Form Inspeksi - Crane Pancang [PDF]

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HEALTH, SAFETY, AND ENVIRONMENT DEPARTMENT PT. PRATAMA WIDYA INSPEKSI CRANE PANCANG Project



Crane Manufacture



Proyek



Pabrikan Crane



Location



Crane Capacity



Lokasi



Kapasitas Crane



InspectioN Date



Lenght Boom



Tanggal Inspeksi



Panjang Boom



Crane Type / Model



Auxillary Hoist Load Capacity



Jenis Crane



Kapasitas Kerekan Bantu



Boom Type / Model



Total Running



Jenis Boom



Total Jam Kerja



Crane Boom Rest Mode



Y



Condition N N/A Anti Two Blocking System Sistem anti dual block



Sling / Chain Tali Baja / Rantai



Supender Ring Cincin Bandulan



Shackle / Pin / Bolt Segel / Pengait / Baut



Electrical Limit Switch Pembatas Saklar listrik LEADER Tiang Pancang Hammer / Vibrator Palu / hammer



Other Device Peralatan lainnya



Alarm / Bell Lonceng / Alarm Load Block / Hook Pengait Beban Safety Latches / Baricade Palang Pengaman / Barikade



Boom Back-Stop Auto Shut Off Penghenti Boom Otomatis



Indicator Rolling / Pitching Indikator Gulingan / Anggukan



Fire Extinghauisher Pemadam Kebakaran



Proper & Adequate Access Akses yang Baik



Certificate & Safety Sign Sertifikat & rambu keselamatan



Warning Sign / Poster Rambu / Poster Keselamatan



Posted Valid Operator Certivicate Sertifikat operator yang berlaku



Posted Valid Crane Certificate Serifikat crane yang berlaku Appropriate Load Chart Crane Diagram beban crane



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Remark



HEALTH, SAFETY, AND ENVIRONMENT DEPARTMENT PT. PRATAMA WIDYA Crane Boom Rest Mode



Y



Condition N N/A



Remark



Daily Crane Log Book Buku harian crane



Housekeeping Kebersihan & Kerapihan



Gressing on All Wire Sling Pelumasan pada semua tali baja



Gressing on All Sheaves / Roller Pelumasan pada semua roda / roler Gressing on All Chain & Spockers Pelumasan pada semua roda gigi Gressing on All Shaft & Swivels Pelumasan untuk semua sumbu putar



Coolant Fluid / Water For Radiator Air pendingin untuk radiator



*) Y= yes, N= No, N/A= Not aplicated



Note:



Foto:



Inspected by,



Approved by,



HSE PT. Pratama Widya



HSE PT. PP



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