PT SURYA GLOBAL MAKMUR

Commissioning – Heavy Equipment

COMMISIONING INSPECTION FORM

HEAVY EQUIPMENT
(dozer, wheelloader, excavator, grader, shovel, compactor)
Company :
Equipment No :
Hours Meter :
Equipment Type :
Date Inspection :

Ref. Item Comment Pass Fail N/A

A. CRITICAL ITEMS (check throughout inspection)

1.  Visibility
Rotary light /Flashing light orange or blue as per Pit
1.1
Traffic Rules
1.2 Asset numbers rear clearly visible.

2.  In the cabin
2.1 Radio communication (Two way)
2.2 Seat condition manufacturers standard
2.3 Seat belt installed properly in good working order
ROPS manufactures/international standard (not
2.4
applicable for excavators)
2.5 FOPS manufactures/international standard
2.6 Fire extinguishers fully charged and mounted properly.
2.7 Fire Suppression – Charged and Operational
2.8 Air Conditioner – Operational
2.9 All electrical gauges working
2.10 Horn – Operation
2.11 Fully enclosed canopy for Coal Mining
2.12 Fatigue warning for haul trucks – if applicable
2.13 Front wiper & windshield washer - Operation
2.14 Safety Pin lock/cable for dump body (for Haul truck only)
2.15 First Aid Kit
2.16 Cab Door Locks & Window Functional
2.17 Noise test < 85 dB in the cabin, if > 85 dB

3.  Mechanical/Electrical
3.1 All work lamps (head, tail, brake, reverse)
3.2 Reversing alarm/movement alarm
Tyres & Rims/Mounting hardware in good condition and
3.3
secure..
 PT SURYA GLOBAL MAKMUR
Commissioning – Heavy Equipment

3.4 Tow point if fitted

3.5 Access system & steps in good condition
3.6 General mechanical condition/All fluid levels correct
3.7 Ground level engine shutdown - Operational
3.8 Handrails, safety chain & bar
3.9 Front spill guard for Haul Truck
3.10 Rear view mirrors – Clear and undamaged
3.11 Blade/Ripper Functions(Dozer & Grader) - Operation
Isolation lock out & battery isolation switch – LCI
3.12
Standard
Check for loose or missing items. (Guards,Covers,
3.13
Steps,etc)
3.14 Steering Operation- Standard and Emergency
3.15 Parking brake - Check Operation as per OEM Standard
3.16 Service brake - Check Operation
3.17 Emergency brake – Check Operation
3.18 Retarder (c/w lamp) - if applicable – Check Operation
Dump Body Function – ADT/OHT – Cycle time for
3.19
Raise/Lower – OEM Specification
3.20 Check for Fault Alarms/Codes active
3.21 Record Machine Hours at completion of Commissioning
If new machine, has OEM Commissioning report been
3.22
supplied?

Comments :

B. COMMISSIONING TEAM :

Hasil Commisioning Layak Tidak Layak

No Temuan Rekomendasi
1
2
3
4
 PT SURYA GLOBAL MAKMUR
Commissioning – Heavy Equipment

Pihak PT. SGM

Pengawas Teknis : ______________________ Signature: ____________________

HSE : ______________________ Signature: _____________________

Mechanic / Technician Name : ______________________ Signature: ____________________

Pihak Kontraktor

Pengawas Teknis : ______________________ Signature: ____________________

HSE : ______________________ Signature: _____________________

Mechanic / Technician Name : ______________________ Signature: ____________________

Commissioning – Heavy Equipment

D. DATA MACHINE

SERIAL NUMBER MODEL PART NUMBER MAKE ARRANGEMENT REMARKS

Machine
Engine
Starter Motor
Alternator
Transmission
Pump
Hydraulic Pump
Differential
Final Drive
Transmission

Note: Inspection to consider, but not be limited to, the items listed in the checklist.
Record issues identified onto the non-conformance for
 PT SURYA GLOBAL MAKMUR
Commissioning – Dump Truck

COMMISIONING INSPECTION FORM

DUMP TRUCK
Project Site : SGM MANDIANGIN, JAMBI
Date Inspection :
Equipment Type :
Machine Serial Number :
Engine Model :
Engine Serial Number :
Hours Meter ( HM ) :
Unit Number :

Ref. Item Comment Pass Fail Remark

A. CRITICAL SAFETY ITEMS

1 Asset Numbers attached and clearly visible
2 Fire extinguishers fully charged and mounted properly
3 All electrical gauges working
4 Horn - Operation
5 Front wiper & windshield washer - Operation
6 Safety Seat Belt Operator and Passenger

BASIC ENGINE
B.
1 Engine Guard (Hood)
2 Turbocharger
3 Air Compressor
4 Crankcase Guard
5 Precleaner
6 Air Cleaner Assembly
7 Inlet Manifold and Piping
8 Exhaust Manifold
9 After Cooler
10 Oil Lines
11 Oil Level
C. FUEL SYSTEM
12 Fuel Injection Pump
13 Fuel Injection Nozzles
14 Fuel Injection Housing and Governor
D. COOLING SYSTEM
15 Radiator and Fan Guard
16 Fan Assembly
17 V- belt Condition
18 Water Pump
19 Oil Cooler
 PT SURYA GLOBAL MAKMUR
Commissioning – Dump Truck

E. ELECTRICAL SYSTEM
20 Alternator
21 Battery and Cable
22 Electric Starting Motor
23 Engine Harness Condition
24 Power Train Harness Condition
25 Lights and Back Up Alarm ( general )
F. STEERING SYSTEM
26 Steering Wheel and Shaft Condition
27 Steering Linkages (Turn wheel L&R to test )
28 Steering Lines
29 Steering Pump
30 Breathers
31 Oil Level
32 Cycle Time Left to Right
G. DRIVE TRAIN
33 Retarder
34 Power shift Transmission
35 Transmission Oil Pump
36 Oil Lines
37 Transmission Oil Level
38 Final Drive
39 Final Drive Oil Level
40 Drive Shaft ( Universal Joint Movement )
41 Differential Oil Level
42 Differential Breathers
H. HYDRAULIC SYSTEM
43 Oil Lines
44 Hoist Cylinder (S) Leaking or Scratch
45 Hoist Cylinder Bearing/Bushing Condition
46 Hydraulic Pump
47 Breathers
48 Oil Level
49 Power Take Off Unit
50 Universal Joint Condition
51 Cycle Time Raise & Lower Body
I. BREAKING SYSTEM
52 Parking Brake Test
 PT SURYA GLOBAL MAKMUR
Commissioning – Dump Truck

53 Service Brake Test

J. FRAME AND BODY

54 Safety Pin In Bucket

55 Body Condition In General

K. SUSPENSION

56 Front Suspension Condition

57 Rear Suspension Condition

L. TYRE

58 General Condition Tyre All Position

M. GREASE SYSTEM

60 Auto Lube Functioning

61 Grease Lines (Broken and leaking)

N. OPERATORS STATION

62 Air Conditioner Function

63 Gauge & Cabin Light Function

64 Seat Condition

65 Cabin Glass Condition

66 Door Left & Right

67 Operators Handbook Behind Seat

 PT SURYA GLOBAL MAKMUR
Commissioning – Dump Truck

Comments :

Hasil Commisioning Layak Tidak Layak

No Temuan Rekomendasi
1
2
3
4

COMMISSIONING TEAM:

Pihak PT. SGM

Pengawas Teknis : ______________________ Signature: ____________________

HSE : ______________________ Signature: _____________________

Mechanic / Technician Name : ______________________ Signature: ____________________

Pihak Kontraktor

Pengawas Teknis : ______________________ Signature: ____________________

HSE : ______________________ Signature: _____________________

Mechanic / Technician Name : ______________________ Signature: ____________________

 PT SURYA GLOBAL MAKMUR
Commissioning – Bus

COMMISIONING INSPECTION FORM

BUS
Project Site : SGM MANDIANGIN, JAMBI
Date Inspection :
Equipment Type :
Machine Serial Number :
Engine Model :
Engine Serial Number :
Hours Meter ( HM ) :
Unit Number :

Ref. Item Comment Pass Fail Remark

A. CRITICAL SAFETY ITEMS

1 Asset Numbers attached and clearly visible
2 Fire extinguishers fully charged and mounted properly
3 All electrical gauges working
4 Horn - Operation
5 Front wiper & windshield washer - Operation
6 Safety Seat Belt Operator and Passenger

BASIC ENGINE
B.
1 Engine Guard (Hood)
2 Turbocharger
3 Air Compressor
4 Crankcase Guard
5 Precleaner
6 Air Cleaner Assembly
7 Inlet Manifold and Piping
8 Exhaust Manifold
9 After Cooler
10 Oil Lines
11 Oil Level
C. FUEL SYSTEM
12 Fuel Injection Pump
13 Fuel Injection Nozzles
14 Fuel Injection Housing and Governor
D. COOLING SYSTEM
15 Radiator and Fan Guard
16 Fan Assembly
17 V- belt Condition
18 Water Pump
19 Oil Cooler
 PT SURYA GLOBAL MAKMUR
Commissioning – Bus

E. ELECTRICAL SYSTEM
20 Alternator
21 Battery and Cable
22 Electric Starting Motor
23 Engine Harness Condition
24 Power Train Harness Condition
25 Lights and Back Up Alarm ( general )
F. STEERING SYSTEM
26 Steering Wheel and Shaft Condition
27 Steering Linkages (Turn wheel L&R to test )
28 Steering Lines
29 Steering Pump
30 Breathers
31 Oil Level
32 Cycle Time Left to Right
G. DRIVE TRAIN
33 Retarder
34 Power shift Transmission
35 Transmission Oil Pump
36 Oil Lines
37 Transmission Oil Level
38 Final Drive
39 Final Drive Oil Level
40 Drive Shaft ( Universal Joint Movement )
41 Differential Oil Level
42 Differential Breathers
H. HYDRAULIC SYSTEM
43 Oil Lines
44 Hoist Cylinder (S) Leaking or Scratch
45 Hoist Cylinder Bearing/Bushing Condition
46 Hydraulic Pump
47 Breathers
48 Oil Level
49 Power Take Off Unit
50 Universal Joint Condition
51 Cycle Time Raise & Lower Body
I. BREAKING SYSTEM
52 Parking Brake Test
 PT SURYA GLOBAL MAKMUR
Commissioning – Bus

53 Service Brake Test

J. FRAME AND BODY

54 Safety Pin In Bucket

55 Body Condition In General

K. SUSPENSION

56 Front Suspension Condition

57 Rear Suspension Condition

L. TYRE

58 General Condition Tyre All Position

M. GREASE SYSTEM

60 Auto Lube Functioning

61 Grease Lines (Broken and leaking)

N. OPERATORS STATION

62 Air Conditioner Function

63 Gauge & Cabin Light Function

64 Seat Condition

65 Cabin Glass Condition

66 Door Left & Right

67 Operators Handbook Behind Seat

 PT SURYA GLOBAL MAKMUR
Commissioning – Bus

Comments :

Hasil Commisioning Layak Tidak Layak

No Temuan Rekomendasi
1
2
3
4

COMMISSIONING TEAM:

Pihak PT. SGM

Pengawas Teknis : ______________________ Signature: ____________________

HSE : ______________________ Signature: _____________________

Mechanic / Technician Name : ______________________ Signature: ____________________

Pihak Kontraktor

Pengawas Teknis : ______________________ Signature: ____________________

HSE : ______________________ Signature: _____________________

Mechanic / Technician Name : ______________________ Signature: ____________________

PT SURYA GLOBAL MAKMUR
Commissioning – Support Equipment

MACHINE INFORMATION

MACHINE DETAIL

LCI Machine Asset No :

Machine Type :

Machine Model :

Machine SN :

Machine Arr :

Engine Model :

Engine SN :

Engine Arr. No :

Date of Commissioning :
 PT SURYA GLOBAL MAKMUR
Commissioning – Support Equipment

COMMISSIONING INSPECTION FORM

SUPPORT EQUIPMENT
(lighting tower, genset, pump)

Project Site : SGM MANDIANGIN, JAMBI

Date Inspection :
Equipment Type :
Machine Serial Number :
Engine Model :
Engine Serial Number :
Hours Meter ( HM ) :
Unit Number :

Ref. Item Comment Pass Fail N/A

A. CRITICAL ITEMS (check throughout inspection)
1.  Visibility
1.1 Lock Out System (Sistem Penguncian)
Safety Guard (Tutup Pelindung) – Fan, Belt, Driveshaft,
1.2
Radiator, etc
1.3 Fire Extinguisher (Tabung Pemadam Kebakaran)
All Warning Tags/ Safety Labels Fitted & Clear (Label
1.4 Peringatan – (Isolation battery Sticker ) tersedia dan
jelas)

2.  Mechanical Inspection
Oil and Fuel Leaks/Levels (Kebocoran Oli dan Bahan
2.1
Bakar)
Belt Condition and Tension (Kondisi belt dan
2.2
ketegangannya)
2.3 Linkages and Mountings (Sambungan dan Dudukan)
2.4 All Retaining Bolts (Baut-baut pengencang)
2.5 Fuel Hose Condition (Kondisi Hose Bahan Bakar)
Radiator Hose Condition and Clamps Tighteness
2.6
(Kondisi Hose Radiator dan Kekencangan Clamps)
2.7 Cooling System Condition (Kondisi Cooling System)
2.8 Air Induction System (Sistem Pemasukkan Udara)
2.9 Exhaust System (Sistem Pembuangan Gas)
Hydraulic Oil Leaks (Kebocoran Oli Hydraulic – Lighting
2.10
Plant only)
Tower Cylinder Condition (Kondisi Silinder Tower –
2.11
Lighting Plant only
Linkages, Hoses & Clamps (Sambungan2, Hose dan
2.12
Lamp) – Lighting Plant only
Mounting & Bolts of Pump & Tank (Baut dan Dudukan
2.13
pada Pompa dan Tangki) – Lighting Plant only
Lift Cylinder – Tele Cylinder – Tilt Cylinder (Lighting Plant
2.14
only)
 PT SURYA GLOBAL MAKMUR
Commissioning – Support Equipment

3.  Electrical Inspection
3.1 Key Switch (Kunci Kontak)
3.2 Switches (Sakelar)
Safety Earth Leakage (Sambungan Peredam tegangan
3.3
tinggi – Ground Cable) – Lighting Plant and Genset only
3.4 Panel Lamp (Lampu Panel)
3.5 Tachnometer (Pengukur Putaran Mesin)
Engine Coolant Temperature Gauge (Pengukur Suhu
3.6
Kerja Mesin)
3.7 Indicator Lamps (Lampu-lampu Peringatan)
3.8 Cable Harness & Terminal (Kabel Harness & Terminal)
3.9 Fuses & Circuit Breaker (Sekering & Pemutus Arus)
Generator, Bolt and Mounting (Generator, Baut serta
3.10
Dudukannya)
Lamps, Mountings & Bolts lamp Bracket (Lampu,
3.11
Dudukan serta baut pengencang lampu)
3.12 Alternator & Belts (Alternator dan Belt nya)
Battery & Electrolyte Level (Battere dan Level Air
3.13
Battere)
Starting Motor Condition & Operation (Kinerja dan
3.14
Kondisi Motor Starter)

4.  Operational Testing
Running Engine and Check Unusual Noise (Nyalakan
4.1
Mesin dan Periksa Suara-suara yang tidak biasa)
Make Sure All Lamps is Function when Engine is running
4.2 (Pastikan semua lampu berfungsi pada saat Mesin
menyala)

Comments :

Hasil Commisioning Layak Tidak Layak

No Temuan Rekomendasi
1
2
3
4
 PT SURYA GLOBAL MAKMUR
Commissioning – Support Equipment

COMMISSIONING TEAM:

Pihak PT. SGM

Pengawas Teknis : ______________________ Signature: ____________________

HSE : ______________________ Signature: _____________________

Mechanic / Technician Name : ______________________ Signature: ____________________

Pihak Kontraktor

Pengawas Teknis : ______________________ Signature: ____________________

HSE : ______________________ Signature: _____________________

Mechanic / Technician Name : ______________________ Signature: ____________________

 PT. SURYA GLOBAL MAKMUR
RAYA
Commissioning – LV

COMMISIONING INSPECTION FORM

LIGHT VEHICLE
Project Site :
Date Inspection :
Equipment Type :
Machine Serial Number :
Engine Model :
Engine Serial Number :
Hours Meter ( HM ) :
Unit Number :

Ref. Item Comment Pass Fail Remark

A. CRITICAL SAFETY ITEMS

1 Asset Numbers attached and clearly visible
2 Fire extinguishers fully charged and mounted properly
3 All electrical gauges working
4 Horn - Operation
5 Front wiper & windshield washer - Operation
6 Safety Seat Belt Operator and Passenger

BASIC ENGINE
B.
1 Engine Guard (Hood)
2 Turbocharger
3 Air Compressor
4 Crankcase Guard
5 Precleaner
6 Air Cleaner Assembly
7 Inlet Manifold and Piping
8 Exhaust Manifold
9 After Cooler
10 Oil Lines
11 Oil Level
C. FUEL SYSTEM
12 Fuel Injection Pump
13 Fuel Injection Nozzles
14 Fuel Injection Housing and Governor
D. COOLING SYSTEM
15 Radiator and Fan Guard
16 Fan Assembly
17 V- belt Condition
18 Water Pump
19 Oil Cooler
 PT. SURYA GLOBAL MAKMUR
RAYA
Commissioning – LV

E. ELECTRICAL SYSTEM
20 Alternator
21 Battery and Cable
22 Electric Starting Motor
23 Engine Harness Condition
24 Power Train Harness Condition
25 Lights and Back Up Alarm ( general )
F. STEERING SYSTEM
26 Steering Wheel and Shaft Condition
27 Steering Linkages (Turn wheel L&R to test )
28 Steering Lines
29 Steering Pump
30 Breathers
31 Oil Level
32 Cycle Time Left to Right
G. DRIVE TRAIN
33 Retarder
34 Power shift Transmission
35 Transmission Oil Pump
36 Oil Lines
37 Transmission Oil Level
38 Final Drive
39 Final Drive Oil Level
40 Drive Shaft ( Universal Joint Movement )
41 Differential Oil Level
42 Differential Breathers
H. HYDRAULIC SYSTEM
43 Oil Lines
44 Hoist Cylinder (S) Leaking or Scratch
45 Hoist Cylinder Bearing/Bushing Condition
46 Hydraulic Pump
47 Breathers
48 Oil Level
49 Power Take Off Unit
50 Universal Joint Condition
51 Cycle Time Raise & Lower Body
I. BREAKING SYSTEM
52 Parking Brake Test
 PT. SURYA GLOBAL MAKMUR
RAYA
Commissioning – LV

53 Service Brake Test

J. FRAME AND BODY

54 Safety Pin In Bucket

55 Body Condition In General

K. SUSPENSION

56 Front Suspension Condition

57 Rear Suspension Condition

L. TYRE

58 General Condition Tyre All Position

M. GREASE SYSTEM

60 Auto Lube Functioning

61 Grease Lines (Broken and leaking)

N. OPERATORS STATION

62 Air Conditioner Function

63 Gauge & Cabin Light Function

64 Seat Condition

65 Cabin Glass Condition

66 Door Left & Right

67 Operators Handbook Behind Seat

 PT. SURYA GLOBAL MAKMUR
RAYA
Commissioning – LV

Comments :

PIHAK PT. SGM :

Pengawas Teknis Name : ______________________ Signature: _____________________

HSE Name : ______________________ Signature: _____________________

Mekanic Name : ______________________ Signature: _____________________

PIHAK KONTRAKTOR :

Pengawas Teknis Name : ______________________ Signature: _____________________

HSE Name : ______________________ Signature: _____________________

Mekanic Name : ______________________ Signature: _____________________