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Ablution Monthly Inspection

The document outlines a monthly inspection checklist for ablution facilities and accessories in a building, detailing various components such as wash basins and toilets. Each component is to be assessed for condition using a rating system from good to broken. The checklist includes sections for notes and signatures from the QC Inspector, QAQC Coordinator, and Site Manager.

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15 views2 pages

Ablution Monthly Inspection

The document outlines a monthly inspection checklist for ablution facilities and accessories in a building, detailing various components such as wash basins and toilets. Each component is to be assessed for condition using a rating system from good to broken. The checklist includes sections for notes and signatures from the QC Inspector, QAQC Coordinator, and Site Manager.

Uploaded by

dicky.ptlbm
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLSX, PDF, TXT or read online on Scribd
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ABLUTION AND ACCESSORIES

MONTHLY INSPECTION

Building Name / Nama Gedung : ________________


Date / Tanggal : ___________________________
CONDITION
NO DESCRIPTION TOILET 1 TOILET 2 TOILET 3 TOILET 4
1 2 3 1 2 3 1 2 3 1 2 3
Wash Basin / Bak Cuci
1 Washbasin Faucet / Kran Bak Cuci tangan
2 Washbasin Drainage / Saluran Pembungan Bak Cuci
3 Washbasin Mirror / Cermin Bak Cuci
Toilet / Toilet
1 Seat Toilet / Toilet duduk
2 Squat Toilet / Toilet Jongkok
3 Flush Push Button / Tombol Pembuangan
4 Cover seat / Tutup Toilet
5 Toilet faucet / Kran Toilet
6 Jet shower / Jet shower
7 Jet shower faucet / Kran Jet shower
8 Toilet water drainage / Pembuangan Air toilet
Others / Lain-lain
1 Sewage Pipe Line / Jalur pipa air kotor
2 Clean Water Pipe line / Jalur pipa air bersih
3 Ablution Floor / Lantai ablution

Condition / Kondisi :
1 : Good / Baik
2 : Dirty / Kotor
3 : Broken / Rusak

Notes / Catatan : Checked By, Acknowledged By,

............................... ...............................

PBP/ GS
QAQC
Inspection Checklist

ABLUTION AND ACCESSORIES


MONTHLY INSPECTION

Building Name / Nama Gedung : ________________


Date / Tanggal : ___________________________
CONDITION
NO DESCRIPTION TOILET 1 TOILET 2 TOILET 3 TOILET 4 REMARKS
1 2 3 4 5 6 1 2 3 4 5 6 1 2 3 4 5 6 1 2 3 4 5 6
Wash Basin / Bak Cuci
1 Washbasin Faucet / Kran Bak Cuci tangan
2 Washbasin Drainage / Saluran Pembungan Bak Cuci
3 Washbasin Mirror / Cermin Bak Cuci
Toilet / Toilet
1 Seat Toilet / Toilet duduk
2 Squat Toilet / Toilet Jongkok
3 Flush Push Button / Tombol Pembuangan
4 Cover seat / Tutup Toilet
5 Toilet faucet / Kran Toilet
6 Jet shower / Jet shower
7 Jet shower faucet / Kran Jet shower
8 Toilet water drainage / Pembuangan Air toilet
Others / Lain-lain
1 Sewage Pipe Line / Jalur pipa air kotor
2 Clean Water Pipe line / Jalur pipa air bersih
3 Ablution Floor / Lantai ablution

Condition / Kondisi :
1. Good / Kondisi Baik 4. Cleaning / Kebersihan

2. Damagae / Rusak 5. Replace / Penggantian

3. Repaired / Diperbaiki 6. Tightening / Kekencangan

Notes / Catatan : Prepared by : Checked by : Acknowledged by :

_________________ _________________ _________________


QC Inspector QAQC Coordinator Site Manager

PBP/ GS

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