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SAFETY INSPECTION REPORT

Applies to Heavy Compactor

[ ] Pre-mobilization [ ] Semi-annual

Contract Name. : Contract No.: Inspection Date :

Equip. No. : Type : Model : Brand :

Police No. : Km/Hourmeter : Service Date : Cap :

Serial No. : Owner :

d
oo
Description to be Checked Remarks

/A
oo

N
G

o
N
Documentation Operator and Equipment

MIGAS / KEMNAKER SILO Certificate (Certification of No.:

1
Inspection (COI) Equipment) (matches unit type-series) Expired :
One-week to Today’s Pre-use Inspection records
2
(Original copy available on unit, N/A for pre-mobilization inspection)
Original Manufacture Name Plate with Serial Number (Year of manufacture)
3 (Name plate is mandatory for pre-mobilization. During periodic inspection, the serial number may be
verified through latest inspection record/sticker)
4 Operation Manual Book (Matches unit type, series and in Bahasa/English)

5 SOP – Standard Operating Procedure equipment (based on OEM Operation Manual book)
No.:
6 SIO / SKK-OPA (BNSP-LSP / KEMNAKER)
Expired :

No.:
7 Contractor Operator Permit
Expired :

Equipment ID Number, Logo

8
Correct Size, minimum size (P x L) 25 x 20 cm, Visible

Safety Inspections and Devices

1 Back-Up Alarm (audible in working condition, 97 decibels minimum)
2 Back-Up Light Adequate Illumination, Function Test
3 Horn Easily Operated From Inside Driver's Cabin, Easy to Hear
4 Windshield Wipers and Washer Wiper Blades Not Perished, Function Test
All Window Glass / Windshield Glass Totally Clear, No Film or Stickers Blocking Vision.
5
Units with OEM Window Tint Will Require Approval by Relevant CPI Authorities.
6 Door and Door Locks, Door Handles, Left - Right, Outside and Inner Test Function
7 Seat Belts for Driver, Operator Good Condition, Properly Mounted with OEM Hi Tensile Bolts
Sign / Sticker for Prohibet Area
8 Install visible and clearly understandable warning signs ;
prohibited non authorized personnel to be on equipment
9 Wheeled Unit Steering Systems Smooth and Controlled, No Worn Out Loose Ball Joints
10 Articulated Unit Steering Systems Smooth and Controlled, No Worn Pins Bushings

11 Articulate Steering LOCK-OUT SAFETY BAR Check all system, Easy Access, No Lost Pins
Service Brake System, Front and Rear
12
Check all system, Properly Adjusted, No Air Leaks, Function Test
13 Parking Brake System Check all system, Properly Adjusted, Test Function
14 Head Lights-Working Lights-Flood Lights Adequate Illumination, Function Test
15 Rear Combination Lights Adequate Illumination, Function Test
16 Front Combination Lights Adequate Illumination, Function Test
17 Electrical Wiring Condition, Fuse Block All Splices Insulated, No Bare Wires
Internal Centrally Mounted Rear View Mirror(s)
18
Not Loose, Clear Unobstructed Vision, Functions Properly
Side mounted Left and Right Mounted Rear View Mirrors
19
Not Loose, Clear Unobstructed Vision, Functions Properly,
Fire Extinguisher
20
Minimum 4kg, Current and Valid Inspection Tag, Properly Mounted and Accessible.
21 First Aid Kit Clean, Tidy, Completely Full
Access Ladder Steps Handrails Securely Mounted, Ergonomic Design, Good Condition, Not Cracked,
22
Not Bent, Not Dilapidated, No Sharp Edges, No Sharp Corners
Safety Guards and Covers
23
All In Place, Not Loose, None Missing, Not Modified, Remain within OEM Specs
ROPS OEM Structural Standards, Minimum Two (2) but Recommend Four (4) Full One-Piece Steel
24
Beams Over the Operator, Mandatory Steel Roof, No Fiberglass Roof

Axle Wheel Bearing Lubrication

25
Oil-Hubs to Be Properly Filled and No Leaks, No MISSING COVERS / CAPS on Grease Type Hubs
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Tires S/D and P/F Unit Rear Tire and Wheel Condition No Broken-Missing Lug Nuts, Nuts Tightening,
26 Tread Depth Minimum 3mm or As per TWI tread Depth , No Recaps / Retreads / Vulcanized
Permitted, Correct Rotation, All-Terrain Mud Grip Tread Pattern
Sheepfoot Wheel Condition
27
No Broken-Missing Lug Nuts, No Broken - Missing Pads, No Cracks
Vibratory System on Drum - S/D and P/F Unit No Broken Nuts / Bolts on Hydraulic Motor, No Leaking
28
Hoses, All Hoses Scure with Clamps, Adequate Power from Vibration System.
Smooth Drum
29
Condition is Smooth, Proper Thickness, No Broken-Missing Bolts / Nuts, No Cracks
Padfoot Drum
30
Condition is Good, No Broken or Missing Pads, Adequate Pad Thickness, No Cracks
31 Wheel Chocks Two Units, Properly Constructed
Driver Monitoring System ( Refer to CPI Contract ) registered on CCPM (link to i-JMS)
32 Perform Function Test, Confirmation that there is no signs of tampering include seals, connections,
plugs, Etc.

Body
1 Body Good Condition, Good Paint and General Appearance, No Excess Damage, No Rust

2 Front-Rear Bumper Bar All Rounded Corners, No Sharp Edges, Not Loose, Properly Mounted

Cabin and Interior

1 Cabin Interior Good Condition, Clean, No Rubbish, Good Housekeeping
Dashboard Indicators, Engine EMS (Electronic Monitoring System)
2 Gauges for Fuel, Hours, Kms, Odometer, Temperature, Brake Air Pressure, Hyd Pressure, Alternator,
Battery Voltmeter, Battery Charging System, etc, All Operating Properly
Wheel Unit Steering Wheel, Steering Column Controls Levers and Switches Check all system and
3
Test Function
4 S/D and P/F Unit Unit Steering System Controls Levers and Switches Test Function
5 All Switches and Knobs on Dashboard Test Function
6 Cabin Air Conditioner or Fan Test Function
Seats, Cushions
7
Securely Mounted, Ergonomically Good Condition, Not Torn Open or Dilapidated
8 Control Linkages and Levers Test Function

Main Frame / Main Chassis / Articulated Steering

Main Chassis Good Frame Condition, Straight, Not Bent, No Cracks, No Uncertified
1
Welding Repairs
Drum and Wheel Mounts Front / Rear
2
Straight Not Bent, No Loose Pins / Bolts / Nuts
Articulated Bearing (Swivel) Condition
3
Properly Lubricated, Not Loose, No Loose Mounting Bolts
Articulated Steering Linkages No Loose Ball Joints, Lubricated Properly, No Loose Pins, Not Worn
4
Out, No Loose Mounting Bolts
5 Rear Bumper Bar No Cracks, Not Loose, Properly Mounted
Lock Pins, Pins and Bushings in Steering Linkages
6
All Pins Properly Secured with Split Cotter Pins and/or Bolted End Plates

Blade, Hydraulic Cylinders

1 Blade Cutting Edge - End Bits Not Worn Out, Tight, No Loose Bolts
Blade Linkages and All Implements No Excessively Worn Pins/Bushings, All Pins Properly Secured
2
with Split Cotter Pins and/or Bolted End Plates
Hydraulic Cylinders No Leaks or Excessively Worn Pins/Bushings, All Pins Properly
3
Secured with Split Cotter Pins and/or Bolted End Plates

Hydraulics, General Hydraulics, Fluids, Fuel, Hoses

1 All Fuel Hoses and Lines Properly Secured, No leaks
2 All Hydraulic Hoses and Hydraulic Lines Properly Secured, No Leaks
3 Hydraulic Tanks Mounts, Leaks, and Filler Cap Properly Secured, No Leaks
4 Fuel Tank Mounts, Leaks, and Filler Cap No Leaks, No loose Mounts
5 Pilot Valves and Hydraulic Cylinders No Leaks
6 Hydraulic Pumps and Motors No Leaks, No Excess Noise
7 All Hydraulic Controls and Hydraulic Control Valves No Leaks, Test Function

Engine(s)
1 Main Engine Clean Appearance, No Defective Mounts, No Leaks, Observe Performance
2 Engine Dipstick Easy to read, Oil Level Adequate
Battery, Battery Covers, Battery Mounting, Battery Terminals Optional Battery Disconnect Switch,
3 Test Function, No Loose or Corroded Cables-Terminals, Battery Hold-Downs in Place, Clean Battery
Box, No Loose Mounts
4 Starter Motor Test Function, Adequate Cranking Strength, No Bad Noises or Overheating
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Alternator Observe Charging Function, No Bad Noises or Overheating, No Loose Mounts,

5
No Loose Belts
6 Cooling System Inspect Radiator and Hoses, No Leaks, No Perished Hoses
7 V-Belts or Serpentine Belts Not Loose, Not Squealing, Not Cracked
8 Exhaust System Check Pipes and Muffler, No leaks, Not Loose
9 Sunstrand pump drive No Leaks, Observe a Function Test
10 Clutch No Smoke or Slipping, Observe a Function Test
11 S/D and P/F Rear Differential / Reduction Gear No Leaks, All Mountings Tight, Nothing Loose
12 Sheepfoot Differentials Front and Rear No Leaks, All Mountings Tight, Nothing Loose
S/D and P/F Hydrostatic Drive, Transmisson, PTO, Drive Shafts, U-Joints, Center Bearing
13
Properly Greased, No Leaks, All Mountings Tight, Nothing Loose

Servicing and Maintenance

1 Maintenance Schedule - PM and PdM Service Records Available

Others
1
2
3

Comments

Good = Good condition

No Good = Broken or Malfunction

N/A = Not Applicable

Inspected by: Checked by Acknowledged by PHR Menerima dan Menyetujui bahwa Alat ini sudah "OK", aman
untuk dioperasikan dan berkomitmen mempertahankan
operasi yang aman.

SIGNATURE, Date :

SM CEM
Contractor's
EPCM-SM-CNS-PCD-CORP-0007 Rev0 (9 Agustus 2021)