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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