Draft Form SCBA - Rev 0.0 [PDF]

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No. : FRM-SD-034-01 Form Revisi : 0.0



FORM CHECKLIST PEMERIKSAAN Self-Contained Breathing Apparatus (SCBA)



EHSC-SUST DEPT



PERIODE : NO. SCBA : LOKASI :



Hal



: 1 dari 1



MANUFAKTUR : KAPASITAS : S/N CYLINDER :



NO



GAMBAR PERALATAN



KEADAAN BAIK TIDAK



BAGIAN YANG DIPERIKSA



1



1



Full Face Mask



2



Demand Valve



3



Air Cylinder Valve



4



High Pressure Hose



5



Backboard



6



Alarming Whistle



7



Pressure Gauge



8



Medium Pressure Hose



9



Pressure Reducer



KETERANGAN



10 Waist Band 11 Belt Buckle 12 Shoulder Strap Fastener 13 Quick Connect Coupling 14 Shoulder Strap 2



15 Over all assembly 16 Headnet and harness anchors 19



17 Regulator connection



17



18 Rubber Components



22



19 Lens 20 Exhalation Valve



16 21 3



21 Speaking Diaphragm



20



22 Lens Frame Retainer 23 Gauge



26



24 Cylinder 23



24



25



25 Valve Hand Wheel 26 Burst disc outlet (clear) 27 Cylinder Pressure (full)



Informasi tambahan Konstruksi Steel or Aluminum



Tanggal Hydro tes



Hydro Re-test 5 Years



Tanggal Hydro Re-test



Masa Pakai Indefinite -



Hoop Wrapped Alum



3 Years



15 Years



Fiberglass Wrapped



3 Years



15 Years



Kevlar Wrapped



3 Years



15 Years



Cover Fiber Wrapped



3 Years



15 Years



Tanggal Expired



Dibuat Oleh,



Diketahui Oleh,



Disetujui Oleh,



(……………………………….) EHS Officer



(………………………………) KTU/Ast. Man



(……………………………..) MM/FM