Company:
PRE-START CHECKLIST FOR BOOM TRUCK/CARGO CRANE
Equipment Num-
Site Name Type of Work
ber
Manufacturer Model Capacity
Year Manufactured Date of First Use Date of Inspection
11 2
Guide Roller/Boom Anti-two Block
1
Wire Rope
7
Angle Indicator
3 Emergency Stop &
Overload Protection
5
Hook & Safety Latch
8
Horn & Beacon Light
6
Hydraulic Device & Cylinder
10
Turntable/Rotating Device
4
Outrigger/Pad
9
Chassis Assembly
Overhead & Ground
12 Certification 14 Oil Leakage 16 18 Fire Extinguisher
Condition
13 Permit to Work 15 Banksman/Signal Man 17 Lifting Gear 19 Alcohol Test
Operator (Sig) Const. Team (Sig) HSE Personnel (Sig)
(Keep the copy of Daily Pre-Start Equipment Checklist on Site for the Job Duration. Submit a copy to the Project HSE Department, if requested/required)
Note: Mark appropriate boxes
with: Acceptable; Unacceptable; Need Further Check; NA Not Applicable
Form: HDEC-HSE-CE-006 (E)
COMPANY :
Equipment No.
DAILY PRE-START CHECKLIST FOR BOOM TRUCK CRANE
MON TUE WED THU FRI SAT SUN REMARKS
No ITEM
/ / / / / / /
1 Wire Rope / Tali Baja
2 Anti-Reserve / Anti Mundur
3 Anti-Two Block / Anti dua blok
4 Load Indicator Function / Fungsi Indikator Beban
5 Hook & Safety Latch / hook dan kunci pengaman
6 Overload Protection / Perlindungan Dari Kelebihan
7 Tire Condition / Kondisi Ban
8 Wind Speed Indicator / Indikator Kecepatan Angin
9 Structure boom / struktur rangka boom
10 Angle Indicator / Indikator Sudut
11 Flash Beacon / Lampu Rotary
12 Brake / Rem
13 Rearview Mirror / kaca spion
14 Hydraulic Cylinder Condition / Kondisi silinder hidrolik
15 Horn / klakson
16 Sheave / pulley
17 Wire Drum / Tali Baja Drum
18 Out rigger (pad) /
19 Lower Frame Condition / Kondisi casis bawah
20 Certification / Sertifikasi
21 Permit To Work / Surat Ijin Kerja
22 Oil Leakeg / Kebocoran oli
23 Banksman / Signal Man
24 Steel Plate Base / Dasar Plat Baja
25 Lifting Gears / Alat Bantu Angkat
26 Fire Extinguisher / APAR
27 Alcohol Test / Test alkohol
Operator Name / Nama Operator :
Sign Construction Team Name / Nama team konstruksi :
HSE Personnel Name / Nama petugas K3 :
(Keep the copy of Daily Pre-Start Equipment Checklist on Site for the Job Duration. Submit a copy to the Project HSE Department, if requested/required)
Note: Mark appropriate boxes
with: Acceptable; Unacceptable; Need Further Check; NA Not Applicable
Form: HDEC-HSE-CE-006 (E)