MISCELLANEOUS EQUIPMENT IN OUT INSPECTIO

Applies to Miscellaneous

Equip. No. : Type : Model :

Serial No. : Hourmeter : Service Date :

Inspected by : Date : Location :

Description to be Checked

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Equipment Documentation

1 Today's Pre-Trip Inspection Original Copy Available on Unit

2 Original Manufacturer Name Plate 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 Company ID Number, Company Logo Correct Size, Minimum 10 Cm Height, Visible

Mandatory Safety Inspections and Devices

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,
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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

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 Description to be Checked

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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

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

Servicing and Maintenance

1 Maintenance Schedule - PM and PdM Service Records Available

Others

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 Description to be Checked

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Comments

Inspected by: Acknowledged by RW and CPI

RW CM RW HES

CEM March 2012

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T IN OUT INSPECTION REPORT
Miscellaneous

Model : Brand :

Service Date :

Location : Owner :
Remarks
/A
N

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 Remarks

/A
N

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 Remarks

/A
N
Good = Good condition, able to be operated in
all CPI areas
No Good = Broken, Malfunction, Repair or Replace

N/A = Not Applicable

wledged by RW and 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

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