Page 1 of 3

EARTH MOVING, EQUIPMENT PRE-MOB INSPECTION REPORT

Scraper CAT 621E, 627E, 627F and Komatsu WS 16S

Equip No : Type : Model : Brand :

Serial No : Km/Hourmeter : Service Date :

Inspected by : Date : Location : Owner :

d
oo
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Description to be Checked Remarks

/A
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N
G

o
N
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 Expired :
6 Company Operator/Driver Permit Expired :
7 Company ID Number, Company Logo Correct Size, Minimum 15 Cm Height, Visible

Mandatory Safety Inspections and Devices

1 Back-Up Alarm Easy to Hear, 97 Decibles Minimum
2 Back-Up Light Adequate Illumination, Function Test
3 Horn Easily Operated From Inside Driver's Cabin, Easy to Hear
4 Windshield Wipers and Washer Wiper Blades Not Perished, Function Test
All Window Glass / Windshield Glass Totally Clear, No Film or Stickers Blocking Vision.
5
Units with OEM Window Tint Will Require Approval by Relevant CPI Authorities.
6 Door and Door Lock, Door Handle, Left - Right, Outside and Inner, Test Function
7 Seat Belt Operator Good Condition, Properly Mounted with OEM Hi Tensile Bolts
8 Articulated Unit Steering System Smooth and Controlled, No Worn Pins Bushings
Service Brake System, Front and Rear
9
Properly Adjusted, No Air Leaks, Function Test
10 Parking Brake System Properly Adjusted, Test Function
11 Head Lights-Working Lights-Flood Lights Adequate Illumination, Function Test
12 Amber Rotary Light Adequate Illumination, Function Test
13 Electrical Wiring Condition, Fuse Block All Splices Insulated, No Bare Wires
Internal Centrally Mounted Rear View Mirror(s)
14
Not Loose, Clear Unobstructed Vision, Functions Properly
Side mounted Left and Right Mounted Rear View Mirror(s)
15
Not Loose, Clear Unobstructed Vision, Functions Properly,
16 Safety Triangles Two Units In Good Condition, Reflective So As Visible at Night
Fire Extinguisher
17
Minimum 4kg, Current and Valid Inspection Tag, Properly Mounted and Accessible.
18 First Aid Kit Clean, Tidy, Completely Full
Access Ladder Steps Handrails Securely Mounted, Ergonomic Design, Good Condition, Not
19
Cracked, Not Bent, Not Dilapidated, No Sharp Edges, No Sharp Corners
Safety Guards and Covers
20
All In Place, Not Loose, None Missing, Not Modified, Remain within OEM Specs
ROPS Meets OSHA Structural Standards, Minimum Two (2) but Recommend Four (4) Full One-
21
Piece Steel Beams Over the Operator, Mandatory Steel Roof, No Fiberglass Roof
Axle Wheel Bearing Lubrication
22 Oil-Hubs to Be Properly Filled and No Leaks, No MISSING COVERS / CAPS on Grease Type
Hubs
TIRES Tire and Wheel Condition No Broken-Missing Lug Nuts Front and Rear, Tread Depth
23 Minimum 3mm or Check Manufacture Wear Indicator, No Recaps / Retreads / Vulcanized
Permitted, Correct Rotation, Tread Mud-Grip Pattern
24 Driver Monitoring System Refer to CPI Contract, Perform Function Test

Body
 Page 2 of 3

EARTH MOVING, EQUIPMENT PRE-MOB INSPECTION REPORT

Scraper CAT 621E, 627E, 627F and Komatsu WS 16S

Equip No : Type : Model : Brand :

Serial No : Km/Hourmeter : Service Date :

Inspected by : Date : Location : Owner :

d
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Description to be Checked Remarks

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N
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N
1 Body Good Condition, Good Paint and General Appearance, No Excess Damage, No Rust

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
3 Steering Wheel, Steering Column Controls Levers and Switches Test Function
4 All Switches and Knobs on Dashboard Test Function
5 Cabin Air Conditioner or Fan Test Function
Seats, Cushions Securely Mounted, Ergonomically Good Condition, Not Torn Open
6
or Dilapidated
7 Control Linkages and Levers Test Function
Rear Engine Remote Control Accelerator System No Loose Mountings, No Leaks, Test
8
Function
Rear Transmission Shift Control System
9
No Loose Mountings, No Leaks, Test Function

Main Frame, Main Chassis

Main Chassis Good Frame Condition, Straight, Not Bent, No Cracks, No Uncertified
1
Welding Repairs
Sub Chassis, Sub Frame Good Condition Straight, Not Bent, No Cracks, No Uncertified Welding
2
Repairs
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 Push Bar No Cracks, Not Loose, Properly Mounted
6 Front Push Bar, Cushion Hitch with Lock System No Cracks, Function Test

Scraper Bowl - Ejector - Self Elevating Conveyor

Bowl Cutting Edges - Side Cutter Bits
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
Self Elevating Conveyor Hydraulic System No Leaks or Excessively Worn Pins/Bushings in
3
Chains, All Pins Properly Secured
Apron and Ejector Linkages No Excessively Worn Pins/Bushings, All Pins Properly Secured with
4
Split Cotter Pins and/or Bolted End Plates
Lock Pins, Pins and Bushings in Linkages for All Implements
5
All Pins Properly Secured with Split Cotter Pins and/or Bolted End Plates

Hydraulics, General Hydraulics, Fluids, Fuel, Hoses

1 All Fuel Hoses and Lines Properly Secured, No leaks
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
5 Air Tank(s) No Leaks, No loose Mounts
6 Pilot Valves and Hydraulic Cylinders No Leaks
7 Hydraulic Pumps and Motors No Leaks, No Excess Noise
 Page 3 of 3

EARTH MOVING, EQUIPMENT PRE-MOB INSPECTION REPORT

Scraper CAT 621E, 627E, 627F and Komatsu WS 16S

Equip No : Type : Model : Brand :

Serial No : Km/Hourmeter : Service Date :

Inspected by : Date : Location : Owner :

d
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Description to be Checked Remarks

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N
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8 All Hydraulic Controls and Hydraulic Control Valves No Leaks, Test Function

Engine(s) - Transmission(s)
1 Front Engine Clean Appearance, No Defective Mounts, No Leaks, Observe Performance
2 Rear Engine Clean Appearance, No Defective Mounts, No Leaks, Observe Performance
3 Engine Dipsticks Front and Rear Easy to read, Oil Level Adequate
Battery, Battery Covers, Battery Mounting, Battery Terminals Front and Rear Optional Battery
4 Disconnect Switch, Test Function, No Loose or Corroded Cables-Terminals, Battery Hold-Downs
in Place, Clean Battery Box, No Loose Mounts
Starter Motor Front and Rear Test Function, Adequate Cranking Strength, No Bad Noises or
5
Overheating
Alternators Front and Rear Observe Charging Function, No Bad Noises or Overheating, No
6
Loose Mounts, No Loose Belts
7 Cooling System Front and Rear Inspect Radiator and Hoses, No Leaks, No Perished Hoses
8 V-Belts or Serpentine Belts Front and Rear Not Loose, Not Squealing, Not Cracked
9 Exhausts Systems Front and Rear Check Pipes and Muffler, No leaks, Not Loose
10 Transmissions Front and Rear No Leaks, Observe a Function Test
11 Differentials Front and Rear No Leaks, All Mountings Tight, Nothing Loose
Transmisson, Drive Shafts, Propeller Shafts, U-Joints, Center Carrier Bearing Front and Rear
12
Properly Greased, No Leaks, All Mountings Tight, Nothing Loose

Servicing and Maintenance

1 Maintenance Schedule - PM and PdM Service Records Available

Others
1
2
3

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

N/A = Not Applicable

Inspected by: Acknowledged 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

RW-CEM RW-HES
Contractor's Name
C-005-RW-12 - Rev-1 - Oct-12