pre-Mobilisasi / Pre-Use
Berkala (Harian / Mingguan / Bulanan)
KONDISI *)
NO. KOMPONEN KETERANGAN
RUSAK
BAIK
N/A
A. SAFETY APPARATUS
1 Fire Extinguisher
2 First Aid Kit
3 Sign Safety Electrical
4 Hazard Electrical
5 Tagging
6 Ear Plug or Ear Muff
7 Personel Protective Equipment
8 Emergency Shut Down (ESD)
B. ELECTRIC SYSTEM & BATTERY SYSTEM
1 Alternator
2 Starter
3 Battery Water Level
4 Condition Battery and Terminal
5 Wiring / Insulation
6 Panel / Gauges/ Level Hours Meter
7 Panel Volt Meter
8 Panel Amper Meter
9 Panel Frequency Meter
10 Automatic Volt Regulator ( AVR )
11 Light Indicator ( Green , Red , Yellow )
12 Stater Swicth / ON / OFF
13 Emergency Engine Stop Lever
14 Ligth Indicator Pressure, Oil
C. CABLE MAIN DISTRIBUTION SYSTEM
1 Cable Conector Insulation
2 Cable Clamp
3 Cable Coupler
4 Cable Length
5 Cable Socket
6 Cable Earth / Bounding
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KONDISI *)
NO. KOMPONEN KETERANGAN
RUSAK
BAIK
N/A
7 Clamp Earth / Bounding
8 Plug Boxes
9 Plug Protection trailing cable and Equipment
10 Fuse Box Distribution
D. HYDRAULIC SYSTEM
1 Pump
2 Selector Valve
3 Holder Valve
4 Hoses
5 Hydraulic Cylinder
6 Hydraulic Oil Tank
7 Radiator
8 Water pump
9 Oil cooler
10 Air Cleaner
11 Belting
E. STRUCTURE CONDITION (LOWER UPPER CONDITION)
1 Body and Paint Condition / Body dan cat
2 Chassis / Frame Condition / Kondisi kerangka
F. ENGINE CONDITION
1 Top Structure
2 Central Structure
3 Lower Structure / Sprocket
4 Oil Leaked / Kebocoran Oli
5 Engine Fuel Leak / Kebocoran pada bahan bakar
6 Engine Water Leak/Kebocoran pada radiator
7 Radiator,ConeClean /Kebersihan
8 Radiator hose and Clamp/Selang dan Clamp radiator
9 V-Belt Condition / kondisi V Belt
10 Air Cleaner Indicator Level/Pengontrol saringan Udara
11 K. Engine Exhaust gas Leak/Kebocoran pada gas
12 L.Engine Mountaintings/Kedudukan Mesin
13 M. Engine Door Looks and Mounting
14 N. Injection Pump/ Pompa Injseksi
15 E. Hour Meter / Odometer/ Pengaturan Kecepatan
16 F. Oil Temp Gauge/ Oil Temperatur
17 G. Water Temp gauge/ Temperatur air
18 H. Oil Filters/ Filter Oli
19 I. Fuel Filter/ Filter bahan bakar
20 J. Seals/Seal
21 K. Exhaust Muffler/Pipe
22 L. Spark Arrestor
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KONDISI *)
NO. KOMPONEN KETERANGAN
RUSAK
BAIK
N/A
G. AIR SYSTEM
1 Power Unit
2 Control Unit
3 Accessories
H. TOOLS
1 Hand Tool Electric / Mechanic
2 Tang Amper
3 Multi Meter
4 Material Insulation
5 Box Waste Oil / Tempat penampungan
I. DISTRIBUTION POWER ELECTRIC SYSTEM
1 Main Panel Distribution
2 Conector Phase - to Pahe ( R - S - T - O - N )
3 Cable Type Main Distribution ( Out - in )
4 Insulation Cable
5 Wiring Diagram Distribution Plate
6 MCCB / LCCB
7 Earthing / Grounding System
J. MECHANICAL SYSTEM
1 Physical Condition
2 Engine
3 Electric System
4 Matering System
5 Exhausr Spark Arrestor
6 Duty Cycle
7 Hose Connector
8 RPM
9 Discharges Line
10 Engine Cover
11 Water Sound Proof
12 Battery Condition
13 Oil Leak Fdrom Engine
14 Regulatar and Gauge
15 Engine Shunt Down
16 Sign and Barricade
17 Swicth
18 Electrode Holder
19 V- Belt Condition
20 Safety Guard / Protection / Ram
K TYRES
1 Front Tire RH/LH / Roda depan kiri - kanan
2 Front Rear Tire RH/LH/ Roda belakang kiri-kanan
L DOCUMENT
1 Manufacture Certificate
2 MSDS
3 SILO DEPNAKER
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TEMUAN / HASIL PEMERIKSAAN / GAMBAR / DOKUMENTASI :
Kondisi Umum Unit Hasil Pemeriksaan *) : BAIK RUSAK
Rekomendasi : Dapat digunakan / Tidak dapat digunakan
Catatan / Kesimpulan :
Dicheck / Dilaporkan oleh Diperiksa oleh Diketahui oleh Disetujui oleh
Operator / Peralatan Petugas QHSSE SOM / PM Konsultan Pengawas / Owner
( .................................................. ) ( .................................................. ) ( .................................................. ) ( .................................................. )
Tanggal : Tanggal : Tanggal : Tanggal :
Keterangan : - *) Isi tanda pada kolom /
- Formulir pemeriksaan ini dapat disesuikan dengan kebutuhan pekerjaan/manufaktur alat/peraturan yang ada.
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