Pre-Mob Inspection Checklists 2 January 2016

Please scroll below
IBU Vehicle Selection & Maintenance Procedure

Revised 10 December 2009
Version 1.0.1.1
2.6. Keselamatan Ban Halam # 4

Ban adalah fitur keselamatan penting yang memerluk
pemilihan yang cermat, dan driver / operator harus dipan
sesuai rekomendasi pabrikan. Tekanan angin Ban harus be
dan dipertahankan pada tekanan operasi yang benar, tekan
ban yang direkomendasikan harus ditampilkan pa
kendaraan dan pengemudi harus diberikan sarana un
memeriksa ban. Driver harus bertanggung jawab un
memeriksa kondisi ban selama pemeriksaan dan melapork
setiap kekurangan angin.
Tapak ban memberikan mencengkeram dan traksi un

mencegah kendaraan Anda tidak tergelincir atau ges
terutama ketika jalan basah. Secara umum, ban tidak am
dan harus diganti bila tapak tinggal 1.6mm. Ban te
dilengkapi indikator treadwear yang memungkinkan An
tahu kapan saatnya untuk mengganti ban tersebut. Indika
indikator initerletak di bagian bawah alur tapak. Kapan
muncul "bahkan" pada tapak luar, itulah saatnya un
mengganti ban Anda. Ban vulkanisir tidak diperbolehk
untuk semua kendaraan, termasuk kendaraan berat.
2.6 Tire Safety - Page # 4.

Tires are an important safety feature requiring care
selection, and drivers/operators should be guided
manufacturers recommendations. Tires need to
maintained at the correct operating pressure, the tire press
recommended should be displayed on vehicles and driv
should be given the means to check them. Drivers sho
responsible for checking tire condition during inspection a
reporting any deficiencies.
maintained at the correct operating pressure, the tire press
recommended should be displayed on vehicles and driv
should be given the means to check them. Drivers sho
responsible for checking tire condition during inspection a
reporting any deficiencies.
The tire tread provides the gripping action and traction t

prevent your vehicle from slipping or sliding, especially wh
the road is wet. In general, tires are not safe and should
replaced when the tread is worn down to 1/16 of an inch. Ti
have built-in treadwear indicators that let you know when i
time to replace your tires. These indicators are raised sectio
spaced intermittently in the bottom of the tread groov
When they appear "even" with the outside of the tread, i
time to replace your tires. Vulcanized tires are not allow
for all vehicles, including heavy vehicles.
ocedure
ng memerlukan
r harus dipandu
Ban harus benar
benar, tekanan
ampilkan pada
sarana untuk
g jawab untuk
dan melaporkan
n traksi untuk
cir atau geser,
ban tidak aman
mm. Ban telah
ngkinkan Anda
sebut. Indikator-
apak. Kapandia
saatnya untuk
diperbolehkan
raan berat.
quiring careful
be guided by
need to be
he tire pressure
les and drivers
Drivers should
inspection and
he tire pressure
les and drivers
Drivers should
inspection and
nd traction that
especially when
e and should be
of an inch. Tires
know when it is
e raised sections
tread grooves.
the tread, it is
re not allowed
Page 13 of 378
VEHICLE - PRE-MOB INSPECTION

Applies to Sedan, Station Wagon, Minibus, Pi
Equip. No. : Type : Model :
Serial No. : Km/Hourmeter : Service
Inspected by : Date : Location
Description to be Checked
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Documentation Operator and Equipment
1 Today's Pre-Trip Inspection Original Copy Available on Unit
2 Original Manufacturer Name Plate with Serial Number Year of Manufacture:
3 Original or a Copy of Operation Manual Book Matches Unit Type and Series
4 SOP - Standard Operating Procedure Based on OEM Operation Manual Book
5 Operator/Driver Government Driving Licence Expiry :
6 Company Operator/Driver Permit Expiry :
7 STNK - Vehicle Document Expiry :
8 KEUR - Inspection Book Expiry :
9 Nota Pajak - Tax Expiry :
10 Kartu Kendali - Traffic Police Document Expiry :
11 Riau BM Police Number Plate Front - Rear Expiry :
12 Company ID Number, Company Logo Correct Size, Minimum 10 Cm Height, Visible
Mandatory Safety Inspections and Devices

1 Back-Up Sensor Alarm Easy to Hear, Function Test
2 Back-Up Light Adequate Illumination, Function Test
3 Horn Easily Operated From Inside Driver's Cabin, Easy to Hear
Seat Belts for Driver, Operator, Passenger(s)
4
Good Condition, Properly, Mounted with OEM Hi-Tensile Bolts
5 All Seats, Cushions Securely Mounted, Ergonomically Good Condition, Not Torn Open or Dilapidated
6 Parking Brake Function Test
7 Service Brakes Front and Rear Properly Adjusted, No Air, Vacuum or Fluid Leaks, Test Function
Axle Wheel Bearing Lubrication
8 Front and Rear Axle Hubs to Be Properly Lubricated and No Leaks, No MISSING COVERS / CAPS on
Grease Type Hubs
Power Steering System Check All Steering Linkages, No Loose Ball Joints, Lubricated Properly, Not Loose,
9
No Excess Freeplay, No Loose Mounting Bolts, Function Test
Page 14 of 378
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Tire and Wheel Condition No Broken-Missing Lug Nuts, As per TWI, tread Depth Minimum 1.6mm, If TWI
10 unavailable Tread Depth Minimum 3mm, No Recaps / Retreads / Vulcanized Tires, Correct Rotation,
Recommend Front and Rear Tread "All-Terrain" Pattern
11 Head Lights High-Low Beam Function Correctly
12 Interior Lights Adequate Illumination, Function Test
13 Rear Combination Lights Adequate Illumination, Function Test
14 Front Combination Lights Adequate Illumination, Function Test
15 Electrical Wiring Condition, Fuse Block All Splices Insulated, No Bare Wires
Side mounted Left and Right Door Mounted Rear View Mirrors
16
Not Loose, Clear Unobstructed Vision, Functions Properly
Internal Centrally Mounted Rear View Mirror
17
All Window Glass / Windshield Glass Totally Clear, No Film or Stickers Blocking Vision.
18
Units with OEM Window Tint Will Require Approval by Relevant CPI Authorities.
19 Windshield Wipers and Washer Wiper Blades Not Perished, Test Function
20 Doors, Door Locks, Door Handles, Left - Right, Outside and Inner Function Test
21 Safety Triangles Two Units In Good Condition, Reflective So As Visible at Night
Fire Extinguisher Mounted on a Proper Bracket, Easily demounted, Accessible. Current and Valid
22 Quarterly Inspection Sticker with a valid Inspection Cycle Tag. Size Kg to 1Kg
23 First Aid Kit Clean, Tidy, Completely Full

Safety Guards and Covers
24
All In Place, Not Loose, None Missing, Not Modified, Remain within OEM Specs
25 Driver Monitoring System Refer to CPI Contract, Perform Function Test
Body
1 Body Condition Good Paint and General Appearance, No Excess Damage, No Rust
Cabin and Interior

1 Cabin Interior Condition Clean, No Rubbish, Good Housekeeping
Dashboard Indicators Gauges For Fuel, Hours, Kms, Odometer, Temperature, Brake Air Pressure,
2
Alternator, Battery Voltmeter, Battery Charging System, etc, All Operating Properly.
3 Steering Wheel Not Loose, Controls Vehicle Properly, Function Test
4 Combination Switch, Light Switch, Switches, Knobs Test Function
6 Cabin Air Conditioner, Fan Function Test
Main Frame and Main Chassis

1 Main Chassis, Frame Good Condition, Straight, Not Bent, No Cracks, No Uncertified Welding Repairs
2 Front and Rear Bumper Bars Rounded Corners, No Sharp Edges, Not Loose, Properly Mounted
3 Springs, Front and Rear, Suspension System Straight, Not Bent, No Loose Pins or Bushings
Page 15 of 378
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4 Fuel Tank No Loose Mounts, Filler Cap, Properly Secured, No Leaks
General Hydraulics, Fluids, Fuel Lines, Hoses

1 All Fuel Hoses and Lines Properly Secured, No leaks
2 All Hydraulic Power Steering Hoses and Hydraulic Lines Properly Secured, No Leaks
Power Steering Pump and Tank
3
No Loose Mount Bolts, No Loose Belt(s), No Leaks, No Excess Noise, Filler Cap Properly Secured
4 Fuel Tank No Loose Mounts, No Leaks, Proper Filler Cap
Engine - Transmission
1 Engine Clean Appearance, No Leaks, No Defective Mounts, Observe Performance
2 Engine Dipstick Easy to read, Oil Level Adequate
Battery, Battery Covers, Battery Mounting
3 Battery Terminals Clean, Optional Battery Disconnect Switch, Test Function, No Loose or Corroded Cables-
Terminals, Battery Hold-Downs in Place, Clean Battery Box, No Loose Mounts
4 Starter Motor Test Function, Adequate Cranking Strength, No Bad Noises or Overheating
Alternator
5
Observe Charging Function, No Bad Noises or Overheating, No Loose Mounts, No Loose Belts
6 Cooling System Radiator, Water Pump and Hoses, No Leaks, No Perished Hoses
7 V-Belts or Serpentine Belts Not Loose, Not Squealing, Not Cracked
8 Exhaust System Check Pipe, Muffler, No leaks, Not Loose
9 Transmission PTO and Auxiliary Transmisson No Leaks, Observe a Function Test
Drive Shafts, Propeller Shafts, U-Joints, Center Carrier Bearing
10
Properly Greased, No Leaks, All Mountings Tight, No Loose Components
11 Clutch No Smoke or Slipping, Observe a Function Test
12 Differentials Front and Rear No Leaks, All Mountings Tight, Nothing Loose
Servicing and Maintenance

1 Maintenance Schedule - PM and PdM Service Records Available
Others
1
2
3
Comments
Vehicle Accpeted
Inspected by: Checked by Acknowledged by CPI

Page 16 of 378
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RW CEM
C822444-COR-CEM-CKL-0001 Rev 1 (17 Nov 2014)

Page 17 of 378
INSPECTION REPORT
on, Minibus, Pick Up and Canopy
Model : Brand :
Service Date : Police No.
Location : Owner :
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/A
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N
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N
Page 18 of 378
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/A
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N
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Page 19 of 378
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/A
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Good = Good condition, able to be operated in all CPI areas

No Good = Broken, Malfunction, Repair or Replace
N/A = Not Applicable
dged by CPI The undersigned hereby accept and agree that this
equipment is "OK" and safe for operation. Menerima dan
Menyetujui bahwa Alat ini sudah "OK" dan aman untuk
dioperasikan.
Page 20 of 378
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Remarks
/A
The undersigned hereby accept and agree that this
N
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N
equipment is "OK" and safe for operation. Menerima dan
Menyetujui bahwa Alat ini sudah "OK" dan aman untuk
dioperasikan.
SIGNATURE, Date
Sub-
Sub-Con.
Con.
Contractor's Name
Page 21 of 378
VEHICLE - PRE-MOB INSPECTIO

Applies to Micro Bus and B
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10 Izin Penumpang - Traffic Police Document Expiry :
11 Riau BM Police Number Plate Front - Rear Expiry :

1 Back up Alarm Easy to Hear, 97 Decibles Minimum
Seat Belts for Driver, Operator, Passenger(s)
4
5 All Seats, Cushions Securely Mounted, Ergonomically Good Condition, Not Torn Open or Dilapidated
7 Service Brakes Front and Rear Properly Adjusted, No Air, Vacuum or Fluid Leaks, Test Function
8 Brake Pedal, Pin & Lock Pin Condition Good condition and preporly installed
9 Clutch Pedal, Pin & Lock Pin Condition Good condition and preporly installed
10 Acelerator Pedal, Bolt, Pin & Lock Pin Good condition and properly installed
Page 22 of 378

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11 Front and Rear Axle Hubs to Be Properly Lubricated and No Leaks, No MISSING COVERS / CAPS on
Grease Type Hubs
Power Steering System Check All Steering Linkages, No Loose Ball Joints, Lubricated Properly, Not Loose,
12
No Excess Freeplay, No Loose Mounting Bolts, Function Test
Bus and Microbus Tire and Wheel Condition No Broken-Missing Lug Nuts, Tread Depth Minimum 3mm, No
13 Recap / Retread / Vulcanized Tires, Correct Rotation, Front Tread Highway Pattern, Recommend Rear
Tread "All-Terrain" Pattern
14 Head Lights High-Low Beam Function Correctly
15 Interior Lights Adequate Illumination, Function Test
19
20
21
25 Bus Wheel Chocks Two Units, Properly Constructed
Fire Extinguisher Properly Mounted and Accessible. Current and Valid Inspection Tag.
26 Microbus Minimum 4kg,
Bus Minimum 8kg,

28
Page 23 of 378

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Body
Cabin and Interior

Dashboard Indicators Gauges For Fuel, Hours, Kms, Odometer, Temperature, Brake Air Pressure,
2
Alternator, Battery Voltmeter, Battery Charging System, etc, All Operating Properly.
3 Steering Wheel Not Loose, Controls Vehicle Properly, Function Test
6 Cabin Air Conditioner, Fan Function Test
Main Frame and Main Chassis

2 Sub Chassis, Sub Frame Good Condition, Straight, Not Bent, No Cracks, No Uncertified Welding Repairs
3 Front and Rear Bumper Bars Rounded Corners, No Sharp Edges, Not Loose, Properly Mounted
4 Springs, Front and Rear, Suspension System Straight, Not Bent, No Loose Pins or Bushings
5 Fuel Tank No Loose Mounts, Filler Cap, Properly Secured, No Leaks
General Hydraulics, Fluids, Fuel Lines, Hoses

2 All Hydraulic Power Steering Hoses and Hydraulic Lines Properly Secured, No Leaks
Power Steering Pump and Tank
3
No Loose Mount Bolts, No Loose Belt(s), No Leaks, No Excess Noise, Filler Cap Properly Secured
4 Fuel Tank No Loose Mounts, No Leaks, Proper Filler Cap
5 Air Tank(s) No Leaks, No loose Mounts
Page 24 of 378

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Battery, Battery Covers, Battery Mounting
3 Battery Terminals Clean, Optional Battery Disconnect Switch, Test Function, No Loose or Corroded Cables-
Terminals, Battery Hold-Downs in Place, Clean Battery Box, No Loose Mounts
Alternator
5
6 Cooling System Radiator, Water Pump and Hoses, No Leaks, No Perished Hoses
8 Exhaust System Check Pipe, Muffler, No leaks, Not Loose
9 Transmission PTO and Auxiliary Transmisson No Leaks, Observe a Function Test
Drive Shafts, Propeller Shafts, U-Joints, Center Carrier Bearing
10
Properly Greased, No Leaks, All Mountings Tight, No Loose Components

Others
1
2
3
Comments

Page 25 of 378

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RW CEM
C822444-COR-CEM-CKL-0002 Rev 2 (2 Jan. 2016)

Page 26 of 378
INSPECTION REPORT
ro Bus and Bus
Model : Brand :
Location : Owner :
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/A
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Page 27 of 378
INSPECTION REPORT
ro Bus and Bus
Model : Brand :
Location : Owner :
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/A
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N
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N
Page 28 of 378
INSPECTION REPORT
ro Bus and Bus
Model : Brand :
Location : Owner :
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/A
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N
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N
Page 29 of 378
INSPECTION REPORT
ro Bus and Bus
Model : Brand :
Location : Owner :
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/A
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N
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ed by CPI The undersigned hereby accept and agree that this equipment is
"OK" and safe for operation. Menerima dan Menyetujui bahwa Alat
ini sudah "OK" dan aman untuk dioperasikan.
Page 30 of 378
INSPECTION REPORT
ro Bus and Bus
Model : Brand :
Location : Owner :
The undersigned hereby accept and agree that this equipment is
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/A
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SIGNATURE, Date
Sub-
Sub-Con.
Con.
Contractor's Name
Page 31 of 378
FORKLIFT EQUIPMENT PRE-MOB INSPECTIO

Applies to Warehouse Industrial Fork Lift Truck u
and CAT 950 / CAT 980 Log Fork
Serial No. : Km/Hourmeter :

Service Date :
Inspected by : Date : Location :
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Original Manufacturer Name Plate with Serial

1 Year of Manufacture:
Number
3 Operator/Driver Government Driving Licence Expired :
4 Operator K3 Lisence from Depnaker Expired :
6 Company Operator/Driver Permit Expired :
7 STNK - Vehicle Document Expired :
8 KEUR - Inspection Book Expired :
9 K3/P3A2 - Depnaker Certification Expired :
10 MIGAS SILO for Forklift Expired :

1 Back up Alarm, Travel Alarm Easy to Hear, 97 Decibles Minimum
4 Windshield Wipers-Washer Wiper Blades Not Perished, Windshield Washer, Test Function
5
7 Seat Belts for Operator Good Condition, Properly, Mounted with OEM Hi Tensile Bolts
Seats, Cushions Securely Mounted, Ergonomically Good Condition, Not Torn Open
8
or Dilapidated
Rear Power Steering System Industrial Fork Lift Truck Smooth and Controlled, No Loose Worn
9
Out Ball Joints, Lubricated Properly, No Excess Freeplay, No Loose Mounting Bolts
Page 32 of 378


Service Date :
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Articulated Steering System Log Forklift Smooth and Controlled No Loose Worn Out Ball Joints,
10
Lubricated Properly, No Excess Freeplay, No Worn Out Pins, No Loose Mounting Bolts
11 Parking Brake System Function Test
12 Service Brake System Properly Adjusted, No Air or Fluid Leaks, Function Test
13 Head Lights-Working Lights-Flood Lights Adequate Illumination, Function Test
16 Electrical Wiring Condition Fuse Block, All Splices Insulated, No Bare Wires
17 Centrally Mounted Rear View Mirror Not Loose, Clear Unobstructed Vision, Functions Properly
Side mounted Left / Right Rear View Mirrors Not Loose, Clear Unobstructed Vision, Functions
18
Properly,
19 Safety Red Cone Two Units In Good Condition, Reflective So As Visible at Night
20 Warehouse Industrial Fork Lift Truck Wheel Chocks Two Units, Properly Constructed
Fire Extinguisher
21
Minimum 4kg, Properly Mounted and Accessible. Current and Valid Inspection Tag.
Safety Guards and Covers All In Place, Not Loose, None Missing, Not Modified, Remain within
23
OEM Specs
24 Oil-Hubs to Be Properly Filled and No Leaks, No MISSING COVERS / CAPS on Grease Type
Hubs
Tire and Wheel Condition Warehouse Fork Lift Truck No Broken-Missing Lug Nuts Front and
Rear, Tread Depth Minimum 3mm or Check Manufacture Wear Indicator, Recap / Retread/
25
Vulcanized Tires Permitted, All-Terrain Pattern on Rear Steer Axle, All-Terrain Pattern on Front
Drive Axle, Correct Rotation
Tire and Wheel Condition CAT 950 / 980 Log Fork No Broken-Missing Lug Nuts Front and Rear,
26 Tread Depth Minimum 3mm or Check Manufacture Wear Indicator, No Recaps / Retreads /
Vulcanized Permitted, Correct Rotation, Tread Mud-Grip Pattern
ROPS Meets OSHA Structural Standards, Minimum Two (2) but Better With Four (4) Full One-
27
Piece Steel Beams Over the Operator, Mandatory Steel Roof, No Fiberglass Roof
Page 33 of 378


Service Date :
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Body
Cabin and Interior

1 Cabin Interior Good Condition, Clean, No Rubbish, Good Housekeeping
Dashboard Indicators, Engine EMS (Electronic Monitoring System)
2 Gauges for Fuel, Hours, Kms, Odometer, Temperature, Brake Air Pressure, Hyd Pressure,
Alternator, Battery Voltmeter, Battery Charging System, etc, All Operating Properly
5 Door and Door Locks, Door Handles, Left - Right, Outside and Inner Function Test
6 Cabin Air Conditioner or Fan Test Function
7 Control Linkages and Levers Test Function
Main Frame and Main Carrier Chassis

Main Chassis Good Frame Condition, Straight, Not Bent, No Cracks, No Uncertified Welding
1
Repairs
Sub Chassis - Sub Frame Good Condition, Straight, Not Bent, No Cracks, No Uncertified
2
Welding Repairs
3 Front and Rear Axle Mounts Straight, Not Bent, No Loose Bolts or Brackets
Forks, Mast, Fork Carriage Frame, Tines

1 Forks-Tines Not Too Thin or Worn Out, Not Bent, No Signs of Fatigue Cracks
Forklift Mast-Carriage, Lifting Chains, Tines No Excessively Loose or Worn Pins or Slides, No
2 Badly Worn Lift Chains, Alternately Raise and Lower Forks, Look for Any Fatigue Cracks, Any
improper Bending,Twisting, or Jamming
Tilt Linkages for Forklift Mast-Carriage Frame Any Excessively Worn Pins/Bushings, All Pins
3
Properly Secured ith Split Cotter Pins and/or Bolted End Plates
Hydraulic Tilt-Cylinders Lift-Cylinders Any Leaks or Excessively Worn Pins/Bushings, All Pins
4
Properly Secured with Split Cotter Pins and/or Bolted End Plates
5 CAT 950 / 980 Wheel Log Fork "Self-Leveling" System is Functioning
Page 34 of 378


Service Date :
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Hydraulics, General Hydraulics, Fluids, Fuel, Hoses
2 All Hydraulic Hoses and Hydraulic Lines Properly Secured, No Leaks
3 Hydraulic Tanks Mounts, Leaks, and Filler Cap Properly Secured, No Leaks
4 Fuel Tank Mounts, Leaks, and Filler Cap No Leaks, No loose Mounts
6 Pilot Valves and Hydraulic Cylinders No Leaks
7 Hydraulic Pumps and Motors No Leaks, No Excess Noise
8 All Controls and Hydraulic Control Valves No Leaks, Test Function

Battery, Battery Covers, Battery Mounting, Battery Terminals Optional Battery Disconnect
3 Switch, Test Function, No Loose or Corroded Cables-Terminals, Battery Hold-Downs in Place,
Clean Battery Box, No Loose Mounts
Alternator
5
6 Cooling System Inspect Radiator and Hoses, No Leaks, No Perished Hoses

8 Exhaust System Inspect Pipe and Muffler, No leaks, Not Loose
9 Transmission No Leaks, Observe a Function Test
Page 35 of 378


Service Date :
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PTO and Transmisson, Drive Shafts, Propeller Shafts, U-Joints, Center Carrier Bearing
12
Properly Greased, No Leaks, All Mountings Tight, Nothing Loose

Others
1
2
3
Comments
RW CEM

Page 36 of 378
RE-MOB INSPECTION REPORT

trial Fork Lift Truck up to 10 ton
/ CAT 980 Log Fork
Model : Brand :
Service Date :
Location : Owner :
Remarks
/A
N
Dipindahkan keatas mungkin lebih baik ?
Pindah kebawah
Pindah ke atas
Page 37 of 378

/ CAT 980 Log Fork
Model : Brand :
Service Date :
Location : Owner :
Remarks
/A
N
Page 38 of 378

/ CAT 980 Log Fork
Model : Brand :
Service Date :
Location : Owner :
Remarks
/A
N
Page 39 of 378

/ CAT 980 Log Fork
Model : Brand :
Service Date :
Location : Owner :
Remarks
/A
N
Page 40 of 378

/ CAT 980 Log Fork
Model : Brand :
Service Date :
Location : Owner :
Remarks
/A
N
Good = Good condition, able to be operated in all CPI

areas
nowledged by CPI The undersigned hereby accept and agree that this
equipment is "OK" and safe for operation. Menerima
dan Menyetujui bahwa Alat ini sudah "OK" dan aman
untuk dioperasikan.
SIGNATURE, Date
Sub-
Sub-Con.
Con.
Contractor's
Name
Page 41 of 378
EARTH MOVING, EQUIPMENT PRE-MOB INSPECTI
Applies to Bulldozer, Track Loader, Trenche
Equip No : Type : Model :
Serial No : Km/Hourmeter : Service Date :
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Number

1 Back-Up Alarm Easy to Hear, 97 Decibles Minimum
4 Windshield Wipers and Washer Wiper Blades Not Perished, Function Test
5
6 Door and Door Locks, Door Handles, Left - Right, Outside and Inner Test Function
7 Seat Belts for Driver, Operator Good Condition, Properly Mounted with OEM Hi Tensile Bolts
8 Track Unit Maneuvering and Steering Systems Smooth and Controlled
9 Travel Service Brake System Properly Adjusted, No Leaks, Function Test
10 Parking Brake System Properly Adjusted, Function Test
Crawler Track Links / Track Shoes
11
No Excessively Loose or Worn Pins or Segments, No Badly Worn Drive Teeth
Crawler Track Rollers, Upper Carrier Rollers
12
No Excess Misalignment, No Leaks, No Flat Spots, No Badly Worn or Loose Bushings
Page 42 of 378
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13 Crawler Idlers No Excess Misalignment, No Leaks, No Flat Spots, Loose Bushings
14 Crawler Track Sprockets No Excess Misalignment, No Excessively Worn Teeth
15 Crawler Hydraulic Drive Motors No Leaks, No Loose Mounting Bolts
16 Belly Guards Good Condition Straight, Not Bent, No Cracks, No Uncertified Welding Repairs
17 Rear Drawbar All Rounded Corners, No Sharp Edges, Not Loose, Properly Mounted
Internal Centrally Mounted Rear View Mirror(s)
22
Side mounted Left and Right Mounted Rear View Mirrors
23
Not Loose, Clear Unobstructed Vision, Functions Properly,
Fire Extinguisher
24
Minimum 4kg, Current and Valid Inspection Tag, Properly Mounted and Accessible.
26 Dozer Winch If Equipped with Winch Must Have Rear Safety Guard Screen Behind Operator
27
ROPS Meets OSHA Structural Standards, Minimum Two (2) but Recommend Four (4) Full One-
28
29 Final Drive Lubrication Properly Filled and No Leaks, No MISSING COVERS / CAPS
Body
1 Body Good Condition, Good Paint and General Appearance, No Excess Damage, No Rust
Cabin and Interior

Page 43 of 378
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3 Track Unit Unit Steering System Controls Levers and Switches Test Function
4 All Switches and Knobs on Dashboard Test Function
6
or Dilapidated
8 Cabin Tilt and Safey Lockout System Test Function
Main Frame
Main Frame
1
Good Condition, Straight, Not Bent, No Cracks, No Uncertified Welding Repairs
Blade, Bucket, Digging Chain

Blade Cutting Edges-End Bits, Digging Chain Teeth-Side Cutters
1
Not Worn Out, Tight, No Loose Bolts
Hydraulic Cylinders No Leaks or Excessively Worn Pins/Bushings, All Pins Properly
2
Secured with Split Cotter Pins and/or Bolted End Plates
Blade Linkages No Excessively Worn Pins/Bushings, All Pins Properly Secured with Split Cotter
3
Pins and/or Bolted End Plates
Trencher Digging Chain and Digging Chain Teeth
4
No Excessively Loose or Worn Out Links, Pins, or Cutters
Lock Pins, Pins and Bushings in Dozer Arm, Linkages for All Implements
5
All Pins Properly Secured with Split Cotter Pins and/or Bolted End Plates
Blade, Bucket, Digging Chain Frame Alternately Raise, Lower and Extend, Look for Any Fatigue
6
Cracks, Any improper Bending,Twisting
Page 44 of 378
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Dozer Winch, Hook and Winch Cable Condition
7
Mechanically Spliced Cable, Cable Not Deformed or Bent, No Excess Broken Wire Strands
8 Track Loader Bucket "Self-Leveling" System is Functioning

7 All Hydraulic Controls and Hydraulic Control Valves No Leaks, Test Function
Engine(s) - Transmission(s)
1 Main Engine Clean Appearance, No Defective Mounts, No Leaks, Observe Performance
Alternator Observe Charging Function, No Bad Noises or Overheating, No Loose Mounts,
5
No Loose Belts
8 Exhaust System Check Pipes and Muffler, No leaks, Not Loose
Page 45 of 378
d
oo
d
oo
G
G
o
N
11 Bevel Gear Case No Leaks, All Mountings Tight, Nothing Loose
12

Others
1
2
3
Comments
RW CEM

Page 46 of 378
d
oo
d
oo
G
G
o
N
Page 47 of 378
T PRE-MOB INSPECTION REPORT
, Track Loader, Trencher
Model : Brand :
Service Date :
Location : Owner :
Remarks
/A
N
Page 48 of 378
Model : Brand :
Service Date :
Location : Owner :
Remarks
/A
N
Page 49 of 378
Model : Brand :
Service Date :
Location : Owner :
Remarks
/A
N
Page 50 of 378
Model : Brand :
Service Date :
Location : Owner :
Remarks
/A
N
Page 51 of 378
Model : Brand :
Service Date :
Location : Owner :
Remarks
/A
N
Sub-Con.
Good = Good condition, able to be operated in

all CPI areas
No Good = Broken, Malfunction, Repair or
Replace
Acknowledged by CPI The undersigned hereby accept and agree

that this equipment is "OK" and safe for
operation. Menerima dan Menyetujui bahwa
Alat ini sudah "OK" dan aman untuk
dioperasikan.
SIGNATURE, Date
Sub-
Sub-Con.
Con.
Contractor's
Name
Page 52 of 378
Model : Brand :
Service Date :
Location : Owner :
Remarks
/A
N
Page 53 of 378

Applies to Compactor
Smooth Drum Vibratory, Pad Foot Vibratory, CAT Sh
d
oo
d
oo
G
G
o
N

5
8 Wheeled Unit Steering Systems Smooth and Controlled, No Worn Out Loose Ball Joints
9 Articulated Unit Steering Systems Smooth and Controlled, No Worn Pins Bushings
10 Articulate Steering LOCK-OUT SAFETY BAR Easy Access, No Lost Pins
Service Brake System, Front and Rear
11
Properly Adjusted, No Air Leaks, Function Test
12 Parking Brake System Properly Adjusted, Test Function
Page 54 of 378

d
oo
d
oo
G
G
o
N
17
18
Fire Extinguisher
19
Access Ladder Steps Handrails Securely Mounted, Ergonomic Design, Good Condition, Not
21
Cracked, Not Bent, Not Dilapidated, No Sharp Edges, No Sharp Corners
22
ROPS OEM Structural Standards, Minimum Two (2) but Recommend Four (4) Full One-Piece
23
Steel Beams Over the Operator, Mandatory Steel Roof, No Fiberglass Roof
Hubs
Tires S/D and P/F Unit Rear Tire and Wheel Condition No Broken-Missing Lug Nuts, Tread
25 Depth Minimum 3mm or Check Manufacture Wear Indicator, No Recaps / Retreads / Vulcanized
Permitted, Correct Rotation, All-Terrain Mud Grip Tread Pattern
Sheepfoot Wheel Condition
26
No Broken-Missing Lug Nuts, No Broken - Missing Pads, No Cracks
Vibratory System on Drum - S/D and P/F Unit No Broken Nuts / Bolts on Hydraulic Motor, No
27
Leaking Hoses, All Hoses Scure with Clamps, Adequate Power from Vibration System.
Smooth Drum
28
Condition is Smooth, Proper Thickness, No Broken-Missing Bolts / Nuts, No Cracks
Padfoot Drum
29
Condition is Good, No Broken or Missing Pads, Adequate Pad Thickness, No Cracks
30 Wheel Chocks Two Units, Properly Constructed
Driver Monitoring System Refer to CPI Contract, Perform Function Test

33
Body
Page 55 of 378

d
oo
d
oo
G
G
o
N
2 Front-Rear Bumper Bar All Rounded Corners, No Sharp Edges, Not Loose, Properly Mounted
Cabin and Interior

3 Wheel Unit Steering Wheel, Steering Column Controls Levers and Switches Test Function
4 S/D and P/F Unit Unit Steering System Controls Levers and Switches Test Function
Seats, Cushions
7
Securely Mounted, Ergonomically Good Condition, Not Torn Open or Dilapidated
Main Frame / Main Chassis / Articulated Steering

Main Chassis Good Frame Condition, Straight, Not Bent, No Cracks, No Uncertified
1
Welding Repairs
Drum and Wheel Mounts Front / Rear
2
Straight Not Bent, No Loose Pins / Bolts / Nuts
Articulated Bearing (Swivel) Condition
3
Properly Lubricated, Not Loose, No Loose Mounting Bolts
Articulated Steering Linkages No Loose Ball Joints, Lubricated Properly, No Loose Pins, Not
4
Worn Out, No Loose Mounting Bolts
5 Rear Bumper Bar No Cracks, Not Loose, Properly Mounted
Lock Pins, Pins and Bushings in Steering Linkages
6 All Pins Properly Secured with Split Cotter Pins and/or Bolted End Plates
Blade, Hydraulic Cylinders

1 Dozer Blade Cutting Edge - End Bits Not Worn Out, Tight, No Loose Bolts
Blade Linkages and All Implements No Excessively Worn Pins/Bushings, All Pins Properly
2
Page 56 of 378

d
oo
d
oo
G
G
o
N
3

5
No Loose Belts
11 S/D and P/F Rear Differential / Reduction Gear No Leaks, All Mountings Tight, Nothing Loose
12 Sheepfoot Differentials Front and Rear No Leaks, All Mountings Tight, Nothing Loose
Page 57 of 378

d
oo
d
oo
G
G
o
N
S/D and P/F Hydrostatic Drive, Transmisson, PTO, Drive Shafts, U-Joints, Center Bearing
13

Others
1
2
3
Comments
RW CEM

Page 58 of 378

o Compactor
d Foot Vibratory, CAT Sheepfoot
Model : Brand :
Service Date :
Location : Owner :
Remarks
/A
N

Page 59 of 378

o Compactor
Model : Brand :
Service Date :
Location : Owner :
Remarks
/A
N
Page 60 of 378

o Compactor
Model : Brand :
Service Date :
Location : Owner :
Remarks
/A
N
Page 61 of 378

o Compactor
Model : Brand :
Service Date :
Location : Owner :
Remarks
/A
N
Page 62 of 378

o Compactor
Model : Brand :
Service Date :
Location : Owner :
Remarks
/A
N
Sub-Con.

all CPI areas
Replace

dioperasikan.
SIGNATURE, Date
Sub-
Sub-Con.
Con.
Contractor's
Name
Page 63 of 378
Applies to Mobile Excavator, Gradall and Badg
d
oo
d
oo
G
G
o
N

Number
8 STNK - Vehicle Document Expired :
10 Nota Pajak - Tax Expired :
11 Kartu Kendali - Traffic Police Document Expired :
12 Police Number Plate - Front and Rear Expired :

2 Swing Alarm Easy to Hear
6
9 Main Steering System Smooth and Controlled, No Worn Out Loose Ball Joints
10 Remote Steering Systems Smooth and Controlled, No Worn Pins Bushings
Page 64 of 378
d
oo
d
oo
G
G
o
N
11 Service Brake System, Front and Rear Properly Adjusted, No Air Leaks, Function Test
12 Parking Brake System Properly Adjusted, Test Function
16 Automatic Hydraulic Swing Brake Witness a Function Test
17 Swing Lock Witness a Function Test
18 Hydraulic Total System Safety Lock Out Witness a Function Test
21 Amber Rotary Light Adequate Illumination, Function Test
24
25
26 Wheels Wheel Chocks, Two Units, Properly Constructed
Fire Extinguisher
28
30
31
32
33
Oil-Hubs to Be Properly Filled and No Leaks, No Missing Covers, Caps on Grease Type Hubs
Tire and Wheel Condition No Broken-Missing Lug Nuts, Tread Depth Minimum 3mm, No
34
Recap / Retread / Vulcanized Tires, All-Terrain Tread Mud-Grip Pattern, Correct Rotation
Body
2 Spare Wheel / Tire Assy If Available Must Be in Good Condition and Properly Mounted
3 Mud Flaps Properly Mounted, Not a Falling Hazard to Following Motorists
Page 65 of 378
d
oo
d
oo
G
G
o
N
Cabin and Interior
3 Steering Wheel, Steering Column Controls Levers and Switches Test Function
6
or Dilapidated
Carrier Main Frame, Main Chassis,

1
Welding Repairs
Sub Chassis, Sub Frame Good Condition Straight, Not Bent, No Cracks, No Uncertified Welding
2
Repairs
Carrier Springs, Suspension System, Front / Rear
3
Straight Not Bent, No Loose Shackle Pins
Swing Bearing (Swivel) Condition
4
Steering Box, Steering Linkages No Loose Ball Joints, Lubricated Properly, No Loose Pins, Not
5
Carrier Remote Control Steering System
6
No Loose Mountings, No Leaks, Test Function
Bucket - Telescopic Boom - Bucket Digging Linkages

Bucket Cutting Edges-End Bits, Bucket-Teeth-Side Cutters
1
2
Bucket and Blade Linkages No Excessively Worn Pins/Bushings, All Pins Properly Secured with
3
Split Cotter Pins and/or Bolted End Plates
Lock Pins, Pins and Bushings in Stick, Boom, Arm, Linkages for All Implements
4
Telescopic Boom Alternately Raise, Lower / Extend Boom Sections and Rotate, Any Fatigue
5 Cracks, Any Improper Bending,Twisting, Kinking, Excess Wear to Internal Slide Rollers and
Rotation Motor / Gears

Page 66 of 378
d
oo
d
oo
G
G
o
N
Upper Engine Clean Appearance, No Defective Mounts, No Leaks,
1
Observe Performance
3 Lower Main Engine Clean Appearance, No Defective Mounts, No Leaks, Observe Performance

7
No Loose Belts
14

Others
1
2
3
Comments
Page 67 of 378
d
oo
d
oo
G
G
o
N
RW CEM

Page 68 of 378
avator, Gradall and Badger
Model : Brand :
Service Date : BM Plate No. :
Location : Owner :
Remarks
/A
N
Page 69 of 378
Remarks
/A
N
Page 70 of 378
Remarks
/A
N
Page 71 of 378
Remarks
/A
N
Sub-Con.

all CPI areas
Page 72 of 378
Remarks
/A
N
Replace

dioperasikan.
SIGNATURE, Date
Sub-
Sub-Con.
Con.
Contractor's
Name
Page 73 of 378
Applies to Excavator Track/Amphibious
d
oo
d
oo
G
G
o
N

Number

1 Travel Alarm Operates Both Ways, Easy to Hear, 97 Decibles Minimum
3 Swing Lights Flashing Okay, Easy to See
4 Horn Easily Operated From Inside Operator's Cabin, Easy to Hear
6
9 Maneuvering and Steering Systems Smooth and Controlled
10 Travel Service Brake System Properly Adjusted, No Leaks, Function Test
12 Automatic Hydraulic Swing Brake Witness a Function Test
13 Swing Lock Witness a Function Test
Page 74 of 378
d
oo
d
oo
G
G
o
N
Crawler Hydraulic Drive Motors Lubrication Reduction Gear to Be Properly Filled and No Leaks,
15
No Mising Covers / Caps, or Grease Fittings, No Excess Noise
Crawler Track Links / Track Cleats
16
No Excessively Loose or Worn Pins or chain link and pads.
Pontoons
17
No Leak, No damage/defect and no weld cracks
18
19
22 Crawler Track Drive Chain Well Lubricated, No Broken or Stretched Links
26
27
Fire Extinguisher
28
29
31
32
Body
Cabin and Interior

3 Steering Controls Levers and Switches Test Function
Page 75 of 378
d
oo
d
oo
G
G
o
N
6
or Dilapidated
Main Frame, Main Chassis

1
Welding Repairs
Swing Bearing (Swivel) Condition
2
Bucket - Boom - Stick - Digging Arm

1
2
Bucket and Boom Linkages No Excessively Worn Pins/Bushings, All Pins Properly Secured with
3
Split Cotter Pins and/or Bolted End Plates
4
Excavator Boom, Digging Stick Alternately Raise, Lower and Extend All Boom Sections, Look for
5
Any Fatigue Cracks, Any improper Bending,Twisting, or Kinking,

Page 76 of 378
d
oo
d
oo
G
G
o
N
5
No Loose Belts

Others
1
2
3
Comments
RW CEM
C822444-COR-CEM-CKL-0008 Rev 3 (2 Jan 2016)

Page 77 of 378
ator Track/Amphibious
Model : Brand :
Service Date :
Location : Owner :
Remarks
/A
N
Page 78 of 378
Remarks
/A
N
If equipped
Page 79 of 378
Remarks
/A
N
Page 80 of 378
Remarks
/A
N
Sub-Con.

all CPI areas

Replace

dioperasikan.
SIGNATURE, Date
Sub-
Sub-Con.
Con.
Contractor's
Name
Page 81 of 378
EARTH MOVING, EQUIPMENT PRE-MOB INSPECTION
Applies to Motor Grader
d
oo
d
/A
oo
N
G
o
N

Number

5
8 Articulated Unit System Smooth and Controlled, No Worn Pins Bushings
9 Articulated Unit LOCK-OUT SAFETY BAR Easy Access, No Lost Pins
10 Service Brake System Properly Adjusted, No Leaks, Function Test
12 Steering System Smooth and Controlled, No Worn Out Pins, No Loose Ball Joints
Page 82 of 378
d
oo
/A
oo
N
G
o
N
13 Wheel Lean System Properly Adjusted, No Leaks, Test Function
19
20
22
Fire Extinguisher
23
25
26
Front Axle Wheel Bearing Lubrication
Hubs
Tires and Wheel Condition No Broken-Missing Lug Nuts Front and Rear, Tread Depth Minimum
28 3mm or Check Manufacture Wear Indicator, No Recaps / Retreads / Vulcanized Permitted,
Correct Rotation, Tread Mud-Grip Pattern
Body
Cabin and Interior

Page 83 of 378
d
oo
/A
oo
N
G
o
N
Seats, Cushions
6
Main Chassis, Main Implement Frame, Tandem Final Drives

Main Chassis Good
1
Frame Condition, Straight, Not Bent, No Cracks, No Uncertified Welding Repairs
Implement Frame
2
Good Condition Straight, Not Bent, No Cracks, No Uncertified Welding Repairs
3 Tandem Final Drives No Excess Misalignment, No Leaks, No Cracks, Loose Bushings
4 Tandem Final Drive Chains No Excess Wear on Excess Noise
5 Circle Hydraulic Drive Motors No Leaks, No Loose Mounting Bolts, Function Test
6
Articulate Control and System
7
No Loose Mountings, No Leaks, Test Function
Blade -Scarifier - Ripper

1 Cutting Edges, End Bits, Scarifier and Ripper Teeth Not Worn Out, Tight, No Loose Mounts
2
Scarifier and Ripper Linkages No Excessively Worn Pins/Bushings, All Pins Properly Secured
3
with Split Cotter Pins, Adequate Lubrication
Blade Scarifier and Ripper Alternately Raise, Lower and Extend Blade Verticaly, Look for Any
4
Fatigue Cracks, Any improper Bending,Twisting, or Kinking, Adequate Lubrication
Lock Pins, Pins and Bushings in All Implements
5
All Pins Properly Secured with Split Cotter Pins, No Excess Wear, Adequate Lubrication
Blade Side Shift Wear Strips in Good Condition, Not Excessively Worn or Loose, Side Shift
6
Actuator Hydraulic Cylinder No Leaks, Function Test Side Shift System

Page 84 of 378
d
oo
/A
oo
N
G
o
N
5
No Loose Belts
10 Differential Rear No Leaks, All Mountings Tight, Nothing Loose
11

Others
1
2
3
Comments

Page 85 of 378
d
oo
/A
oo
N
G
o
N
RW CEM

Page 86 of 378
PRE-MOB INSPECTION REPORT
Motor Grader
Model : Brand :
Service Date :
Location : Owner :
Remarks
Page 87 of 378
Remarks
Page 88 of 378
Remarks
Page 89 of 378
Remarks
Sub-Con.

all CPI areas
Replace
The undersigned hereby accept and agree

Page 90 of 378

Remarks
dioperasikan.
SIGNATURE, Date
Sub-
Sub-Con.
Con.
Contractor's
Name
Page 91 of 378
Applies to Wheel Loader, Backhoe
Equip No : Model :
d
oo
d
oo
G
G
o
N

Number

5
8 Backhoe Steering System Smooth and Controlled
9 Wheel loader Articulated Steering System Smooth and Controlled, No Worn Pins Bushings
10 Wheel loader Articulate Steering LOCK-OUT SAFETY BAR Easy Access, No Lost Pins
Page 92 of 378
d
oo
d
oo
G
G
o
N
19
20
21
Fire Extinguisher
22
24
25
Backhoe Front Axle Wheel Bearing Lubrication
26
Oil-Hubs to Be Properly Filled and No Leaks, No Missing Covers / Caps on Grease Type Hubs
Tire and Wheel Condition No Broken-Missing Lug Nuts Front and Rear, Tread Depth Minimum
Correct Rotation, All-Terrain Tread Mud-Grip Pattern
Body
2 Backhoe Mud Flaps Properly Mounted, Not a Falling Hazard to Following Motorists
Cabin and Interior

6
or Dilapidated
Main Frame, Main Chassis, Backhoe Side Shift Frame

Page 93 of 378
d
oo
d
oo
G
G
o
N
1
Welding Repairs
Backhoe Side Shift System Frame Good Condition Straight, Not Bent, No Cracks, Hydraulic
2
Lock System Function Test, No Uncertified Welding Repairs
Wheel Loader Articulate Center Bearing
3
No Excessively Loose or Worn Pins or Bushings, Adequate Lubrication
Axle Mounts, Axle Pivot System, Front / Rear
4
Straight Not Bent, No Loose Pins / Bushings, Adequate Lubrication
Backhoe Swing Bearing (Swivel) Condition
5
Properly Lubricated, Not Loose, No Loose Mounting Bolts, Adequate Lubrication
Backhoe Steering Box, Steering Linkages, No Loose Ball Joints, Lubricated Properly, No Loose
6
Pins, Not Worn Out, No Loose Mounting Bolts
Wheel Loader Articulated Steering System
7
No Loose Ball Joints, Lubricated Properly, No Loose Mountings, No Leaks, Test Function
Bucket - Boom - Stick - Digging Arm

1
Hydraulic Lift Cylinders No Leaks or Excessively Worn Pins/Bushings, All Pins Properly
2
Bucket Linkages No Excessively Worn Pins/Bushings, All Pins Properly Secured with Split Cotter
3
Pins and/or Bolted End Plates, Adequate Lubrication
Backhoe Boom and Outrigger Linkages No Excessively Worn Pins/Bushings, All Pins Properly
4
Secured with Split Cotter Pins and/or Bolted End Plates, Adequate Lubrication
5
Backhoe Digging Stick Alternately Raise, Lower and Extend All Boom Sections, Look for Any
6
Fatigue Cracks, Any improper Bending,Twisting, Kinking, Adequate Lubrication
7 Front End Loader Bucket "Self-Leveling" System is Functioning

Page 94 of 378
d
oo
d
oo
G
G
o
N
5
No Loose Belts
12

Others
1
2
3
Comments
RW CEM

Page 95 of 378
el Loader, Backhoe
Model : Brand :
Service Date :
Location : Owner :
Remarks
/A
N
Page 96 of 378
Remarks
/A
N
Page 97 of 378
Remarks
/A
N
Page 98 of 378
Remarks
/A
N
Sub-Con.

all CPI areas
Replace

dioperasikan.
SIGNATURE, Date
Sub-
Sub-Con.
Con.
Contractor's
Name
Page 99 of 378
Applies to Soil Stabilizer
d
oo
d
oo
G
G
o
N

Number

2 Travel Alarm Operates Both Ways, Easy to Hear, 97 Decibles Minimum
6
9 Steering System Smooth and Controlled, No Worn Out Loose Ball Joints
10 Service Air Brake System, Front and Rear Properly Adjusted, No Air Leaks, Function Test
11 Mechanical Parking Brake System Properly Adjusted, Test Function

12 Automatic Hydraulically Activated Parking Brake System Properly Adjusted, Test Function
13 Hydraulic Total System Lock Out Witness a Function Test
Page 100 of 378
d
oo
d
oo
G
G
o
N
18
19
Fire Extinguisher
22
24
25
26
27
Tire and Wheel Condition No Broken-Missing Lug Nuts, Tread Depth Minimum 3mm,
28 No Recap / Retread / Vulcanized Tire, All-Terrain Pattern on Rear, Correct Rotation, Highway
Tread Pattern on Front
Driver Monitoring System Refer to CPI Contract, Perform Function Test

29
Body
3 Front Bumper Bar All Rounded Corners, No Sharp Edges, Not Loose, Properly Mounted
Cabin and Interior

6
or Dilapidated
Main Chassis, Main Frame

Page 101 of 378
d
oo
d
oo
G
G
o
N
Main Chassis and Frame Components Good Condition, Straight, Not Bent, No Cracks, No
1
Uncertified Welding Repairs
2 Springs, Front Suspension System Straight Not Bent, No Loose Shackle Pins
3
Rotor - Rotor Housing

Rotor Teeth Cutters
1
Not Worn Out, Tight, No Loose Mount Bolts
2
Rotor Housing Lifting Arms Linkages No Excessively Worn Pins/Bushings, All Pins Properly
3

7 Rotor Hydraulic Pumps and Motors No Leaks, No Excess Noise
5
No Loose Belts
9 Hydrostatic Transmission No Leaks, Observe a Function Test
10 Master Clutch No Smoke or Slipping, Observe a Function Test
11 Rear Differential No Leaks, All Mountings Tight, Nothing Loose
Page 102 of 378
d
oo
d
oo
G
G
o
N
Hydrostatic Transmisson, PTO, Drive Shafts, Propeller Shafts, U-Joints, Carrier Bearing Properly
12
Greased, No Leaks, All Mountings Tight, Nothing Loose

Others
1
2
3
Comments
RW CEM

Page 103 of 378
Soil Stabilizer
Model : Brand :
Service Date :
Location : Owner :
Remarks
/A
N
Page 104 of 378
Remarks
/A
N
Page 105 of 378
Remarks
/A
N
Page 106 of 378
Remarks
/A
N
Sub-Con.

all CPI areas

Replace

dioperasikan.
SIGNATURE, Date
Sub-
Sub-Con.
Con.
Contractor's
Name
Page : 107 of 378
TELESCOPIC BOOM PRE-MOB INSPECTION RE
Applies to Mobile Crane Telescopic Boom
Serial No. : Km/Hourmeter : Service Date :

d
oo
d
/A
oo
N
G
o
N
Documentation Operator and Equipment :

7 Operator SIO from Migas/Depnaker Expiry :
12 Offcial Police Letter for Non BM Plate Expiry :
13 Police Number Plate Front - Rear Expiry :
Correct Size, Minimum 15 Cm Height,
14 Company ID Number, Company Logo Visible
15 MIGAS SILO Certificate Matches Unit Type -Series Expiry :

3 Horn Controlled, Easily Operated From Inside Operator's Cabin, Easy to Hear
Special for Foco - Horn for Operator When Outside of Cabin
4
Easily Operated from Button next to Crane Controls
5 Original Factory Load Chart Visible, Affixed to Cabin Wall, in English or Bahasa
6 Boom Angle Indicator Affixed to Boom and Functioning Properly
7 Sight Level Bubble Indicator and Functioning Properly
Boom Hoist Automatic Limit Switch
8
Witness a Function Test, Must Shut Off Boom Hoist Control at Maximum 78
Page : 108 of 378
d
oo
d
/A
oo
N
G
o
N
Boom Backstop System
9
Witness a Function Test, Must Shut Off Boom Hoist Controlt
10 Safety Pawls for Hoist Drums Function Test, Easily Engaged / Disengaged by Operator
11 Anti Two Block Alarm Test its Function
Operator's Electronic Operational Aids Lifting Units Must be Equipped With this Function.
If a Load Rate Indicator, Rated Capacity Indicator, Must Witness a Function Test.
12 If an Automatic Moment Limiter or Rated Capacity Load Limiter or Load Moment Limiter,
Must Witness a Function Test, Must Shut Off Boom Hoist at Maximum 78,
Must Shut Off Boom-Down Overload and Hoist-Up Overload.
13 Safety Device Emergency Switch as per OEM Check and Function Test
14 Positive-Free-Fall Lockout System Witness a Function Test

Hook Block Sheaves, Pins, Bushings
15
Good Condition, Adequate Lubrication, Sheaves No Flat Spots
Boom Point Sheaves, Pins, Bushings
16
Gantry No Fatigue Cracks

Gantry Sheaves, Pins, Bushings
17
Good Condition, Adequate Lubrication,
Sheaves No Flat Spots
18 Safety Latch in Hook Block and Headache Ball Not Bent, Positive Closing Action
Both Hooks Swivel Bearing Assys Good Condition, Not Loose, Properly Lubricated,
Both Hooks Main Nut Above Swivel Bearing
19
Not Loose, Locked in Place By Proper and Safe SPLIT Cotter Pin
Can NOT become Undone
20 Main and Auxiliary Hoist Cable Condition No Excess of Broken Wire Strands
Telescopic Boom
21 Fully Extend All Telescopic Boom Section and Boom Down, Look for Fatigue Cracks, Excessive
Bending, Excessive Twisting, Exessive Kinking, Excess Wear on Sliding Surfaces
Folding Jib Look for Cracks, Bent Chords, Bent Lacings.

Maximum Bend Main Chord 1mm per 1meter.
22 Maximum Bend Lacing 3mm per 1meter.
Maximum Depth of Corrosion Pitting 0.8mm.
Maximum Depth of Dent, Score, Scratch 1mm.
23 Boom Mount Connecting PINS All Must Be Secured by Proper and Safe SPLIT Cotter Pins
24 Hoisting and Lowering Brakes Function Test, All Brake Actions Smooth and Controlled
25 Carrier Power Steering Systems Function Test, Smooth and Controlled, Easy Maneuvering
Carrier Steering Box, Steering Linkages No Excess Freeplay, No Loose Ball Joints, Lubricated
26
Properly, No Worn Out Pins, No Loose Mounting Bolts, Function Test
Rough Terrain Carrier Steering Systems Smooth and Controlled, No Excess Freeplay,
27 Function Test Rear Steering Lock Out, No Loose Ball Joints, Lubricated Properly,
No Worn Out Pins, No Loose Mounting Bolts
Carrier Axle Wheel Bearing Lubrication
Hubs
Page : 109 of 378
d
oo
d
/A
oo
N
G
o
N
TIRES Carrier Tire and Wheel Condition No Broken-Missing Lug Nuts,Tread Depth Minimum
29 3mm, No Recap / Retread / Vulcanized Tires, Correct Rotation,Tread Mud-Grip Pattern on Rear,
Tread Highway Pattern on Front (All Terrain).
TIRES Rough Terrain Tire and Wheel Condition
No Broken-Missing Lug Nuts Front and Rear, Tread Depth Minimum 3mm or Check
30
Manufacture Wear Indicator, No Recaps / Retreads / Vulcanized Permitted, Correct Rotation,
Tread Mud-Grip Pattern
Seat Belts Driver, Operator, Passenger,
31
Seats, Cushions
32 Securely Mounted, Ergonomically Good Condition, Not Torn Open
or Dilapidated
33 Carrier Parking Brake System Function Test
34 Carrier Brakes Front and Rear Properly Adjusted, No Air or Fluid Leaks, Test Function

43 All Window Glass / Windshield Glass Totally Clear, No Film or Stickers Blocking Vision.
Side mounted Left and Right or Door mounted Rear View Mirrors
46
Not Loose Clear Unobstructed Vision, Functions Properly
47
48 Wheeled Units Wheel Chocks, Two Units, Properly Constructed
Fire Extinguisher
50
52
53
54 Swing Bearing (Swivel) Clean Condition, Lubricated, Not Loose, No Loose Mounting Bolts
55 Hook Rollers and Roller Circle Face Lubricated, Not Loose, No Loose Mounting Bolts
56 Swing System Function Test, Must Be Smooth and Controlled

Page : 110 of 378
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57 Swing Parking Brake Must Be Positive Action, Witness a Function Test
Swing Operating Brake ~ Automatic Hydraulic
58
Must Be Positive Action, Witness a Function Test
59 Swing Lock Must Be Positive Action, Witness a Function Test
60 Red Flag Lihat Atas dan Anda Selamat
61 Load Test Witness a Test a Load-Test at 100% of MIGAS Certified SWL capacity
Body
Crane Cabin and Carrier Cabin Interior


Main Chassis, Frame Good Condition, Straight, Not Bent, No Cracks, No Uncertified Welding
1
Repairs
Sub Chassis, Sub Frame Good Condition, Straight, Not Bent, No Cracks, No Uncertified
2
Welding Repairs
3 Carrier Springs, Suspension System Front / Rear, Straight, Not Bent, No Loose Pins
4 Carrier Axle Mounts, Front and Rear All U-Bolts Tight, No Cracks
5 Carrier Outrigger Extension and Retraction Cylinders Test Function, No Leaks
6 Carrier Outrigger Vertical Jack Cylinders No Loose Mountings, Test Function

7 Carrier Outrigger PADS Proper and Safe, No Cracks, No Excess Distortion
Carrier Outrigger Remote Control System Levers
8
No Loose Mountings, Loose Pins,Test Function
9 Electrical Wiring Condition, Fuse Block All Splices Properly Insulated, No Bare Wires
10 Counterweight Mountings All Holding Bolts / Pins are Safe, Tight, No Loose Mountings
11 Front / Rear Bumper Bars Rounded Corners, No Sharp Edges, Not Loose, Properly Mounted
Crane Hydraulics, General Hydraulics, Fluids, Fuel, Hoses

Page : 111 of 378
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/A
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3 Hydraulic Tank(s) Tight Mounts, No Leaks, Filler Cap Properly Secured
4 Fuel Tank(s) Tight Mounts, No Leaks, Filler Cap Properly Secured
6 Hydraulic Pilot Valves No Leaks

Hydraulic Cylinders Any Leaks or Excessively Worn Pins/Bushings, All Pins Properly Secured
9
with Split Cotter Pins and/or Bolted End Plates
10 Remote Control System Levers for Outriggers No Loose Mountings, Loose Pins, Test Function
Upper Engine Clean Appearance, No Leaks, No Defective Mounts, Observe Performance,

1
No Smoke
Lower Engine Clean Appearance, No Leaks, No Defective Mounts, Observe Performance,

2
No Smoke
Battery, Battery Covers, Battery Mounting, Battery Terminals

4 Optional Battery Disconnect Switch, Test Function, No Loose or Corroded Cables-Terminals,
Battery Hold-Downs in Place, Clean Battery Box, No Loose Mounts
Alternator Observe Charging Function, No Bad Noises or Overheating, No Loose Mounts, No
6
Loose Belts
9 Exhaust System Check Pipe and Muffler, No leaks, Not Loose

10 Transmission and Auxiliary Transmisson No Leaks, Observe a Function Test
11
12 Carrier Differentials Front and Rear No Leaks, All Mountings Tight, Nothing Loose

Others
1
Page : 112 of 378
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Comments
RW CEM

Page : 113 of 378
MOB INSPECTION REPORT
Crane Telescopic Boom
Model : Brand :
Service Date : Police No. :
Location : Owner :
Remarks
Page : 114 of 378
Remarks
Page : 115 of 378
Remarks
Page : 116 of 378
Remarks
Page : 117 of 378
Remarks
Page : 118 of 378
Remarks

all CPI areas
Replace
dioperasikan.
SIGNATURE, Date
Sub- Sub-
Sub-Con.
Con. Con.
Contractor's
Name
Page : 119 of 378
TELESCOPIC BOOM PRE-MOB INSPECTION RE

Applies to Rough Terrain Crane Telescopic B

d
oo
d
/A
oo
N
G
o
N

Correct Size, Minimum 15 Cm Height,
14 Company ID Number, Company Logo Visible
16 MIGAS SILO Certificate Matches Unit Type -Series Expiry :

Special for Foco - Horn for Operator When Outside of Cabin
4
8
Page : 120 of 378
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oo
d
/A
oo
N
G
o
N
Boom Backstop System
9
Witness a Function Test, Must Shut Off Boom Hoist Controlt
12 If an Automatic Moment Limiter or Rated Capacity Load Limiter or Load Moment Limiter,
Must Witness a Function Test, Must Shut Off Boom Hoist at Maximum 78,

15
16

Gantry Sheaves, Pins, Bushings
17
Good Condition, Adequate Lubrication,
Sheaves No Flat Spots
19
20 Main and Auxiliary Hoist Cable Condition No Excess of Broken Wire Strands
Telescopic Boom
21 Fully Extend All Telescopic Boom Section and Boom Down, Look for Fatigue Cracks, Excessive
Bending, Excessive Twisting, Exessive Kinking, Excess Wear on Sliding Surfaces
Folding Jib Look for Cracks, Bent Chords, Bent Lacings.

Maximum Bend Main Chord 1mm per 1meter.
22 Maximum Bend Lacing 3mm per 1meter.
23 Boom Mount Connecting PINS All Must Be Secured by Proper and Safe SPLIT Cotter Pins
25 Carrier Power Steering Systems Function Test, Smooth and Controlled, Easy Maneuvering
26
Rough Terrain Carrier Steering Systems Smooth and Controlled, No Excess Freeplay,
27 Function Test Rear Steering Lock Out, No Loose Ball Joints, Lubricated Properly,
No Worn Out Pins, No Loose Mounting Bolts
Carrier Axle Wheel Bearing Lubrication
Hubs
Page : 121 of 378
d
oo
d
/A
oo
N
G
o
N
TIRES Carrier Tire and Wheel Condition No Broken-Missing Lug Nuts,Tread Depth Minimum
29 3mm, No Recap / Retread / Vulcanized Tires, Correct Rotation,Tread Mud-Grip Pattern (All
Terrain).
TIRES Rough Terrain Tire and Wheel Condition
No Broken-Missing Lug Nuts Front and Rear, Tread Depth Minimum 3mm or Check
30
Manufacture Wear Indicator, No Recaps / Retreads / Vulcanized Permitted, Correct Rotation,
Tread Mud-Grip Pattern
31
Seats, Cushions
or Dilapidated
34 Carrier Brakes Front and Rear Properly Adjusted, No Air or Fluid Leaks, Test Function

43 All Window Glass / Windshield Glass Totally Clear, No Film or Stickers Blocking Vision.
46
47
Fire Extinguisher
50
52
53

Page : 122 of 378
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/A
oo
N
G
o
N
58
59 Swing Lock Must Be Positive Action, Witness a Function Test
Body


1
Repairs
Sub Chassis, Sub Frame Good Condition, Straight, Not Bent, No Cracks, No Uncertified
2
Welding Repairs
3 Carrier Springs, Suspension System Front / Rear, Straight, Not Bent, No Loose Pins

8

Page : 123 of 378
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oo
d
/A
oo
N
G
o
N

Hydraulic Cylinders Any Leaks or Excessively Worn Pins/Bushings, All Pins Properly Secured
9
with Split Cotter Pins and/or Bolted End Plates
10 Remote Control System Levers for Outriggers No Loose Mountings, Loose Pins, Test Function

1
No Smoke

2
No Smoke

6
Loose Belts

11

Others
1
Page : 124 of 378
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/A
oo
N
G
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2
Comments
RW CEM
C822444-COR-CEM-CKL-0012A Rev 1 (2 Jan 2016)

Page : 125 of 378

in Crane Telescopic Boom
Model : Brand :
Service Date : Police No. :
Location : Owner :
Remarks
Page : 126 of 378
Remarks
Page : 127 of 378
Remarks
Page : 128 of 378
Remarks
Ditambahkan
Page : 129 of 378
Remarks
Page : 130 of 378
Remarks

all CPI areas
Replace
dioperasikan.
SIGNATURE, Date
Sub- Sub-
Sub-Con.
Con. Con.
Contractor's
Name
Page 131 of 378
LATTICE BOOM PRE-MOB INSPECTION R

Applies to Mobile Crane with Lattice Boom

d
oo
d
oo
G
G
o
N
15 MIGAS SILO Certificate Matches Unit Type-Series Expiry :


4 Carrier Back-Up Light Adequate Illumination, Function Test
Special for Mobile Crane - Horn for Operator When Outside of Cabin
6
9 Sight Level Bubble Level Indicator Visible and Functioning Properly
10
Page 132 of 378
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d
oo
G
G
o
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Boom Backstops
13
Not Bent, No Excessively Worn "Oval", Sliding "Telescoping" Freely In and Out
If an Automatic Moment Limiter or Rated Capacity Load Limiter or Load Moment Limiter,
14
Must Witness a Function Test, Must Shut Off Boom Hoist at Maximum 78
Not Mandatory For Units Assigned To Pile Driving Operations
Hook Block, Sheaves, Pins, Bushings
17
18 Good Condition, Adequate Lubrication, Sheaves No
Flat Spots
19 Gantry Sheaves, Pins, Bushings
21
Boom Pendants Cables Pin Condition Good, Pins held by Proper and Safe SPLIT Cotter Pins,
22 Rope Sockets Not Deformed or Bent, No Excess of Broken Wire Strands, Measure Cable
Diameter with Calipers to Ensure No Excess Shrinkage, No Intenal Rust or Corrosuion.
Boom Hoist Cable Condition Rope Socket Ends Swaged, No Hand Spliced Ends, Socket Ends
23 Not Deformed or Bent, Wire Rope Cable Not Deformed, Not Bent, No Kinks, Not Crushed, No
Excess of Broken Wire Strands
Main and Auxiliary Hoist Cable Rope Socket Ends Swaged, No Hand Spliced Ends, Socket
24 Ends Not Deformed or Bent, Wire Rope Cable Not Deformed, Not Bent, No Kinks, Not Crushed,
No Excess of Broken Wire Strands
All Boom Sections, including Jib

Boom down for Inspection
Examine for Cracks, Bent Chords, Bent Lacings, Dents, Corrosion
25 Maximum Bend Main Chord 1mm per 1meter.
Maximum Bend Lacing 3mm per 1meter.
26 Boom Connecting PINS All Must Be Secured by Proper and Safe SPLIT Cotter Pins
28
Seat Belts for Driver, Operator, Passenger
29
Seats, Cushions
30
31 Carrier Brakes Front and Rear Check Properly Adjusted, No Air or Fluid Leaks, Test Function
Page 133 of 378
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G
o
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Carrier Front Axle Wheel Bearing Lubrication
36
Carrier Tire and Wheel Condition No Broken-Missing Lug Nuts,Tread Depth Minimum 3mm, No
37 Recap / Retread / Vulcanized Tires, All Terrain Tread Mud-Grip Tread Pattern on Rear, Tread
Highway Pattern on Front, Correct Rotation
42
45
46
Fire Extinguisher
49
51
All Safety Guards and Covers
52
53 Swing System All Systems Function Test, Must Be Smooth and Controlled
55
56 Swing Lock Must Be Positive ACtion, Witness a Function Test
Body
Page 134 of 378
d
oo
d
oo
G
G
o
N

1
Repairs
Sub Chassis, Sub Frame Good Condition, Straight, Not Bent, No Cracks, No Uncertified Welding
2
Repairs
4 Carrier Springs, Suspension System, Front and Rear Straight, Not Bent, No Loose Pins
8
11 Counterweight Mountings Inspect All Holding Bolts - Pins, Safe, Tight, No Loose Mountings
12 Front - Rear Bumper Bars Rounded Corners, No Sharp Edges, Not Loose, Properly Mounted

1
No Smoke
2
No Smoke
Page 135 of 378
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G
o
N
6
Loose Belts
11

Others
1
2
3
Comments
RW CEM

Page 136 of 378

rane with Lattice Boom
Model : Brand :
Service Date : BM Plate No. :
Location : Owner :
Remarks
/A
N
Page 137 of 378
Remarks
/A
N
Page 138 of 378
Remarks
/A
N
Page 139 of 378
Remarks
/A
N
Page 140 of 378
Remarks
/A
N
Good = Good condition, able to be operated in all CPI

areas
cknowledged by CPI The undersigned hereby accept and agree that this
equipment is "OK" and safe for operation.
Menerima dan Menyetujui bahwa Alat ini sudah
"OK" dan aman untuk dioperasikan.
SIGNATURE, Date
Sub-
Sub-Con. Sub-
Con. Con.
Contractor's
Name
Page 141 of 378
LATTICE BOOM PRE-MOB INSPECTI

Applies to Crawler Crane with Lattice

d
oo
d
oo
G
G
o
N


7 Sight Level Bubble Level Indicator Visible and Functioning Properly
8
Boom Backstops
11
12 If a Load Rate Indicator, Rated Capacity Indicator, Must Witness a Function Test.
If an Automatic Moment Limiter or Rated Capacity Load Limiter or Load Moment Limit
15
Page 142 of 378
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G
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Flat Spots
17 Gantry Sheaves, Pins, Bushings
19
Boom Pendants Cables Pin Condition Good, Pins held by Proper and Safe SPLIT Cotter Pins,
20
Rope Sockets Not Deformed or Bent, No Excess of Broken Wire Strands
Boom Hoist Cable Condition Rope Socket Ends Swaged, No Hand Spliced Ends, Socket Ends
21 Not Deformed or Bent, Wire Rope Cable Not Deformed, Not Bent, No Kinks, Not Crushed, No
Excess of Broken Wire Strands
Main and Auxiliary Hoist Cable Rope Socket Ends Swaged, No Hand Spliced Ends, Socket
22 Ends Not Deformed or Bent, Wire Rope Cable Not Deformed, Not Bent, No Kinks, Not Crushed,
No Excess of Broken Wire Strands
All Boom Sections, including Jib

Examine for Cracks, Bent Chords, Bent Lacings, Dents, Corrosion
23 Maximum Bend Main Chord 1mm per 1meter.
Maximum Bend Lacing 3mm per 1meter.
24 Boom Connecting PINS All Must Be Secured by Proper and Safe SPLIT Cotter Pins
25 Brakes for Hoisting and Lowering Function Test, All Brake Actions Smooth and Controlled
Crawler Walking, Travel Brakes and Steering System
26
Function Test, Must Be Smooth and Controlled
Automatic Crawler Parking Brake System
27
Check Properly Adjusted, No Air or Fluid Leaks, Test Function
Seat Belts for Operator
28
Seats, Cushions
29
34 Battery Disconnect Switch No Loose Wires or Battery Cable Connections, Function Test
35
Page 143 of 378
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G
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38
39
Fire Extinguisher
40
42
43
44 Swing System All Systems Function Test, Must Be Smooth and Controlled
45 Swing Parking Brake ~ Mechanical Must Be Positive Action, Witness a Function Test

46
Body


1
Repairs
2
3
6 Crawler Track Drive Chain Well Lubricated, No Broken or Stretched Links
Page 144 of 378
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G
o
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Crawler Track Frame Extension System
8 Test Function and Operation of Hydraulics, No Leaks, No Loose Mounting Bolts, Carefully
Witness Function Test
Crawler Self Jacking Hydraulic System
9 Test Function and Operation of Hydraulics, No Leaks, No Loose Mounting Bolts, Carefully
Witness Function Test
Page 145 of 378
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G
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Swing Bearing (Single Swivel Bearing type Fully Enclosed) Clean Condition, Properly Lubricated,
10
Not Loose, No Loose Mounting Bolts
Swing Hook Rollers and Swing Roller Circle Face Properly Lubricated, Properly Adjusted,
11
Not Loose, No Loose Mounting Bolts

Main Engine Clean Appearance, No Leaks, No Defective Mounts, Observe Performance,
1
No Smoke
5
Loose Belts
PTO, Drive Shafts, Propeller Shafts, U-Joints, Center Carrier Bearing
10

Others
1
2
Page 146 of 378
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G
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3
Comments
RW CEM

Page 147 of 378
Sub-Con.
Crane with Lattice Boom
Model : Brand :
Service Date :
Location : Owner :
Remarks
/A
N
Page 148 of 378
Remarks
/A
N
Page 149 of 378
Remarks
/A
N
Page 150 of 378
Remarks
/A
N
Page 151 of 378
Remarks
/A
N
Page 152 of 378
Remarks
/A
N
dged by CPI The undersigned hereby accept and agree that this equipment is
SIGNATURE, Date
Sub-Con. Sub-
Sub-
Con. Con.
Contractor's
Name
Page 153 of 378
LATTICE BOOM PRE-MOB INSPECTION REP

Applies to Side Boom

d
oo
oo
G
G
o
N



5
Boom Backstops
7
8
Good
Boom Condition, Adequate
Point Sheaves, Pins,Lubrication,
Bushings Sheaves No Flat Spots
Flat Spots
10 Safety Latch in Hook Blocks Not Bent, Positive Closing Action
11
Can
BoomNOT become
Pendants Undone
Cables Pin Condition Good, Pins held by Proper and Safe SPLIT Cotter Pins,
12
Rope Sockets Not Deformed or Bent, No Excess of Broken Wire Strands
Boom Hoist Cable Condition
13
Rope Sockets Not Deformed or Bent, No Kinks, No Excess of Broken Wire Strands
Page 154 of 378
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oo
oo
G
G
o
N
14 Main
Boomand Auxiliary Hoist Cable Good Condition, No Kinks, No Excess of Broken Wire Strands
Section
15 Examine for Cracks, Bends, Dents, Corrosion
Maximum Bend Main Boom 1mm per 1meter.
16 Maximum Depth ofPINS
Boom Connecting Corrosion Pitting
All Must 0.8mm. by Proper and Safe SPLIT Cotter Pins
Be Secured
Crawler Walking, Travel Brakes and Steering System

18
Function Test, Must Be Smooth and Controlled
Seat Belt Operator
19
Seats, Cushions
20
21 Working Lights-Flood Lights Adequate Illumination, Function Test
Fire Extinguisher
24

26
Body


Page 155 of 378
d
oo
oo
G
G
o
N
1
Repairs
2
Repairs
Crawler Track Frames
3
No Loose Mounting Bolts, No Cracks
4
5
10 Front - Rear Push Bars Rounded Corners, No Sharp Edges, Not Loose, Properly Mounted
General Hydraulics, Fluids, Fuel, Hoses
Engine Clean Appearance, No Leaks, No Defective Mounts, Observe Performance,

1
No Smoke


5
Loose Belts
Page 156 of 378
d
oo
oo
G
G
o
N
10
12 Final Drives No Leaks, All Mountings Tight, Nothing Loose
Others
1
2
3
Comments
RW CEM

Page 157 of 378

to Side Boom
Model : Brand :
Service Date :
Location : Owner :
Remarks
/A
N

Page 158 of 378
Remarks
/A
N
Page 159 of 378
Remarks
/A
N
Page 160 of 378
Remarks
/A
N

all CPI areas

Replace
dioperasikan.
SIGNATURE, Date
Sub-Con. Sub-
Sub-
Con. Con.
Contractor's
Name
Page : 161 of 378
TELESCOPIC BOOM CRANE PRE-MOB INSPECT

Applies to Hydraulic Boom Crane truck, Foco
Inspected by : Date : Locatio
d
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G
16 MIGAS SKPP Certificate Matches Unit Type -Series Expiry :
Upper Structure attachment

1 Manufacture
2 Model
3 Capacity
4 Serial Number
5 Year Made

Page : 162 of 378
d
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G
Horn for Operator When Outside of Cabin
4
7 Sight Level Bubble Indicator and Function Properly
9 Safety device for Overwinding/Anti Two Block swich Alarm as per OEM Check, Test Function
Operator's Operational Aid Hydraulic System Load Pressure Gauge
11
Visible, Operating and Indicating Properly, Mounted Properly
12 Hoist Winch Automatic Brake System Free-Fall Lockout Witness and Record Load Test
15 Automatic Swing Brake Must Be Positive Action, Witness a Function Test
16
17
18 Vertical Boom Support Section No Fatigue Cracks Pins, Bushings Good Condition, Adequate Lubrication
19 Safety Latch in Hook Block Not Bent, Positive Closing Action
Hook Swivel Bearing Assys Good Condition, Not Loose, Properly Lubricated
20 Main Nut Above Swivel Bearing
Not Loose, Locked in Place By Proper and Safe SPLIT Cotter Pin, Can NOT become Loose and Undone
Main Hoist Cable Condition No Excess of Broken Wire Strands, ensure the length of wire rope and size as
21
per OEM recommended and function test, refer to ASME B30.07
Special for PROPER and SAFE mounting of Crane Column Base onto Truck Chassis
Must use only genuine OEM supplied hardware, i.e., Brackets, U-Bolts, long straight Bolts, Clamp Plates
and Spacers.
A total of eight (8) long straight Bolts or four (4) U-Bolts per crane.
All U-Bolts, Bolts, and Nuts, must be made of Hi-Tensile 120,000 psi (Grade 8) Steel.
All Spacers, Fastening Plates must have been formed by use of a Milling machine.
22
All holes in Clamp plates must have been drilled by a Drilling Machine.
Nothing, no parts, no holes, nothing is allowed to have been cut or formed by using an Oxy/Acetylene
Cutting Torch.
No holes are allowed to be drilled in the truck chassis RAILS.
No welding is allowed to be done to the truck Chassis RAILS.
Fastening Clamp Plates which are BENT are too thin and therefore are not permitted.
Telescopic Boom
Fully Extend all Sections, Look for Cracks, Bends, Excessively Worn Sliding Guide Strips.
23 Maximum Bend 1mm per 1meter.
Page : 163 of 378
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24 Boom Mount Connecting Pins All Must Be Secured by Proper and Safe SPLIT Cotter Pins
25 Truck Power Steering Systems Function Test, Smooth and Controlled, Easy Maneuvering
Truck Steering Box, Steering Linkages No Excess Freeplay, No Loose Ball Joints, Lubricated Properly, No
26
Worn Out Pins, No Loose Mounting Bolts, Function Test

27
Oil-Hubs to Be Properly Filled and No Leaks, No MISSING COVERS / CAPS on Grease Type Hubs
TIRES and Wheel Condition No Broken-Missing Lug Nuts, Tread Depth Minimum 3mm, No Recap /
Retread / Vulcanized Tires, Tread Mud-Grip (All Terrain) on rear and front, Correct Rotation (Vulcanized tire
28
not allowed for all vehicles, including heavy vehicles), see IBU-MVS - page : 4. all rear tires on all axles
must be same Tread (V-Lug or S-Lug, or U-Lug and Rib-Lug)
29
Seats, Cushions
or Dilapidated
31 Truck Parking Brake System Function Test
Truck Service Air / Hydraulic Brakes Front and Rear
32
Properly Adjusted, No Air or Fluid Leaks, Test Function

40
43
44
Fire Extinguisher
47
Access Ladder Steps Handrails Securely Mounted, Ergonomic Design, Good Condition, Not Cracked, Not
49
Bent, Not Dilapidated, No Sharp Edges, No Sharp Corners

51
Page : 164 of 378
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Load Test Perform Load Test at 100% of the crane 's capacity as per its OEM Load Chart and record the
53 results on special separate sheet witness signed by all concerned parties
Body

2 Gauges for Fuel, Hours, Kms, Odometer, Temperature, Brake Air Pressure, Hyd Pressure, Alternator,
Battery Voltmeter, Battery Charging System, etc, All Operating Properly
2 Sub Chassis, Sub Frame Good Condition, Straight, Not Bent, No Cracks, No Uncertified Welding Repairs
3 Truck Springs, Suspension System Front / Rear, Straight, Not Bent, No Loose Pins
4 Truck Axle Mounts, Front and Rear All U-Bolts Tight, No Cracks
5 Truck Outrigger Extension and Retraction Cylinders Test Function, No Leaks
6 Beam Outrigger Extension Lock Pin Test Function.
7 Truck Outrigger Vertical Jack Cylinders No Loose Mountings, Test Function
8 Truck Outrigger PADS Proper and Safe, No Cracks, No Excess Distortion
Truck Outrigger Remote Control System Levers
9
13 Underrun protection as appropriate Ensure No Loose, No Crack, No Sharp Edges, No Bent, Straight

Page : 165 of 378
d
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Hydraulic Cylinders Any Leaks or Excessively Worn Pins/Bushings, All Pins Properly Secured with Split
9
Cotter Pins and/or Bolted End Plates
10 Left and Right Control System Levers for Outriggers No Loose Mountings, Loose Pins, Test Function
Truck Engine Clean Appearance, No Leaks, No Defective Mounts, Observe Performance,
1
No Smoke
2 Truck Engine Dipstick Easy to read, Oil Level Adequate
3 Optional Battery Disconnect Switch, Test Function, No Loose or Corroded Cables-Terminals, Battery Hold-
Downs in Place, Clean Battery Box, No Loose Mounts
5 Alternator Observe Charging Function, No Bad Noises or Overheating, No Loose Mounts, No Loose Belts

10
11 Truck Differentials Front and Rear No Leaks, All Mountings Tight, Nothing Loose

Others
1
2
3
Comments
Page : 166 of 378
d
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G
RW CEM

Page : 167 of 378

om Crane truck, Foco, Unic.
Model : Brand :
Location : oo
d
Owner :
Remarks
/A
G
N
o
N
Page : 168 of 378
d
oo
Remarks
/A
G
N
o
N
Page : 169 of 378
d
oo
Remarks
/A
G
N
o
N
Page : 170 of 378
d
oo
Remarks
/A
G
N
o
N
Page : 171 of 378
d
oo
Remarks
/A
G
N
o
N
Good = Good condition, able to be

operated in all CPI areas
Replace
Page : 172 of 378
d
oo
Remarks
/A
G
N
o
N
Acknowledged by CPI
The undersigned hereby accept and
agree that this equipment is "OK" and
safe for operation. Menerima dan
Menyetujui bahwa Alat ini sudah "OK"
dan aman untuk dioperasikan.
SIGNATURE, Date
Sub-
Con.
Contractor's Name
Page 173 of 378
VEHICLE PRE-MOB INSPECTION REPO

Applies to A-Frame Truck
Serial No. : Km/Hourmeter : Service D
d
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Documentation Operator & Equipment
12 Official SAMSAT Letter for Non BM Plate Expiry :


4 Load Chart Visible, Affixed to Cabin Wall, in English or Bahasa
A-Frame, and Back Stop Condition Fully Lower A-Frame, Look for Fatigue Cracks, Excessive Bending,
5
Excessive Twisting, Exessive Kinking, Excess Wear on Lower Pins
Sheave - Snatch Block on Uppermost Point of A-Frame Arrange a Suitably High and Safe Platform for
6 Inspection. Inspect Very Carefully to Ensure Properly Greased Bearings, No Excess Wear on Pin, No
Excess Wear on Shackle, No Excess Wear on Sheave Groove.
Sheave - Snatch Block on Top of Truck Steel Deck Arrange Suitable Rigging to Lift Snatch Block UP to
7 an Exposed Position for Inspection. Inspect Very Carefully to Ensure Properly Greased Bearings, No
Excess Wear on Pin, No Excess Wear on Shackle, No Excess Wear on Sheave Groove.
Page 174 of 378
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Truck Seat Belts for Driver, Operator, Passenger
8
Good Condition, Properly, Mounted with OEM Hi Tensile Bolts
Seats, Cushions
9
10 Truck Parking Brake Function Test
11 Truck Brakes Front and Rear Properly Adjusted, No Air or Fluid Leaks, Function Test

15
Retread / Vulcanized Tires, Tread Mud-Grip (All Terrain) on rear and front, Correct Rotation (Vulcanized
16
tire not allowed for all vehicles, including heavy vehicles), see IBU-MVS - page : 4. all rear tires on all
axles must be same Tread (V-Lug or S-Lug, or U-Lug and Rib-Lug)
Truck Power Steering System, Steering Linkages No Excess Freeplay, No Loose Ball Joints, Lubricated
17
Properly, No Loose Pins, No Loose Mounting Bolts, Function Test
18 Truck Head Lights-Working Lights-Flood Lights Adequate Illumination, Function Test
19 Truck Rear Combination Lights Adequate Illumination, Function Test
20 Truck Front Combination Lights Adequate Illumination, Function Test
21 All Electrical Wiring Condition, Fuse Block All Splices Insulated, No Bare Wires
Truck Internal Centrally Mounted Rear View Mirrors
22
Truck Side mounted Left and Right or Door mounted Rear View Mirrors
23
24 Carrier Windshield Wipers Wiper Blades Not Perished, Windshield Washer, Test Function
25
26 Door and Door Locks, Door Handles Left - Right, Outside and Inner, Test Function
27
Access Ladder Steps Handrails Securely Mounted, Ergonomic Design, Good Condition, Not Cracked,
30
Not Bent, Not Dilapidated, No Sharp Edges, No Sharp Corners
Fire Extinguisher
31
32 First Aid Kit Clean Tidy, Completely Full
Page 175 of 378
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Body
Cabin Interior
Dashboard Indicators
3 Steering System Controls Test Function
4 Combination Switch Light Switch, Switches Knobs Test Function
6 All Control Linkages and Levers Test Function
2
Repairs
3 Carrier Springs, Suspension System Front / Rear, Straight, Not Bent, No Loose Shackle Pins

6 Pilot Valves No Leaks
9
Winch
Winch Winch Must Have a Solid Rear Safety Guard Screen Behind Operator,
1
Perform Function Load Test, Observe Winch Brake System, No Creeping Down
Winch, Hook and Winch Cable Condition
2
Page 176 of 378
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Hoist Cable Condition
3 Rope Socket Ends Swaged, No Hand Splices Ends, Socket Ends Not Deformed or Bent, Wire Rope
Cable Not Deformed, Not Bent, No Kinks, Not Crushed, No Excess of Broken Wire Strands
Boom Pendants Cables Pin Condition Good, Pins held by Proper and Safe SPLIT Cotter Pins, Rope
4
Sockets Not Deformed or Bent, No Excess of Broken Wire Strands
Engine - Transmission - Differentials

1 Engine Clean Appearance, No Leaks, No Defective Mounts, Observe Performance, No Smoke
3 Optional Battery Disconnect Switch, Test Function, No Loose or Corroded Cables-Terminals, Battery
Hold-Downs in Place, Clean Battery Box, No Loose Mounts
Alternator
5

10

Others
1
2
3
Comments

Page 177 of 378
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Page 178 of 378
INSPECTION REPORT
A-Frame Truck
Model : Brand :
Service Date : Police No:
Location : Owner :
d
oo
/A Remarks
G
N
o
N
Page 179 of 378
d
oo
Remarks
/A
G
N
o
N
Page 180 of 378
d
oo
Remarks
/A
G
N
o
N
Page 181 of 378
d
oo
Remarks
/A
G
N
o
N

all CPI areas

Replace

Page 182 of 378
d
oo
Remarks
/A
G
N
o
N
dioperasikan.
SIGNATURE, Date
Sub-
Sub-Con. Sub-
Con. Con.
Contractor's Name
Page 183 of 378
AUTOMOTIVE TYPE TRUCK PRE-MOB INSPE

Applies to Flatbed Truck, Oxy-Acetylene Truck
Equip No. Type :
Serial No : Km/Hourmeter :
Inspected by : Date :

2 Number Year of Manufacture:

Seat Belts Driver, Swamper, Center Passenger, Good Condition, Properly Mounted with OEM
4
Hi-Tensile Bolts
5 Seats, Cushions Securely Mounted, Ergonomically Good Condition, Not Torn Open or Dilapidated
7 Brakes Front and Rear Properly Adjusted, No Air or Fluid Leaks, Function Test
Page 184 of 378
Power Steering System Steering Linkages No Excess Freeplay, No Loose Ball Joints, Lubricated Properly,
11
No Loose Pins, No Loose Mounting Bolts, Function Test
12
not allowed for all vehicles, including heavy vehicles), see IBU-MVS - page : 4. all rear tires on all axles must
be same Tread (V-Lug or S-Lug, or U-Lug and Rib-Lug)

13
18
20
Not Loose, Clear Vision, Unobstructed, Functions Properly
Internal Centrally Mounted Rear View Mirrors
21
Fire Extinguisher
24
Minimum 4kg, Welding Truck 8 Kg, Properly Mounted and Accessible. Current Valid Inspection Tag.
26
27 Safety Guards All Covers in Place, Not Loose, None Missing, Not Modified, Remain within OEM Specs
Body
Cabin and Interior

Page 185 of 378
2 Gauges for Fuel, Hours, Kms, Odometer, Temperature, Brake Air Pressure, Hyd Pressure, Alternator, Battery
Voltmeter, Battery Charging System, etc, All Operating Properly

1 Main Chassis, Frame Condition Straight, Not Bent, No Cracks, No Uncertified Welding Repairs
2 Sub Chassis, Sub Frame Condition Straight, Not Bent, No Cracks, No Uncertified Welding Repairs
3 Front and Bumper Bars Straight, Not Bent, No Cracks, No Sharp Edges
4 Axle Mounts Front and Rear, All U-Bolts Tight, No Cracks
5 Suspension System Springs Front / Rear, Straight, Not Bent, No Loose Shackle Pins

5 Air Tank No Leaks, No loose Mounts
Rear Flatbed
Steel Deck Made of Chequered Plate

1 Wooden Decks No Dangerous Holes, No Rotten Wood, No Broken Splintered Sharp Wood
Side Posts No Bent Side Posts, No Bent Side Stanchions - Side Posts Easily Adjustable
Bottle Storage Racks

Oxy-Acetylene Truck Bottle Racks Rigid, No Fatigue Cracks, Proper Locking Brackets to Secure Bottles
1
Positively, Securely Safely

Page 186 of 378
Alternator
5
8
9 Exhaust System Inspect Pipe, Muffler, No leaks, Not Loose
10 Automatic Transmission No Leaks, Observe a Function Test of Shifting Sequence
11 Main Mechanical Transmission and Auxiliary Transmisson No Leaks, Observe a Function Test

Others
1
2
3
Comments
RW CEM
Page 187 of 378
Page 188 of 378

xy-Acetylene Truck, Cargo Truck
Model : Brand :
Service Date :
Police No:
Location : Owner :
d
oo
Remarks
d
/A
oo
N
G
o
N
Page 189 of 378
d
oo
Remarks
/A
oo
N
G
o
N
Page 190 of 378
d
oo
Remarks
/A
oo
N
G
o
N
Page 191 of 378
d
oo
Remarks
/A
oo
N
G
o
N
Sub-Con.
Good = Good condition, able to be operated in all

CPI areas

Replace
nowledged by CPI The undersigned hereby accept and agree that

this equipment is "OK" and safe for operation.
Menerima dan Menyetujui bahwa Alat ini sudah
"OK" dan aman untuk dioperasikan.
SIGNATURE, Date
Sub-
Sub-Con.
Sub-
Con. Con.
Contractor's Name
Page 192 of 378
d
oo
Remarks
/A
oo
N
G
o
N
Page 193 of 378
AUTOMOTIVE TYPE TRUCK PRE-MOB INSPECT

Applies to Prime Movers, 6x4 and 6x6
Equip No. Type : Model :
Serial No : Km/Hourmeter : Service
d
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G
Number

4
Hi-Tensile Bolts
Page 194 of 378
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Power Steering System Steering Linkages No Excess Freeplay, No Loose Ball Joints, Lubricated
11
Retread / Vulcanized Tires, Tread Mud-Grip Pattern on Rear, Tread Highway Pattern on Front, Correct
12
Rotation (Vulcanized tire not allowed for all vehicles, including heavy vehicles), see IBU-VSMP - page : 4
and all rear tires on all axles must be same Tread (V-Lug or S-Lug, or U-Lug and Rib-Lug.

13
18
20
21
Fire Extinguisher
24
26
Body
Cabin and Interior

Page 195 of 378
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Prime Mover 5th Wheel ,

5th Wheel To Be Completely Washed, Inspect Both Jaws for Excess Wear, No Excess Oval Shape, No
1
Excessively Loose Pins / Bushings
5th Wheel Lock System Test by Using a Pry Bar to Open and Close Jaws Manually, Make Sure Jaws
2 Close Strongly and Positively to a FULL LOCK Position, No Bent Release Lever, Springs on Sliding Lock
are NOT Weak
Truck to Trailer Air Brake Supply System, Glad Hand Seals No Leaks from Glad Hand Seals
3 Trailer Hose Color Coding is Red Emergency on Left Side and is Yellow or Blue Service on Right Side
Check Hose Correct Color and No Leaks, No Lines / Pipes Hanging Loo
Winch
1 Winch If Equipped with Winch Must Have Rear Safety Guard Screen Behind Operator
Winch, Hook and Winch Cable Condition
2
Page 196 of 378
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Alternator
5
8

Others
1
2
3
Comments

Page 197 of 378
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RW CEM

Page 198 of 378

Movers, 6x4 and 6x6
Model : Brand :
Service Date :
Police No:
Location : Owner :
d
Remarks
oo
/A
G
N
o
N

Page 199 of 378
d
Remarks
oo
/A
G
N
o
N
Page 200 of 378
d
Remarks
oo
/A
G
N
o
N
Page 201 of 378
d
Remarks
oo
/A
G
N
o
N

all CPI areas

Replace
owledged by CPI The undersigned hereby accept and agree

dioperasikan.
SIGNATURE, Date
Page 202 of 378
d
Remarks
oo
/A
G
N
o
N
Contractor's Name
Page 203 of 378

Applies to Amr Roll Truck
Equip No. Type : Model :
Serial No : Km/Hourmeter : Service
d
oo
G
Number

4
Hi-Tensile Bolts
Page 204 of 378
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11
12

13
18
20
21
Fire Extinguisher
24
26
Body
Cabin and Interior

Page 205 of 378
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8 All Controls and Air & Hydraulic Control Valves No Leaks, Test Function
Rear Arm Roll

Lifting Arm and Hook. Good Paint, No Rust, No Fatigue Cracks, No Excessive Bending or Twisting,
1
Clean, No Deformed or Loose Hinge Pins, Levers, Function Test
2 Rear End Roller Not Bent, Function Test Closing / Opening Action
Stabilizer jack, Not Bent, No Leak, Function Test To Lock and Unlock (during loading and unloading)
3
Hyd. Cylinders, Not Bent, No Leak, Function Test
4

Page 206 of 378
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Alternator
5
8

Others
1
2
3
Comments
RW CEM

Page 207 of 378

Amr Roll Truck
Model : Brand :
Service Date :
Police No:
Location : Owner :
d
Remarks
oo
/A
G
N
o
N
Page 208 of 378
d
Remarks
oo
/A
G
N
o
N
Page 209 of 378
d
Remarks
oo
/A
G
N
o
N
Page 210 of 378
d
Remarks
oo
/A
G
N
o
N
Sub-Con.

all CPI areas

Replace

dioperasikan.
SIGNATURE, Date
Contractor's Name
Page 211 of 378

Applies to Dump Truck
Equip No : Type : Truck Dump Model :
d
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G
Number

4
Hi-Tensile Bolts
Page 212 of 378
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11
12

13
18
20
21
Fire Extinguisher
24
26
Body
Cabin and Interior

Page 213 of 378
d
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Rear Dump Body Tray

Dump Tray Good Paint, No Rust, No Fatigue Cracks, No Excessive Bending or Twisting, Clean,
1
No Deformed or Loose Tailgate Hinge Pins, No Worn Out Dump Lift Levers, Function Test
2 Dump Tray Tailgate Locks Not Bent, Function Test Closing / Opening Action
Dump Tray Safety Lockouts for Raised Position while Servicing
3 Not Bent, Function Test To Lock and Unlock

Page 214 of 378
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Alternator
5
8

Others
1
2
3
Comments
RW CEM
Page 215 of 378
d
oo
G
Page 216 of 378

Dump Truck
Model : Brand :
Location : d
Owner :
Remarks
oo
/A
G
N
o
N
Page 217 of 378
d
Remarks
oo
/A
G
N
o
N
Page 218 of 378
d
Remarks
oo
/A
G
N
o
N
Page 219 of 378
d
Remarks
oo
/A
G
N
o
N
Sub-Con.

all CPI areas

Replace

dioperasikan.
SIGNATURE, Date
Contractor's Name
Page 220 of 378
d
Remarks
oo
/A
G
N
o
N
Page 221 of 378
TANK TRUCKS PRE-MOB INSPECTION

Applies to Water Truck, Fuel Truck, Vacuum Truc
Equip. No. : Type :
Keterangan Tera from Badan Meteorologi (Specially for
14
Fuel Tank Truck)

Special for Vacuum Truck Before Performance of a Suction and Discharge Test, Tank Must Be Flushed Out
2
and Totally Free of OIL or CONTAMINANTS
5 Seat Belts Driver, Operator, Passenger, Good Condition, Properly, Mounted with OEM Hi-Tensile Bolts
Page 222 of 378
12
13
14

19
21
22
Fire Extinguisher
25
Truck Minimum 4kg, Properly Mounted and Accessible. Current and Valid Inspection Tag.
27
28 Safety Guards Covers All in Place, Not Loose, None Missing, Not Modified, Remain within OEM Specs
Tank Clean Paint, Washed Free All Extrernal Grease Dirt, Look for Excessive Deformed or Bent Sides, Leak
29
Test by Filling
32 Grounding Cable for Fuel Tank Truck Function Test
Body
Cabin and Interior

Page 223 of 378
4 Combination Switch, Light Switch, Switches Knobs Test Function

3 Front and Rear Bumper Bars Straight, Not Bent, No Cracks, No Sharp Edges
5 Suspension System Front / Rear, Straight, Not Bent, No Loose Pins

9 Pipes, Lines, Hoses,Fittings Properly Secured, No Leaks
Special for Vacuum Tank and Pump

Vacuum Pump - Thompson or Other Manufacturers
1
Clean Appearance, No Leaks, Test, Observe and Record Performance
Special for Water Truck

Water Pump - Robin, Honda or Other Manufacturer
1
Clean Appearance, No Leaks, Test, Observe and Record Performance
Special for Asphalt Truck

1 Asphalt Pump PTO Driven Clean Appearance, No Leaks, Test, Observe and Record Performance
Special for Fuel Truck

Page 224 of 378
No Gasoline or Diesel "Auxiliary" Engine is Permitted For Fuel Truck
1
Fuel Truck Must Be PTO Driven Only, NO Auxiliary Engine Allowed
Fuel Pump PTO Driven Proper Safety Guard(s) Covering Drive Belts, Clean Appearance, No Leaks, Test,
2
Observe and Record Performance
3 Fuel Dispensation Meter System Clean Appearance, No Leaks, Test, Observe and Record Performance
4 Pipes, Lines, Hoses, Filling Gun with Nozzle Fittings Properly Secured, No Leaks
Battery, Battery Covers, Battery Mounting, Battery Terminals Optional Battery Disconnect Switch, Test
3 Function, No Loose or Corroded Cables-Terminals, Battery

8
9 Exhaust System, Pipe, Muffler No leaks, Not Loose
10 TransmissionTransmission and Auxiliary Transmisson No Leaks, Observe a Function Test
13

Others
1
2
3
Comments
Page 225 of 378
RW CEM

Page 226 of 378

Truck, Vacuum Truck, Asphalt Truck
Model : Brand :
Location : Owner :
d
Remarks
oo
d
/A
oo
N
G
o
N
Page 227 of 378
d
Remarks
oo
d
/A
oo
N
G
o
N
Page 228 of 378
d
Remarks
oo
d
/A
oo
N
G
o
N
Page 229 of 378
d
Remarks
oo
d
/A
oo
N
G
o
N

all CPI areas

Replace
Page 230 of 378
d
Remarks
oo
d
/A
oo
N
G
o
N

dioperasikan.
SIGNATURE, Date
Sub-Con.
Contractor's Name
Page 231 of 378
BUCKET AND AUGER VEHICLE PRE-MOB INSPEC

Applies to Bucket Truck, Polecat Truck
d
oo
G
Number


1 Back Up Alarm Easy to Hear, 97 Decibles Minimum
Boom, Lift Arm, and Back Stop Condition Fully Raise All Boom Sections, Look for Fatigue Cracks,
7
Excessive Bending, Excessive Twisting, Exessive Kinking, Excess Wear on Sliding Surfaces

8
Witness a Function Test, Must Shut Off Boom Hoist Control
Page 232 of 378
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Operator's Electronic Operational Aids AML- Load Rate Indicator - Rated Capacity Indicator
Witness an Operational Function Test
9
If fitted with an Automatic Moment Limiter or Rated Capacity Load Limiter, Witness a Function Test, If
Overloaded Must Shut Off Boom Arm Hoist Control
Bucket Leveling System Cable Has No Excess of Broken Strands, Pins and Bushings in Sheaves Not
11
Loose, Sheaves No Flat Spots, All Good Condition and Lubricated
Boom Swivel Bearing Condition
12 No loose Mounting Bolts, Bearing Not Loose,
Properly Lubricated
13 Boom and Lift Arm Folding Action Smooth and Controlled, Function Test
Man Bucket General Condition No Fatigue Cracks, No Excess Bending or Deformation, No Excessive
14
Twisting, No Exessive Kinking
15 Swing System All Actions Smooth and Controlled
16 Swing Brake Must Be Positive ACtion, Witness a Function Test
18 Carrier Maneuvering and Steering Systems Smooth and Controlled
Carrier Seat Belts for Driver, Operator, Passenger
19
Good Condition, Properly, Mounted with OEM Hi Tensile Bolts
Seats, Cushions
20
21 Carrier Parking Brake Function Test
22 Carrier Brakes Front and Rear Properly Adjusted, No Air or Fluid Leaks, Function Test

26
27
Carrier Power Steering System, Steering Linkages No Excess Freeplay, No Loose Ball Joints, Lubricated
28
29 Carrier Head Lights-Working Lights-Flood Lights Adequate Illumination, Function Test
30 Carrier Rear Combination Lights Adequate Illumination, Function Test
31 Carrier Front Combination Lights Adequate Illumination, Function Test
Carrier Internal Centrally Mounted Rear View Mirrors
33
Carrier Side mounted Left and Right or Door mounted Rear View Mirrors
34
Page 233 of 378
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35 Carrier Windshield Wipers Wiper Blades Not Perished, Windshield Washer, Test Function
36
38
Access Ladder Steps Handrails Securely Mounted, Ergonomic Design, Good Condition, Not Cracked,
41
Not Bent, Not Dilapidated, No Sharp Edges, No Sharp Corners
Fire Extinguisher
42
43 First Aid Kit Clean Tidy, Completely Full
Body
Cabin Interior
4 Combination Switch Light Switch, Switches Knobs Test Function
2
Repairs
3 Carrier Springs, Suspension System Front / Rear, Straight, Not Bent, No Loose Shackle Pins
8 Carrier Outrigger Remote Control System Levers No Loose Mountings, Loose Pins,Test Function
Page 234 of 378
d
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G

6 Pilot Valves No Leaks
9

Alternator Observe Charging Function, No Bad Noises or Overheating, No Loose Mounts, No Loose
5
Belts

10

Others
1
2
Page 235 of 378
d
oo
G
3
Comments
RW CEM

Page 236 of 378
E PRE-MOB INSPECTION REPORT

Truck, Polecat Truck
Model : Brand :
Location : Owner :
d
oo
/A Remarks
G
N
o
N
Page 237 of 378
d
oo
Remarks
/A
G
N
o
N
Page 238 of 378
d
oo
Remarks
/A
G
N
o
N
Page 239 of 378
d
oo
Remarks
/A
G
N
o
N
Page 240 of 378
d
oo
Remarks
/A
G
N
o
N
all CPI areas

Replace

dioperasikan.
SIGNATURE, Date
Sub-
Sub-Con. Sub-
Con. Con.
Contractor's Name
Page 241 of 378
CONCRETE MIXER TRUCK PRE-MOB INSPE

Applies to Concrete Mixer Truck
Equip. No. : Type :

4 Seat Belts Driver, Operator, Passenger, Good Condition, Properly, Mounted with OEM Hi-Tensile Bolts
11
Page 242 of 378
12
13

18
20
21
Fire Extinguisher
24
Truck Minimum 4kg, Properly Mounted and Accessible. Current and Valid Inspection Tag.
26
27 Safety Guards Covers All in Place, Not Loose, None Missing, Not Modified, Remain within OEM Specs
Body
Cabin and Interior

4 Combination Switch, Light Switch, Switches Knobs Test Function
Page 243 of 378
3 Front and Rear Bumper Bars Straight, Not Bent, No Cracks, No Sharp Edges
5 Suspension System Front / Rear, Straight, Not Bent, No Loose Pins

9 Pipes, Lines, Hoses, Fittings Properly Secured, No Leaks
Special for Concrete Mixer System
1 Main Hydraulic Pump Clean Appearance, No Leaks, Test, Observe Performance

Pump PTO Drive Shaft Clean Appearance, No Loose Coupling, No Excess Vibration, Test, Observe
2
Performance
3 PTO System Proper Safety Guard(s) Covering Drive Belts, Clean Appearance, No Loose Covers
Water Flushing Pump Clean Appearance, No Loose Coupling, No Excess Vibration, Test, Observe
4
Performance
5 Water Flushing System Good Hoses, No Leaks, Test, Observe Performance
6 Water Pipes, Lines, Hoses, Flushing Hose Nozzle Fittings Properly Secured, No Leaks
7 Mixer Drum Agitators and Mixing Baffles not Broken, Not Loose or Cracked, Not Excessively Deformed
Mixer Drum Bearings Upper and Lower Properly Lubricated, Not Broken, Not Loose or Cracked, No
8
Excessive Noise, No Excess Vibration, Test, Observe Performance
Mixer Drum Drive Chain or Drive Gears Properly Lubricated, Not Broken, Not Loose or Cracked, No
9
Discharge Shute System Swing Hinges and Pivots not Broken, Not Loose or Cracked, Not Excessively
10
Deformed, Hydraulic Lift and Lower System Functions Properly, Traveling Lock Functions Properly
Engine - Transmission and Auxiliary Engine if Equipped

Page 244 of 378

8
10 TransmissionTransmission and Auxiliary Transmisson No Leaks, Observe a Function Test
13

Others
1
2
3
Comments

Page 245 of 378
RW CEM

Page 246 of 378

ncrete Mixer Truck
Model : Brand :
Location : Owner :
d
Remarks
oo
d
/A
oo
N
G
o
N
Page 247 of 378
d
Remarks
oo
d
/A
oo
N
G
o
N
Page 248 of 378
d
Remarks
oo
d
/A
oo
N
G
o
N
Page 249 of 378
d
Remarks
oo
d
/A
oo
N
G
o
N

all CPI areas

Replace

dioperasikan.
SIGNATURE, Date
Page 250 of 378
d
Remarks
oo
d
/A
oo
N
G
o
N
Contractor's Name
Page 251 of 378
TRAILERS PRE-MOB INSPECTION REP

Applies to Hi Boy and Lowboy Trailers
Serial No. : Km/Hourmeter : Service Date
d
oo
G
G
o
N
Documentation Operator & Equipment :
2 Original Manufacturer Name Plate on Chassis Year of Manufacture:
3 Original Manufacture Nameplate on Landing Legs Clearly and Visible on Frame
6 Maximum Load Stenciled Clearly and Visible on Frame
9 Nota Pajak - TAX Expiry :
Police Number Plate
10 Expiry :
Rear Same Number as Prime Mover

King Pin and Bearing Plate To Be Totally Washed Clean of All Grease, Look for Excessively
1 Worn or Deformed Kingpin, Bent, Excessive Wear to Kingpin Shoulder, Measure Wear with
Calipers or Go-NoGo Gauge if Required
Tires and Wheels No Broken-Missing Lug Nuts, Tread Depth Minimum 3mm,
2
No Recap / Retread / Vulcanized Tires, Recommend Highway Tread Pattern, Correct Rotation
Axles and Wheel Bearing Lubrication

Hubs
Suspension System No Loose Axle Mount Bolts, No Worn Out Bushings and Pins in Walking
4
Beams or Rocker Arms, All U-Bolts Tight, No Cracks
Flatbed Steel Deck
To be Chequered Plate, No Dangerous Holes, No Fatigue Cracks, No Sharp Edges
Flatbed Wooden Deck
5 Wooden Floor Good Condition, No Rotten Wood, No Dangerous Holes, No Broken Splintered
Sharp Wood
Side Posts, Side Stanchions, Cargo Tie Down Rails
No Bent Side Posts, No Bent Side Stanchions - Side Posts Easily Adjustable
Page 252 of 378
d
oo
G
G
o
N
6 Light Connection Electrical Cable, Inspect Male Plug and Female Socket, No Bare Wires
7 All Electrical Wiring Condition, Fuse Block, All Splices Insulated, No Bare Wires
8 Air Brake Hose Connection Glad Hand Fittings, Rubber Seals, No Air Leaks
Access Ladder Steps Handrails Securely Mounted, Ergonomic Design, Good Condition,
9
Not Cracked, Not Bent, Not Dilapidated, No Sharp Edges, No Sharp Corners
Air Brake System Visually Check Air Brake Adjustment, Watch Slack Adjuster for Excess Travel,
10
Not Out of Adjustment
11 Air Brake System Conduct a "Stall Test" of Brake Function
Truck to Trailer Air Brake Supply System
12 Check both Glad Hand Seals, Check all Hoses, Lines, Pipes, Not Hanging Loose, NO Glad Hand
Rubbers or Hose Leaks.
Truck to Trailer Air Brake Supply System

Trailer Hose and Glad Hand Color Coding:
13 Red Emergency on Left Side and is Yellow or Blue Service on Right Side
Check Hose Correct Color and No Leaks, Lines / Pipes Not Hanging Loose
No Leaks from Glad Hand Rubber Seals
14 For Parking When Disconnected from PM Two Wheel Chocks

Landing Gear - Landing Legs
15 Record Manufacture Label for Rated Capacity, Not To Be Overloaded as per Manufacture Label,
No Loose Diagonal Braces, No Loose Mounting Bolts, Test Function
Low Boy Gooseneck
16
Straight, Not Bent, No Cracks, No Uncertified Welding Repairs, No Fatigue Cracks
18
All Safety Guards Covers in Place, Not Loose, None Missing, Not Modified, Remain within
19
OEM Specs
Underrun protection as appropriate Ensure No Loose, No Crack, No Sharp Edges, No Bent,
20
Straight
Accessories
Working Lights-Flood Lights Adequate Illumination, Properly Mounted, Not a Falling Hazard to
1
Following Motorists, Function Test
Rear Combination Lights Adequate Illumination, Properly Mounted, Not a Falling Hazard to
2
Following Motorists, Function Test
Back-Up Light Adequate Illumination, Properly Mounted, Not a Falling Hazard to Following
3
Motorists, Function Test
5 Under Run Protection Properly Mounted

Others
Page 253 of 378
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G
o
N
1
2
3
Comments
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OB INSPECTION REPORT
oy and Lowboy Trailers
Model : Brand :
Service Date :
Location : Owner :
d
oo
/A Remarks
G
N
o
N
Page 255 of 378
d
oo
Remarks
/A
G
N
o
N
Page 256 of 378
d
oo
Remarks
/A
G
N
o
N

all CPI areas

Replace
cknowledged by CPI The undersigned hereby accept and agree

dioperasikan.
SIGNATURE, Date
Sub-
Con.
Contractor's Name
Page 257 of 378
WELDING MACHINE PRE-MOB INSPECTION

Applies to Welding Machine Diesel Powe

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Equipment Documentation
2 Original Manufacturer Name Plate Year of Manufacture:

1 Copper Grounding Cable and Connections Properly Connected Using Correct Hardware
2 Circuit Breaker Clean Undamaged by Weather
3 Auxiliary Electrical Connection for Power Tools Good Proper Waterproof Receptacle Cover
Welding Leads - Electrode Holder - Ground Clamp
4
Proper Splices, No Twisted Wire Joins, Properly Connected Using Correct Hardware
5 Welding Current Control Rheostats Clean, Readable, Undamaged by Weather
6 Electrical Wiring Condition Fuse Block, All Splices Properly Insulated, No Bare Wires
7 Trailer Towing Ring -Towing Connecting Devices Not Bent, No Fatigue Cracks
Trailer Wheels and Tires, Wheel Condition, No Broken-Missing Lug Nuts, Tread Depth Minimum 3mm, No
8
Recap / Retread / Vulcanized Tires Allowed
Trailer Suspension System, Springs
9
No Loose Axle Mount Bolts, No Worn Out Spring Bushings and Pins All U-Bolts Tight, No Cracks
Brass Stud Bolts Welding Output
10 Proper Insulation on Cable Connection, Good General Condition, Tight, Good Color, Not Burnt, Not
Overheated, Not Loose
Engine Protection Covers All Covers in Place, Not Loose, None Missing, Not Modified, Remain
11
within OEM Specs
Safety Covers and Guards All Covers in Place, Not Loose, None Missing, Not Modified, Remain
12
within OEM Specs
13 Ground Fault Circuit Interrupter (GFCI) Properly Connected, Function Test
14 Tralier Safety Stand Leg Not Bent, Not Unsafe or in Danger of Collapsing
Front Panel
Indicators
1 Engine Oil Pressure Gauge, Engine Temperature, Fuel Gauge, Hourmeter, Battery Voltmeter, Battery
Charging System, etc, All Operating Properly
Page 258 of 378
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2 Engine Controls Easy to Use, Test Function
Frame and Body

2 Engine Cover Hinges Inspect Latches for Safety Holding Brackets, Can NOT Pinch Fingers
Engine

Alternator
5

Others
1
2
3
Comments
RW CEM
Page 259 of 378
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C822444-COR-CEM-CKL-0026 Rev 1 (12 Feb 2015)
Page 260 of 378

Machine Diesel Power
Model : Brand :
Service Date :
Location : Owner :
d
Remarks
oo
/A
G
N
o
N
Page 261 of 378
d
Remarks
oo
/A
G
N
o
N

all CPI areas

Replace
nowledged by CPI The undersigned hereby accept and agree
dioperasikan.
SIGNATURE, Date
Sub-
Con.
Contractor's Name
Page 262 of 378
d
Remarks
oo
/A
G
N
o
N
Page 263 of 378
ELECTRIC WELDING MACHINE PRE-MOB INSPEC

Applies to Welding Machine AC/DC Electric P
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Welding Leads - Electrode Holder - Ground Clamp Proper Splices, No Twisted Wire Joins, Properly
4
Connected Using Correct Hardware
5 Welding Current Control Rheostats Clean, Readable, Undamaged by Weather
Brass Stud Bolts Welding Output
6 Proper Insulation on Cable Connection, Good General Condition, Tight, Good Color, Not Burnt, Not
Overheated, Not Loose
Special Unit Protection Covers
7
All Covers in Place, Not Loose, None Missing, Not Modified, Remain within OEM Specs
8 Ground Fault Circuit Interrupter (GFCI) Properly Connected, Function Test
Body
3 Stand Legs Not Bent, Not Unsafe or in Danger of Collapsing
Front Panel :
1 A/C Power Connection Properly Connected Using Correct Hardware
2 Transformer Not Burnt or Overheating, Properly Connected Using Correct Hardware
Internal Electrical Components
3
Clean General Condition, Good Color, Not Burnt, Not Overheated, Tight, Not Loose
Page 264 of 378
ELECTRIC WELDING MACHINE PRE-MOB INSPEC

Applies to Welding Machine AC/DC Electric P
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Cooling Fan Clear Condition, Airflow Path IN and OUT Not Blocked by Leaves, Dirt, Plastic Bags,
4
Observe Function

Others
1
2
3
Comments
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Page 265 of 378

chine AC/DC Electric Power
Model : Brand :
Service Date :
Location : Owner :
d
oo
Remarks
/A
G
N
o
N
Page 266 of 378

chine AC/DC Electric Power
Model : Brand :
Service Date :
Location : Owner :
d
oo
Remarks
/A
G
N
o
N

all CPI areas
Replace

dioperasikan.
SIGNATURE, Date
Sub-
Con.
Contractor's Name
Page 267 of 378
AIR COMPRESSOR PRE-MOB INSPECTION R

Applies to Air Compressors - Wheeled and Stationary, Diesel

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2 Original Manufacturer Name Plate Year of Manufacture
Air Receiver Tank Original Manufacturer Name Plate Intact Not Modified and Certified with ASME or
6
Equivalent Genuine Reference Number
1 Automatic Overpressure Safety Release Valve Test Function
2 Quick Change Air Hose Couplers Connector and Clamps must be SAFETY WIRED
3 Air Manifold Discharge Check Valve Test Function
Trailer Wheels and Tires, Wheel Condition, No Broken-Missing Lug Nuts, Tread Depth Minimum 3mm,
5
Recap / Retread / Vulcanized Tires Allowed
Trailer Suspension System, Springs, Brakes
6 No Loose Axle Mount Bolts, No Worn Out Spring Bushings and Pins All U-Bolts Tight, No Cracks,
Parking Brake Functional
8
within OEM Specs
Fire Extinguisher Minimum 2kg, Properly Mounted and Accessible. Current and Valid Inspection
9
Tag. Two Safety Triangles
10 Safety Stand Leg Not Bent, Not Unsafe or in Danger of Collapsing
Engine and Main Compressor Unit

Page 268 of 378
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Alternator
5
6 Cooling System, Radiator, Hoses No Leaks, No Perished Hoses
9 Air-Oil Separator Tank-Filters Clean Appearance, No Leaks, Observe Performance
10 A/C Powered Unit Power Connected Properly Connected Using Correct Hardware
11 Hose and Pipes Properly Secured, No Leaks
Frame, Carrier and Body
Others
1
2
3
Comments

Page 269 of 378
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RW CEM

Page 270 of 378
-MOB INSPECTION REPORT

and Stationary, Diesel and Electric Powered
Model : Brand :
Service Date :
Location : Owner :
d
oo Remarks
/A
G
N
o
N
Page 271 of 378
d
oo
Remarks
/A
G
N
o
N
Good = Good condition, able to be operated

in all CPI areas
Replace
knowledged by CPI The undersigned hereby accept and agree

operation. Menerima dan Menyetujui
bahwa Alat ini sudah "OK" dan aman
untuk dioperasikan.
SIGNATURE, Date
Page 272 of 378
d
oo
Remarks
/A
G
N
o
N
Sub-
Con.
Contractor's Name
Page 273 of 378
PILE HAMMER PRE-MOB INSPECTION RE

Applies to Diesel Pile Hammer
Serial No. : Hourmeter : Service Da
d
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1 Lifting Trip Lock System Check Function, Not Worn Out, Not Damaged or Bent
2 Pile Hammer Leads Clamps Not Worn Out, Good General Condition, No Cracks, Good Lubrication
Shackle and Pin Correct Size, Safety Pin Installed, Can not Fall Off or Wind Undone, Can
3
Not Release by Itself
Hammer Head Buffer Wood
4
Made of Suitable Shock Absorbing Hard Wood Material, Suitably Sacrificial
Safety Covers and Guards
5
Main Units :
1 Cylinder Housing Good Clean General Condition, Good Lubrication
2 Hammer Piston Good Clean General Condition, Good Lubrication
3 Fuel Pump No Leaks, Test Function
4 Fuel Line Condition Properly Secured, No Leaks, Test Function
5 Tag Line Made of Good Rope, Good Clean General Condition

Others
1
2
3
Comments
Page 274 of 378
PILE HAMMER PRE-MOB INSPECTION RE

Applies to Diesel Pile Hammer
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RW CEM

Page 275 of 378
esel Pile Hammer
Model : Brand :
Service Date :
Location : Owner :
d
Remarks
oo
/A
G
N
o
N
Page 276 of 378
esel Pile Hammer
Model : Brand :
Service Date :
Location : Owner :
d
Remarks
oo
/A
G
N
o
N

all CPI areas

dioperasikan.
SIGNATURE, Date
Sub-
Con.
Contractor's Name
Page 277 of 378
PILE EXTRACTOR PRE-MOB INSPECTION R

Applies to Pile Extractor Machine
Serial No. : Km/Hourmeter : Service Da
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1 Hydraulic Coupler Connections Good General Condition, Proper Clamps
3 Vibrating Clamp Good General Condition, Test Clamp Function
4 Emergency Stop Undamaged by Weather, Function Test
5
within OEM Specs
Engine and Main Pumping Unit
2 Engine Controls Control Linkages and Levers, Test Function
4 Hydraulic Pump Controls Control Linkages and Levers, Test Function

Alternator
7
Page 278 of 378
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11 Hydraulic Filters Clean Appearance, No Leaks, Observe Condition Indicator
12 A/C Powered Unit Power Connected Properly Connected Using Correct Hardware
Manifold-Pipes-lines for Pressured Hydraulic Oil Distribution

14
All Hydraulic Hoses and Hydraulic Lines, Properly Secured, No Leaks
15 Hydraulic Tank No Loose Mounts, No Leaks, Filler Cap Properly Secured, No Leaks
17
Frame and Body


Others
1
2
3
Comments

Page 279 of 378
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RW CEM

Page 280 of 378

Extractor Machine
Model : Brand :
Service Date :
Location : Owner :
d
Remarks
oo
/A
G
N
o
N
Page 281 of 378
d
Remarks
oo
/A
G
N
o
N

all CPI areas
Replace
dioperasikan.
Page 282 of 378
d
Remarks
oo
/A
G
N
o
N
dioperasikan.
SIGNATURE, Date
Sub-
Con.
Contractor's Name
Page 283 of 378
PORTABLE CONCRETE MIXER PRE-MOB INSP

Applies to Portable Concrete Mixe
Equip. No. : Type :
Serial No. : hourmeter :

2 Trailer Wheels and Tires, Wheel Condition, No Broken-Missing Lug Nuts, Tread Depth Minimum 3mm
Trailer Suspension System, Springs, Brakes No Loose Axle Mount Bolts, No Worn Out Spring Bushings and
3
Pins All U-Bolts Tight, No Cracks, Parking Brake Functional
5
within OEM Specs
6
Body
3
Main Frame and Mixer Drum

1 Main Chassis, Frame Condition Straight, Not Bent, No Cracks
2 Mixer Drum, Not Bent, No Cracks, No Improper Welding Repairs
3 Mixer Drum Baffles Bars. Straight, Not Bent, No Cracks, No Sharp Edges
4 Mixer Drum Mounts Front and Rear, All Bolts Tight, No Cracks
Mixer Drum Bearings Upper and Lower Properly Lubricated, Not Broken, Not Loose or Cracked, No
5
Mixer Drum Drive Chain or Drive Gears Properly Lubricated, Not Broken, Not Loose or Cracked, No
6
Page 284 of 378
7 Mixer Drum Wheel, Not Broken, Not Loose or Cracked, Test, Observe Performance
Discharge Shute System Hinges and Pivots not Broken, Not Loose or Cracked, Not Excessively Deformed,
8
Lift and Lower System Functions Properly, Traveling Lock Functions Properly
Water Flushing Pump Clean Appearance, No Loose Coupling, No Excess Vibration, Test, Observe
9
Performance
10 Water Flushing System Good Hoses, No Leaks, Test, Observe Performance
11 Water Pipes, Lines, Hoses, Flushing Hose Nozzle Fittings Properly Secured, No Leaks
General Fluids, Fuel, Hoses

3 Pipes, Lines, Hoses,Fittings Properly Secured, No Leaks
Gasoline or Diesel "Auxiliary" Engine - Transmission


7 V-Belts Not Loose, Not Squealing, Not Cracked
Engine PTO and Transmisson, Drive Shafts, Bearing
8

Others
1
2
3
Comments
Page 285 of 378
RW CEM

Page 286 of 378
R PRE-MOB INSPECTION REPORT

able Concrete Mixer
Model : Brand :
Service Date :
Location : Owner :
d
Remarks
oo
d
/A
oo
N
G
o
N
Page 287 of 378
d
Remarks
oo
d
/A
oo
N
G
o
N
Page 288 of 378
d
Remarks
oo
d
/A
oo
N
G
o
N
all CPI areas

Replace

dioperasikan.
SIGNATURE, Date
Sub-
Sub-Con.
Con.
Contractor's Name
Page 289 of 378
PORTABLE GENERATOR PRE-MOB INSPECTI

Applies to Portable Genset
Serial No. : Hourmeter : Service D
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Special Electrical Receptacle Protection Covers

4

5
Trailer Suspension System, Springs, Brakes No Loose Axle Mount Bolts, No Worn Out Spring
8
Bushings and Pins All U-Bolts Tight, No Cracks, Parking Brake Functional
9
within OEM Specs
Body
Page 290 of 378
d
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Front Panel :
1 A/C Power Connection Properly Connected Using Correct Hardware
2 Transformer Not Burnt or Overheating, Properly Connected Using Correct Hardware
Internal Electrical Components

3
Clean General Condition, Good Color, Not Burnt, Not Overheated, Tight, Not Loose
Air Cooling Clear Condition, Airflow Path IN and OUT Not Blocked by Leaves, Dirt, Plastic Bags,
4
Observe Function
Engine

Alternator
5

Others
1
Page 291 of 378
d
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2
3
Comments
RW CEM

Page 292 of 378

Portable Genset
Model : Brand :
Service Date :
Location : Owner :
d
oo
Remarks
/A
G
N
o
N
Page 293 of 378
d
oo
Remarks
/A
G
N
o
N
Page 294 of 378
d
oo
Remarks
/A
G
N
o
N Good = Good condition, able to be operated in
all CPI areas
Replace

dioperasikan.
SIGNATURE, Date
Sub-Con.
Sub-
Con.
Contractor's Name
Page 295 of 378
HYDROSTATIC TEST PUMP PRE-MOB INSPECTI

Applies to HydrostaticTest Pump

d
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2 Quick Change Hose Couplers Connector and Clamps must be SAFETY WIRED
3 Pressure Manifold Discharge Check Valve Test Function

7
within OEM Specs
Engine and Main Pumping Unit

Page 296 of 378
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Alternator
5
Frame and Body
Others
1
2
3
Comments
RW CEM

Page 297 of 378

rostaticTest Pump
Model : Brand :
Service Date :
Location : Owner :
d
oo
/A Remarks
G
N
o
N
Page 298 of 378
d
oo
Remarks
/A
G
N
o
N

in all CPI areas
Replace

untuk dioperasikan.
SIGNATURE, Date
Sub-Con.
Sub-
Con.
Contractor's Name
Page 299 of 378
WATER PUMP PRE-MOB INSPECTION RE

Applies to Water Pump

d
oo
G
2 Trailer Wheels and Tires, Wheel Condition, No Broken-Missing Lug Nuts, Tread Depth Minimum 3mm,

5
within OEM Specs
Engine and Main Pump Unit

Alternator
5
Page 300 of 378
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10 Pump Housing No Cracks, No leaks
11 Flexible Drive Coupling between Pump and Engine No Loose Bolts, No Excess Misalignment
12 Pump Mounting No Cracks, No Loose Mount Bolts
Frame and Body


Others
1
2
3
Comments
RW CEM

Page 301 of 378
o Water Pump
Model : Brand :
Service Date :
Location : Owner :
d
oo Remarks
/A
G
N
o
N
Page 302 of 378
d
oo
Remarks
/A
G
N
o
N

in all CPI areas
Replace

untuk dioperasikan.
SIGNATURE, Date
Sub-Con.
Sub-
Con.
Contractor's Name
Page 303 of 378
CONCRETE VIBRATOR PRE-MOB INSPECTION

Applies to Concrete Vibrator Mechanical, Air, El
Serial No. : Service D

d
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1 Coupler and Rubber All Connection in good condition no damage (Air Type)
2 Plug and Cable Ensure the cable and plug in good condtion
3 Vibrator Head Ensure no damage and in good condtion
4
within OEM Specs
5
6
Engine Unit and Vibratory Head

3 Recoil Starter Rope Test Function, Adequate Strength, No Frayed Places
5 Vibratory Head Test and Observe Performance
6 Cable Drive Properly Secured, No Binding, Spins Freely
Frame, Carrier and Body

1 General Condition Good Paint and General Appearance, No Excess Damage, No Rust
2 Engine Covers Inspect Latches for Safety Holding Brackets, Can NOT Pinch Fingers

Page 304 of 378
CONCRETE VIBRATOR PRE-MOB INSPECTION

Applies to Concrete Vibrator Mechanical, Air, El

d
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G
Others
1
2
3
Comments
RW CEM

Page 305 of 378

tor Mechanical, Air, Electrical
Model : Brand :
Service Date :
Location : Owner :
d
oo Remarks
/A
G
N
o
N
Page 306 of 378

tor Mechanical, Air, Electrical
Model : Brand :
Service Date :
Location : Owner :
d
oo Remarks
/A
G
N
o
N

in all CPI areas
Replace

untuk dioperasikan.
SIGNATURE, Date
Sub-Con.
Sub-
Con.
Contractor's Name
Page 307 of 378
SANDBLASTER PRE-MOB INSPECTION RE

Applies to Sand Blasting Equipment

d
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G
Air Receiver Tank Original Manufacturer Name Plate Intact Not Modified and Certified with ASME or
6
Equivalent Genuine Reference Number

2 Quick Change Air Hose Couplers Connector and Clamps must be SAFETY WIRED
3 Air Manifold Discharge Check Valve Test Function

8
within OEM Specs
9 Safety Stand Legs Not Bent, Not Unsafe or in Danger of Collapsing
10 Safety Cable or hose connector No rust good condition, function test
Main Unit
1 Sand Pot
2 Coupler and Hose All Coupler and hose in good condition no damage
3 Connection and Extentension All Connection in good condition no damage
4 Fitting and Clamps All Fitting and Clamp in good condition no damage
5 Valve All valves in good condition no damage
Frame and Body

Page 308 of 378
SANDBLASTER PRE-MOB INSPECTION RE

Applies to Sand Blasting Equipment

d
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2 Covers Hinges Inspect Latches for Safety Holding Brackets, Can NOT Pinch Fingers

Others
1
2
3
Comments
RW CEM

Page 309 of 378

Blasting Equipment
Model : Brand :
Service Date :
Location : Owner :
d
oo Remarks
/A
G
N
o
N
Page 310 of 378

Blasting Equipment
Model : Brand :
Service Date :
Location : Owner :
d
oo Remarks
/A
G
N
o
N

in all CPI areas
Replace

untuk dioperasikan.
SIGNATURE, Date
Sub-Con.
Sub-
Con.
Contractor's Name
Page 311 of 378
ASPHALT and CONCRETE CUTTING MACHINE PRE-MOB

Applies to Concrete - Asphalt Cutter and Br
d
oo
G

1 Handle Good General Condition, Proper instalation
3
within OEM Specs
4 Ensure the cutter wheel in good condition no damage
Body
Engine Unit and Cutter Head

11 Cutter Drive Properly Secured, No Binding, Spins Freely

Page 312 of 378
ASPHALT and CONCRETE CUTTING MACHINE PRE-MOB

Applies to Concrete - Asphalt Cutter and Br
d
oo
G
Others
1
2
3
Comments
RW CEM

Page 313 of 378
MACHINE PRE-MOB INSPECTION REPORT

Asphalt Cutter and Breaker
Model : Brand :
Service Date :
Location : Owner :
d
oo
Remarks
/A
G
N
o
N
Page 314 of 378
MACHINE PRE-MOB INSPECTION REPORT

Asphalt Cutter and Breaker
Model : Brand :
Service Date :
Location : Owner :
d
oo
Remarks
/A
G
N
o
N

all CPI areas
Replace

dioperasikan.
SIGNATURE, Date
Sub-Con.
Sub-
Con.
Contractor's Name
Page 315 of 378
HAND PLATE COMPACTOR PRE-MOB INSPECT

Applies to Hand Plate Compactor
d
oo
G

3
within OEM Specs
Body
3 Vibrator Plate Inspect the Vibrator Plate in good condition and no damage
Engine Unit and Vibratory System

11 Vibratory System Properly Secured, No Binding, Spins Freely
12 Ensure the V-Belt Check the v-belt in good condition no damage
13
14
Page 316 of 378
HAND PLATE COMPACTOR PRE-MOB INSPECT

Applies to Hand Plate Compactor
d
oo
G
15
Others
1
2
3
Comments
RW CEM

Page 317 of 378

d Plate Compactor
Model : Brand :
Service Date :
Location : Owner :
d
oo
Remarks
/A
G
N
o
N
Page 318 of 378

d Plate Compactor
Model : Brand :
Service Date :
Location : Owner :
d
oo
Remarks
/A
G
N
o
N

all CPI areas
Replace

dioperasikan.
SIGNATURE, Date
Sub-Con.
Sub-
Con.
Contractor's Name
Page 319 of 378
HAND COMPACTOR ROLLER PRE-MOB INSPECT

Applies to Hand Compactor Roller
d
oo
G

3
within OEM Specs
Body
3 Safety Stand Legs Not Bent, Not Unsafe or in Danger of Collapsing
4 Ensure all hoses Check the hose no leaks
Engine Unit and Vibratory System

11 Roller & Vibratory System Properly Secured, No Binding, Spins Freely
12 Ensure the V-Belt Check the v-belt in good condition no damage
13 Ensure the Control Check all control lever in good condition no damage

Page 320 of 378
HAND COMPACTOR ROLLER PRE-MOB INSPECT

Applies to Hand Compactor Roller
d
oo
G
Others
1
2
3
Comments
RW CEM

Page 321 of 378

d Compactor Roller
Model : Brand :
Service Date :
Location : Owner :
d
oo
Remarks
/A
G
N
o
N
Page 322 of 378

d Compactor Roller
Model : Brand :
Service Date :
Location : Owner :
d
oo
Remarks
/A
G
N
o
N

all CPI areas
Replace

dioperasikan.
SIGNATURE, Date
Sub-Con.
Sub-
Con.
Contractor's Name
MISCELLANEOUS EQUIPMENT IN OUT INSPECT
Applies to Miscellaneous
d
oo
G
N
5 Correct Size, Minimum 10 Cm Height, Visible Correct Size, Minimum 10 Cm Height, Visible

1 Appearance and machine safe to operate / test Paint, rust, stains, cleanliness
2 Hydraulic fluid tank and cap contamination, fluid level, instalation, leak.
3 Hoses and fittings cracked, bent, broken, instalation, leaks, wear, frayed, cut
4 Hydraulic system operation
5 Hydraulic valves, cylincers etc instalation, wear, frayed, cut, operation.
6 Gearbox planeraty fluid level, instalation, operation.
7 Sheet metal and guards cracked, bent, broken, fluid level, operation
Wheels, / tires, lugs inflation cracked, bend, broken, instalation, leaks, torqued properly, wear,
8
frayed,cut
9 Towing / parking components cracked, bent, broken, instalation, operation
10 Unit cooling system cleanliness, contamination, instalation, leaks
11 Electrical wiring instalation, operation, wear, frayed, cut
12 Panel control cracked, instalation, all componen operation
13 Shut down / override system instalation, operation
14 Aux power output opertion
15 GFCI / circuit protection instalation, operation
16 Lifting, fixtures, tower etc cracked, bent, broken, instalation, operation
17 Electrical components cracked, bent, broken, instalation, wear, frayed, cut
18 Sweeper, scrubber brushes adjustment, instalation, operation, wear, frayed, cut
19 Sweeper, scrubber brushes vaccums system adjustment, instalation, operation, leaks
Page 323 of 378

d
oo
G
N
20 Scrubber water reclamation adjustment, cracked, bent, broken, instalation, operation, leaks
21 Load / output test adjustment, operation
22 All function checkout adjustment, operation
Engine
1 Fuel tank and cap contamination, fluid level, instalation, leak.
2 Engine oil contamination, fluid level, leaks
3 Battery, cables and charge instalation, leaks, operation, wear, frayer, cut
4 Exhaust system cracked, bent, broken, instalation, leaks, operation
5 Engine ferformance operation
6 Fuel system adjustment, instalation, leaks, operation
7 Air intake system cracked, bent, broken, instalation, leaks
8 Starting system operation
9 Alternator Operation
10 Belts adjustment, instalation, wear, frayed, cut

Others
1
2
3
Comments
Page 324 of 378

d
oo
G
N
RW CEM
Page 325 of 378

NT IN OUT INSPECTION REPORT
Miscellaneous
Model : Brand :
Service Date :
Location : Owner :
d
Remarks
oo
/A
G
N
o
N
Beberapa item dihilangkan
Page 326 of 378

d
Remarks
oo
/A
G
N
o
N

all CPI areas

dioperasikan.
SIGNATURE, Date
Page 327 of 378

d
Remarks
oo
/A
G
N
o
N
Sub-
Sub-Con.
Con.
Contractor's Name
Page 328 of 378

Applies to Pipe Hanger
d
oo
G
N
1 Company ID Number, Company Logo
2 Original Manufacturer Name Plate if Any
3 Original or a Copy of Operation Manual Book if Any
4 SOP - Standard Operating Procedure
5 Original Copy Available of Test Load
6 Size of Pipe Hanger
8
9
10

1 Appearance and pipe hanger safe to operate / test Paint, rust, stains, cleanliness
2 Ensure no Welding Craked no rusty, instalation.
3 Ensure No Bent check, bent, broken, instalation.
4 Ensure Color Code Still Valid check color and date.
5
6
7
9
10
11
12
13
14
Page 329 of 378

d
oo
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N
15

1 Maintenance Schedule - Inspection Quarterly Records Available
Others
1
2
3
Comments
RW CEM
C822444-COR-CEM-CKL-0041 Rev 0 (17 Nov. 2014)
Page 330 of 378

o Pipe Hanger
Model : Brand :
Service Date :
Location : Owner :
d
Remarks
oo
/A
G
N
o
N
Page 331 of 378

d
Remarks
oo
/A
G
N
o
N

all CPI areas

dioperasikan.
SIGNATURE, Date
Sub-
Sub-Con.
Con.
Contractor's Name
Page 332 of 378

Applies to Drop Hammer
d
oo
G
N
5 Original Copy Available of Test Load
6 Size of Pipe Hanger
8
9
10

1 Appearance and drop hammer safe to operate / test Paint, rust, stains, cleanliness
2 Ensure no Welding Craked no rusty, instalation.
3 Ensure No Bent check, bent, broken, instalation.
5
6
7
9
10
11
12
13
14
Page 333 of 378

d
oo
G
N
15

Others
1
2
3
Comments
RW CEM
Page 334 of 378

o Drop Hammer
Model : Brand :
Service Date :
Location : Owner :
d
Remarks
oo
/A
G
N
o
N
Page 335 of 378

d
Remarks
oo
/A
G
N
o
N

all CPI areas

dioperasikan.
SIGNATURE, Date
Sub-
Sub-Con.
Con.
Contractor's Name
Page 336 of 378

MISCELLANEOUS TOOLS IN OUT INSPECTION
Applies to Hand Tools
Serial No. : Hourmeter : Service Date :
d
oo
d
oo
G
G
o
N
1 Company ID Number, Company Logo (Box)
5 Original Copy Available of Cestificate
7
Description Of Tools Size Quantity

Appearance and Tools safe to operate / test Paint, rust, stains,
1
no local made, and cleanliness
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
Page 337 of 378

d
oo
d
oo
G
G
o
N
19
20
21
22
23
24
Others
1
2
3
Comments
RW CEM
Page 338 of 378

IN OUT INSPECTION REPORT
o Hand Tools
Model : Brand :
Service Date :
Location : Owner :
N
/A
Remarks
Page 339 of 378

Remarks
/A
N

all CPI areas

dioperasikan.
SIGNATURE, Date
Sub-Con.
Sub-
Con.
Contractor's Name
Page 340 of 378

ASPHAT FINISHER EQUIPMENT IN OUT INSPEC
Applies to Asphalt Finsher
d
oo
G
N
1 Today's Pre-Trip Inspection
2 Original Manufacturer Name Plate
3 Original or a Copy of Operation Manual Book
6 Original Copy Available on Unit
8 Matches Unit Type and Series
9 Based on OEM Operation Manual Book
10 Correct Size, Minimum 10 Cm Height, Visible

1 Appearance and machine safe to operate / test Paint, rust, stains, cleanliness
2 Crawler Track Links No Excessively Loose or Worn Pins or chain link
3 Oscillating Axle No Excessively Loose and nor leaks
4 Oscillating Push Roller No damage and properly working order
5 Hopper and Feeders No damage, properly working order and no leak of the cylinder
6 Spreading Screws No speriral damage, properly working order
7 Controls Joistick steering No speriral damage, properly working order, no leaks and test
8 Tamper Drive No damage and properly working order
9 Tamper Bars No damage and properly working order
10 Screed Plate Screed plate no damage and properly working order
11 Crown Control Screed plate hinge at center no damage and properly working order
12 Hydraulic fluid tank and cap contamination, fluid level, instalation, leak.
13 Hoses and fittings cracked, bent, broken, instalation, leaks, wear, frayed, cut
14 Hydraulic system operation
Page 341 of 378

d
oo
G
N
15 Hydraulic valves, cylincers etc instalation, wear, frayed, cut, operation.
16 Gearbox planeraty fluid level, instalation, operation.
17 Sheet metal and guards cracked, bent, broken, fluid level, operation
Wheels, / tires, lugs inflation cracked, bend, broken, instalation, leaks, torqued properly, wear,
18
frayed,cut
19 Towing / parking components cracked, bent, broken, instalation, operation
20 Unit cooling system cleanliness, contamination, instalation, leaks
21 Electrical wiring instalation, operation, wear, frayed, cut
22 Panel control cracked, instalation, all componen operation
23 Shut down / override system instalation, operation
24 Aux power output opertion
25 Lifting, fixtures, tower etc cracked, bent, broken, instalation, operation
26 Electrical components cracked, bent, broken, instalation, wear, frayed, cut
27 Sweeper, scrubber brushes adjustment, instalation, operation, wear, frayed, cut
28 Scrubber water reclamation adjustment, cracked, bent, broken, instalation, operation, leaks
29 Load / output test adjustment, operation
30 All function checkout adjustment, operation
Engine
1 Fuel tank and cap contamination, fluid level, instalation, leak.
2 Engine oil contamination, fluid level, leaks
3 Battery, cables and charge instalation, leaks, operation, wear, frayer, cut
4 Exhaust system cracked, bent, broken, instalation, leaks, operation
5 Engine ferformance operation
6 Fuel system adjustment, instalation, leaks, operation
7 Air intake system cracked, bent, broken, instalation, leaks
8 Starting system operation
9 Alternator Operation
10 Belts adjustment, instalation, wear, frayed, cut

Others
Page 342 of 378

d
oo
G
N
1
2
3
Comments
RW CEM
Page 343 of 378

Asphalt Finsher
Model : Brand :
Service Date :
Location : Owner :
d
Remarks
oo
/A
G
N
o
N
Page 344 of 378

d
Remarks
oo
/A
G
N
o
N
Page 345 of 378

d
Remarks
oo
/A
G
N
o
N

all CPI areas

dioperasikan.
SIGNATURE, Date
Sub-
Sub-Con.
Con.
Contractor's Name
Page 346 of 378

HYDRAULIC POWER PACK PRE-MOB INSPECTI
Applies to Hydraulic Power Pack
Serial No. : Km/Hourmeter : Service Da
d
oo
G

1 Hydraulic Coupler Connections Good General Condition, Proper Clamps
4
within OEM Specs
Engine Unit
2 Engine Controls Control Linkages and Levers, Test Function

Alternator
6
7 D/C Powered Unit Power Connected Properly Connected Using Correct Hardware
Engine Indicators
8 Gauges for Fuel, Hours, Kms, Odometer, Temperature, Battery Voltmeter, Battery Charging System,
etc, All Operating Properly

12 All Filters, Fuel, Oil. Air Inspect Condition, No Bad Condition
Manifold-Pipes-lines
14
Properly Secured, No Leaks
16
Power Pack Unit

2 Hydraulic Pump Controls Control Linkages and Levers, Test Function
4 Hydraulic Filters Clean Appearance, No Leaks, Observe Condition Indicator
5 Hydraulic Tank No Loose Mounts, No Leaks, Filler Cap Properly Secured, No Leaks
Manifold-Pipes-lines for Pressured Hydraulic, Coupler, fitting, Oil Distribution
7
8 Hydraulic Oil Cooler No Leaks, Test Function
Hydraulic Oil Cooler Lines
9
10 D/C Powered Unit Power Connected Properly Connected Using Correct Hardware
Hydraulic Indicators
11
Gauges for Pressure, Hours, etc, All Operating Properly
Frame and Body

2 Machine Cover Hinges Inspect Latches for Safety Holding Brackets, Can NOT Pinch Fingers

Others
1
2
3
Comments
RW CEM
C822444-COR-CEM-CKL-0045 Rev 0 (27 June 2014)

ECTION REPORT
k
del : Brand :
vice Date :
ation : Owner :
d
Remarks
oo
/A
G
N
o
N
all CPI areas
Replace
dioperasikan.
SIGNATURE, Date
Sub-
Con.
Contractor's Name
PILE HAMMER PRE-MOB INSPECTION REPO
Applies to Hydraulic Pile Hammer
Serial No. : Hourmeter : Service Date :
d
oo
d
oo
N
G
o
N

1 Hammer Leads Clamps Not Worn Out, Good General Condition
2 Mounting Eye Assembly Check Function, Not Worn Out, Not Damaged or Bent
3 Lifting Trip Lock System Check Function, Not Worn Out, Not Damaged or Bent
Hammer Head
4
Made of Suitable Shock Absorbing Hard Wood Material, Suitably Sacrificial
5 Hammer Construction Not Worn Out, Not Damaged or Bent, Manufacturer
6
Shackle and Pin Correct Size, Safety Pin Installed, Can not Fall Off or Wind Undone, Can
7
Not Release by Itself
Main Units :
1 Top Cover Assembly Check Function, Not Worn Out, Not Damaged or Bent
2 Cylinder Assembly Check Function, Not Worn Out, Not Damaged or Bent
3 Cylinder Housing Assembly Check Function, Not Worn Out, Not Damaged or Bent
4 Piston Rod Assembly Check Function, Not Worn Out, Not Damaged or Bent
5 Connecting Rod Assembly Check Function, Not Worn Out, Not Damaged or Bent
6 Ram Housing Assembly Check Function, Not Worn Out, Not Damaged or Bent
7 Ram Assembly Check Function, Not Worn Out, Not Damaged or Bent
8 Cap Housing Assembly Check Function, Not Worn Out, Not Damaged or Bent
9 Drive Cap Assembly Check Function, Not Worn Out, Not Damaged or Bent
10 Pile Cap Assembly Check Function, Not Worn Out, Not Damaged or Bent
11 Leader Guide Assembly Check Function, Not Worn Out, Not Damaged or Bent
Hydraulic Units :
1 Hydraulic Cylinder Check Function, Not Worn Out, Not Damaged or Bent, Not Leaks.
2 Hydraulic Accumulator Check Function, Not Worn Out, Not Damaged or Bent, Not Leaks.
3 Accumulator Bladder Check Function, Not Worn Out, Not Damaged or Bent, Not Leaks.
Elelctrical Units :
1 Electrical Wiring Condition All Splices Insulated, No Bare Wires
2 Remote Control Check Function, All Splices Insulated, No Bare Wires

Others
1
2
3
Comments
RW CEM
C822444-COR-CEM-CKL-0046 Rev 0 (27 June 2014)

EPORT
Brand :
Owner :
Remarks
/A
N
all CPI areas

dioperasikan.
SIGNATURE, Date
Sub-
Con.
Contractor's Name
Applies to GFCI
d
oo
G
N
1 Today's Pre-Trip Inspection
2 Original Manufacturer Name Plate
3 Original or a Copy of Operation Manual Book
7 Correct Size, Minimum 10 Cm Height, Visible

1 Copper Grouding Cable and Connections Property Connected Using Correct Hardware
2 GFCI Anti Contact Automatic switch
3 Auxiliary Electrical Connectiong for Power Tolls Good Proper Waterfroof Receptacle Cover
Brass Stud Bolts Out Put Proper Insulation on cable Connection Good General Condition, tight, good
4
color, not bumt, not overheated
Safety Covers and guards all covers in place, not loose, none missing, not modified remind within
5
LOTO and TAG.
6 Electrical wiring condition fuse block, all splices property insulated, no bare wires
7 Safety Stand Leg not bent, not unsafe or in danger of collapsing
Front Panel
1 Switch control easy to use, test function
2 Indicator easy to read, function when operation
Frame and Body

1 Body condition good paint and general appearance, not excess damage, not rust
2 Electric Cover Hinges inspect latches for safety holding brackets can NOT pinch fingers
Engine
1 Circuit clean appearance, no leaks, observed performance
Page 357 of 378

d
oo
G
N
2 Switch test function, adequate cranking strength, no bad noises of overheating, easy to use
3 Cooling System
4 Output System inspect cable, conection, covers

Others
1
2
3
Comments
RW CEM
C822444-COR-CEM-CKL-0047 Rev 0 (13 Jan 2015).
Page 358 of 378

es to GFCI
Model : Brand :
Service Date :
Location : Owner :
d
Remarks
oo
/A
G
N
o
N
Page 359 of 378

d
Remarks
oo
/A
G
N
o
N

all CPI areas

dioperasikan.
SIGNATURE, Date
Sub-
Sub-Con.
Con.
Contractor's Name
Page 360 of 378

Page 361 of 378
Applies to Tractor and Rotavator Attachmen
Equip No : Type: Model :
d
oo
d
oo
G
G
o
N

Number

4 Steering System Smooth and Controlled
9 Rear and Front Combination Lights Adequate Illumination, Function Test
11
12
14
Page 362 of 378
d
oo
d
oo
G
G
o
N
Fire Extinguisher
15
17
18
Tractor Front Axle Wheel Bearing Lubrication
19 Oil-Hubs to Be Properly Filled and No Leaks, No Missing Covers / Caps on Grease Type Hubs
Tire and Wheel Condition No Broken-Missing Lug Nuts Front and Rear, Tread Depth Minimum
Correct Rotation, All-Terrain Tread Mud-Grip Pattern
Body
Main Frame, Main Chassis, Backhoe Side Shift Frame

1
Welding Repairs
5 No Loose Belts

12
13 Different lock unit.No leaks,all mountings tight, no loose,Observe a function test
Page 363 of 378
d
oo
d
oo
G
G
o
N
14 Four wheel drive system .Observe a function test
Attachment Tractor-towed recycle and stabilizers

Drive Shaft Line, Propeller Shafts, U-Joints, Center Carrier Bearing
1
2 Drive Rotor Properly Installed, and All Mountings Tight, No Loose
3 Drive Gear Properly Installed, and Function Test
4 Recycle Cover Properly Installed, and All Mountings Tight, No Loose

Rotor Housing Lifting Arms Linkages No Excessively Worn Pins/Bushings, All Pins Properly
5
6 Tip, Teeth, Adapter Properly Installed, and Function Test and Working order
7 Linked Couplers Properly Installed, and Function Test and Working order
8 Hyd. Cylinder Properly Installed, and Fucntion test and working order

Others
1
2
3
Comments
RW CEM
Page 364 of 378
d
oo
d
oo
G
G
o
N
Page 365 of 378
nd Rotavator Attachment
Model : Brand :
Service Date :
Location : Owner :
Remarks
/A
N
Page 366 of 378
Remarks
/A
N
Page 367 of 378
Remarks
/A
N
Sub-Con.

all CPI areas
Replace

dioperasikan.
SIGNATURE, Date
Sub-
Sub-Con.
Con.
Contractor's
Page 368 of 378
Remarks
/A
N
Page 369 of 378
ASPHALT and CONCRETE BREAKER PRE-MOB INS

Applies to Concrete/Asphalt Breaker
d
oo
G

3
within OEM Specs
4 Ensure the cutter wheel in good condition no damage
Body
1 Switch Trigger Clean Appearance, working order and test function
2 Side Handle No damage
4 Cap Cover No damage
8 Handle and Cover No damage.
11 Electrical cable cord and Plug Properly installed, Secured, No damage
12 Chisel, Point, Cutter and scoop
14
16
18
20
22
24

Page 370 of 378
ASPHALT and CONCRETE BREAKER PRE-MOB INS

Applies to Concrete/Asphalt Breaker
d
oo
G
Others
1
2
3
Comments
RW CEM
C822444-COR-CEM-CKL-0049 Rev 0 (2 Mar 2015)

Page 371 of 378
KER PRE-MOB INSPECTION REPORT

rete/Asphalt Breaker
Model : Brand :
Service Date :
Location : Owner :
d
oo
Remarks
/A
G
N
o
N
Page 372 of 378
KER PRE-MOB INSPECTION REPORT

rete/Asphalt Breaker
Model : Brand :
Service Date :
Location : Owner :
d
oo
Remarks
/A
G
N
o
N

all CPI areas
Replace

dioperasikan.
SIGNATURE, Date
Sub-Con.
Sub-
Con.
Contractor's Name
Page : 373 of 378
ROADSIDE INSPECTIONS FOR SAFET
CHECKLIST
Inspected by : Date : Locatio
d
oo
G

14 MIGAS SKPP Certificate Matches Unit Type -Series Expiry :
Safety Inspections and Devices

2 All Light Adequate Illumination, Function Test
Wire Rope No Excess of Broken Wire Strands, ensure the length of wire rope and size as per OEM
6
recommended and function test, refer to ASME B30.07
Page : 374 of 378
d
oo
G
Special for PROPER and SAFE mounting of Crane Column Base onto Truck Chassis for Foco Truck
Must use only genuine OEM supplied hardware, i.e., Brackets, U-Bolts, long straight Bolts, Clamp Plates
and Spacers.
A total of eight (8) long straight Bolts or four (4) U-Bolts per crane.
All U-Bolts, Bolts, and Nuts, must be made of Hi-Tensile 120,000 psi (Grade 8) Steel.
All Spacers, Fastening Plates must have been formed by use of a Milling machine.
7
All holes in Clamp plates must have been drilled by a Drilling Machine.
Nothing, no parts, no holes, nothing is allowed to have been cut or formed by using an Oxy/Acetylene
Cutting Torch.
No holes are allowed to be drilled in the truck chassis RAILS.
No welding is allowed to be done to the truck Chassis RAILS.
Fastening Clamp Plates which are BENT are too thin and therefore are not permitted.
8 Steering Systems Function Test, Smooth and Controlled, Easy Maneuvering

Bushings in Stick, Boom, Arm, Linkages for All Implements
9 All Pins Properly Secured with Split Cotter Pins and/or Bolted End Plates, Not Worn Out, Tight, No Loose
Bolts
Dump, Blade , No Fatigue Cracks, No Excessive Bending or Twisting,
10
No Deformed or Loose Pins, Function Test
11
not allowed for all vehicles, including heavy vehicles), see IBU-MVS - page : 4. all rear tires on all axles
must be same Tread (V-Lug or S-Lug, or U-Lug and Rib-Lug)
12
Seats, Cushions
or Dilapidated
14
Fire Extinguisher
16
Body & Chassis Condition Good Paint and General Appearance, No Excess Damage, No Rust, Main
19
Chassis, Frame Good Condition, Straight, Not Bent, No Cracks, No Uncertified Welding Repairs
Under carriage group Good Condition, Straight, Not Bent, No Cracks, No Excess Misalignment, No Leaks,
21
No Flat Spots, No Badly Worn or Loose Bushings, No Uncertified Welding Repairs
23 Hydraulic system Properly Secured, No Leaks
Engine Group Clean Appearance, No Leaks, No Defective Mounts, Observe Performance,
24
No Smoke
26
27 Electric System
28 Accessories
Page : 375 of 378
d
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G
29 SMO HE PROCEDURE
Others
1
2
3
Comments
Inspected by: The undersigned hereby accept and a

Menerima dan Menyetujui bahwa
RW CEM - COORDINATOR
C822444-COR-CEM-CKL-0050 Rev.0 (4 Sept. 2015)

Page : 376 of 378
CTIONS FOR SAFETY
CKLIST
Model : Brand :
Location : oo
d
Owner :
Remarks
/A
G
N
o
N
Page : 377 of 378
d
oo
Remarks
/A
G
N
o
N
Page : 378 of 378
d
oo
Remarks
/A
G
N
o
N
Good = Good condition, able to be

operated in all CPI areas
Replace
ersigned hereby accept and agree that this equipment is "OK" and safe for operation.
nerima dan Menyetujui bahwa Alat ini sudah "OK" dan aman untuk dioperasikan.
Sub-
Con.
OPERATOR

Pre-Mob Inspection Checklists 2 January 2016

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IBU Vehicle Selection & Maintenance Procedure

2.6. Keselamatan Ban Halam # 4

Tapak ban memberikan mencengkeram dan traksi un

2.6 Tire Safety - Page # 4.

The tire tread provides the gripping action and traction t

VEHICLE - PRE-MOB INSPECTION

Equip. No. : Type : Model :

Serial No. : Km/Hourmeter : Service

Inspected by : Date : Location

2 Original Manufacturer Name Plate with Serial Number Year of Manufacture:

Mandatory Safety Inspections and Devices

23 First Aid Kit Clean, Tidy, Completely Full

Cabin and Interior

Main Frame and Main Chassis

General Hydraulics, Fluids, Fuel Lines, Hoses

Servicing and Maintenance

Inspected by: Checked by Acknowledged by CPI

C822444-COR-CEM-CKL-0001 Rev 1 (17 Nov 2014)

Service Date : Police No.

Good = Good condition, able to be operated in all CPI areas

VEHICLE - PRE-MOB INSPECTIO

Equip. No. : Type : Model :

Serial No. : Km/Hourmeter : Service

Inspected by : Date : Location

2 Original Manufacturer Name Plate with Serial Number Year of Manufacture:

Mandatory Safety Inspections and Devices

VEHICLE - PRE-MOB INSPECTIO

Equip. No. : Type : Model :

Serial No. : Km/Hourmeter : Service

Inspected by : Date : Location

27 First Aid Kit Clean, Tidy, Completely Full

VEHICLE - PRE-MOB INSPECTIO

Equip. No. : Type : Model :

Serial No. : Km/Hourmeter : Service

Inspected by : Date : Location

Cabin and Interior

Main Frame and Main Chassis

General Hydraulics, Fluids, Fuel Lines, Hoses

VEHICLE - PRE-MOB INSPECTIO

Equip. No. : Type : Model :

Serial No. : Km/Hourmeter : Service

Inspected by : Date : Location

Servicing and Maintenance

Inspected by: Checked by Acknowledged by CPI

VEHICLE - PRE-MOB INSPECTIO

Equip. No. : Type : Model :

Serial No. : Km/Hourmeter : Service

Inspected by : Date : Location

C822444-COR-CEM-CKL-0002 Rev 2 (2 Jan. 2016)

Service Date : Police No.

Service Date : Police No.

Service Date : Police No.

Service Date : Police No.

Good = Good condition, able to be operated in all CPI areas

Service Date : Police No.

FORKLIFT EQUIPMENT PRE-MOB INSPECTIO

Equip. No. : Type : Model :

Serial No. : Km/Hourmeter :

Inspected by : Date : Location :

Original Manufacturer Name Plate with Serial

Mandatory Safety Inspections and Devices

FORKLIFT EQUIPMENT PRE-MOB INSPECTIO

Equip. No. : Type : Model :