Form Safety Inspection

PT INDOKAL INDOKA L MANDIRI MANDI RI PRAT PRATAMA

NO. UNIT

:

 HEAVY EQUI

DATE

: …… ……

MODEL/TYPE KONDISI NO.

PEMERIKSAAN

1

 APA$  APA$  A%&t Pe'&d&' Pe'&d&' A(i $in)&n ! / Fire Extinguisher 

2

*ot&+ P3* / First Aid Kit Box 

3

L&'(, $ot&ri / Rotary Lamp

4

-&,+ Pen)&'&n / Seat Belt 

5

 A%&r' M,nd,r / Backward Alarm

7

*&& -(ion *&n&n 0 *iri / Rearview Mirror 

8

$&dio *o',ni+&i / Radio ommunication

9

Air Conditioner AC!

1" 11 12 13 14 15 1# 17 18 19 2" 21 22

KETERANGAN :

BAIK

RUSAK

Ampah Site Ofce

|

Jl. A. Yani

MENT SAFETY INSPECTION

………………….. 2018 IMP.-E/I-P"""1

TDK ADA

KETERANGAN

Pr!"r# $%&

-&id Y&o A%&tt& -E -(.

PT. INDOKAL MANDIRI PRATAMA  RT.01 No.14 Dea Ro!o"

| Ampah, Kal-Teng | INDON#SIA

PT INDOKAL MANDIRI PRATAMA

NO. UNIT MODEL/TYPE NO.

:

DATE

1

 APA$ 5*).  A%&t Pe'&d&' A(i $in)&n ! / Fire Extinguisher 

2

*ot&+ P3* / First Aid Kit Box 

3

L&'(, $ot&ri / Rotary Lamp

4

-&,+ Pen)&'&n / Seat Belt 

5

 A%&r' M,nd,r / Backward Alarm

7

*&& -(ion *&n&n 0 *iri / Rearview Mirror 

8

$&dio *o',ni+&i / Radio ommunication

1" 11 12 13 14 15 1# 17 18 19 2" 21 22

KETERANGAN :

: …… ……

: E'CAVATOR

PEMERIKSAAN

9

 HEAVY EQUI

BAIK

KONDISI RUSAK

MENT SAFETY INSPECTION

………………….. 2018 IMP.-E/I-P"""1

TDK ADA

KETERANGAN

Pr!"r# $%&

-&id Y&o A%&tt& -E -(.