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3 DUMP Truck Inspection Form

This dump truck inspection form documents an inspection of a dump truck. It lists aspects of the truck that were checked such as the general condition, chassis, tires, engine, lights, brakes, hydraulic systems, and more. The inspector notes the condition and any issues found for each aspect. At the end, the inspector provides a recommendation and conclusion summarizing the overall condition of the truck and any work needed. The form is signed by the HSE coordinator and inspector.

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Idam Yo
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341 views2 pages

3 DUMP Truck Inspection Form

This dump truck inspection form documents an inspection of a dump truck. It lists aspects of the truck that were checked such as the general condition, chassis, tires, engine, lights, brakes, hydraulic systems, and more. The inspector notes the condition and any issues found for each aspect. At the end, the inspector provides a recommendation and conclusion summarizing the overall condition of the truck and any work needed. The form is signed by the HSE coordinator and inspector.

Uploaded by

Idam Yo
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLS, PDF, TXT or read online on Scribd
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DUMP TRUCK INSPECTION FORM

Doc. No. Rev. No.


QC-HSE
ATTACHMENT 4
HSE-FF-L.4 D
HSE Date : Page 1 of 1

PEMILIK / COMPANY TAHUN PEMBUATAN /


YEAR MANUFACTURE
MODEL TANGGAL DIPERIKSA / INSPECTION
DATE

POL.NUMBER DRIVER

PABRIK / MANUFACTURE

KONDISI / KETERANGAN /
ASPEK YANG DIPERIKSA/ASPECT TO BE CHECK
CONDITION REMARKS
UMUM/ Kondisi fisik secara umum / Condition physic in general
GENERAL Rangka & Chasis (Karat / Rusak) / Chasis (Corotion / Broken)
Roda / Ban kanan-kiri / Condition Tier (Right / Left)
Mesin (kotor, ada oli, dll / Does Condition Machine Dirty
Knalpot (Diberi Peredam / Diberi Pembalut ?) / Does arrestor has cap
Klaxon / Does Horn working properly
Cairan hidraulic Bocor ? / Does Hydrolic Leak?
Rem / Does Brake work properly
Tutup Tangki BBM / Does cap gasoline appear
KABIN / Pintu (bisa menutup? ada pegangan ?) / Does door can be close and have handle ?
CABIN Lampu penerangan / Does dashboard lamp work
Jendela dan Kaca Jendela (ada yang pecah ?) / Does window and window glass in good
condition?
Kotak P3K / Does first aid box inside?
Pen ha us air hujan (wiper) / Does water in wiper tank full?
Alat Pemadam Api Ringan / Does Fire Extinguisher inside ?
LAMPU/ Lampu Besar / Does infront lamp work
LAMP Lampu Jalan
Lampu Kecil Depan
Lampu Belakang / Does back lamp work
Lampu Rem / Does Brake Lamp Work
Lampu Sign Kanan / Does Right Sign Lamp Work
Lampu Sign Kiri / Does Left Sign Lamp Work
Lampu Mundur / Does Reverse Lamp Work
BAK Hidraulic baik ? / Does hydraulic leak
Karat / Rusak / Does it corotion / broken
Pintu Belakang (Baik / Macet ) / Does back door in good condition
REKOMENDASI / RECOMMENDATION
:………………………………………………………………………………………………………………………..
KESIMPULAN / CONCLUSION
:………………………………………………………………………………………………………………………..

:………………………………………………………………………………………………………………………..

Mengetahui / Acknowledge Prepared by :

Controlled Copy, Do Not Duplicate For Internal Use Only


(………………………) (………………………)
HSE Coordinator Inspector

Controlled Copy, Do Not Duplicate For Internal Use Only

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