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Form 03 Pile Driving Machine Inspection

1) The document is an inspection form for a pile driving machine at the Synthetics Rubber Indonesia – U3 Project. 2) It records information about the machine, operator, and results of a safety inspection checking items like the hydraulic, electrical, and braking systems. 3) The inspection found issues that required corrective action, and the status was marked as "Not OK" until repairs could be made.

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Denny Syafwalufi
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62 views2 pages

Form 03 Pile Driving Machine Inspection

1) The document is an inspection form for a pile driving machine at the Synthetics Rubber Indonesia – U3 Project. 2) It records information about the machine, operator, and results of a safety inspection checking items like the hydraulic, electrical, and braking systems. 3) The inspection found issues that required corrective action, and the status was marked as "Not OK" until repairs could be made.

Uploaded by

Denny Syafwalufi
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Synthetics Rubber Indonesia – U3 Project

PILE DRIVING MACHINE INSPECTION


EMPLOYER / ITB Doc No. :
Client Work No.: U3 CLASSIFICATION: D3
Project Doc. No.: 14122-ED-00-QA-PRC-0019

CLASS AREA DIS TYP SUB-TYP SEQ SHEET REV. Page 1 of 2


Contractor Work No.: 14122
ED 00 QA PRC 0019 0 Date : 2015-12-04

INSPECTION FORM

□ Pile Driver □ Pile Drawer □ Boring Machine □ Earth Auger


Type of Equipment : OPERATOR LICENSE

Equip No./ Tag No. : Operator Name :

Manufacturer : SIO Type :

Company User :
SIO Number :
Certificate Number :

Month of Inspection : Validity :


This form must be completed by the operator and company user before entering the equipment to be
operated in the site project area, and at any time of setting location. All equipment condition must meet to the
safety regulation and CONTRACTOR SHE Management Plan

Result column: (  ) Yes/Good, Acceptable, ( X ) Not/Bad, Not to use, ( NA ) Not applicable


No Check Item Result Remarks

1 Operator has a valid License


2 Equipment has valid certificate
3 Hydraulic system in good condition
4 Traveling system in good condition
5 Diesel hammer system in good condition
6 All electrical system are in good
7 Brake system
8 Operations Handle
9 Back Mirror
10 Lighting Device
11 Alarm System
12 Safety device
13 Boom Hoist Limiting Device
14 Wire sling is in good condition
15 Rigger man provided / qualified
16 Fork horn in good condition
17 Lubrication system
18 Oil leaking
19 Fuel Reservoir
20 Each Side of windows glasses
21 Leveling indicator devices
22 Safe Guards for moving parts
23 Certificate Emission Test
24 Fire Extinguisher
Synthetics Rubber Indonesia – U3 Project
PILE DRIVING MACHINE INSPECTION
EMPLOYER / ITB Doc No. :
Client Work No.: U3 CLASSIFICATION: D3
Project Doc. No.: 14122-ED-00-QA-PRC-0019

CLASS AREA DIS TYP SUB-TYP SEQ SHEET REV. Page 2 of 2


Contractor Work No.: 14122
ED 00 QA PRC 0019 0 Date : 2015-12-04

INSPECTOR REPORT
Corrective Action Required

Inspection Status:  OK
 Not OK
 Order for Repair

Subcontractor
Inspected by Date : Name : Signature :
Position :
Approved by Date : Name : Signature :
Position :
Contractor
Inspector Date : Name : Signature :
Position :
Reviewer Date : Name : Signature :
Position :
SHE Manager Date : Name : Signature :
Position :

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