Company:

PRE-START CHECKLIST FOR HYDRAULIC (MOBILE) CRANE

Equipment
Site Name 　 Type of Work 　 Number 　
Manufacturer 　 Model 　 Capacity 　
Year Manufactured 　 Date of First Use 　 Date of Inspection 　

11
　 Sheave
2
　 Anti-two Block
　　
　
　
　 6
Structure/Boom
　
　
　
　 1
Wire Rope
　
　
　
　
　
　
　　
　
　
　
　4 Hook & Safety Latch
　
　
　
　 12
　 3
Hydraulic Cylinder Wire Drum
　
　
　
　
　
　
5 8
　
　
Overload Protection Brake
　
　
　
　　
　 9
　 Counterweight
　
　

　
　
　
　
　
　
　
　
　
　
　
　
　
　 13
　 Tire Assembly 7
　 Horn & Rearview Mirror 10
　　 Outrigger/Pad

14 Certification 　 16 Oil Leakage 　 18 Lifting Gears 　 20 Fire Extinguisher 　

Overhead & Ground
15 Permit to Work 　 17 Banksman/Signal Man 　 19 　 21 Alcohol Test 　
Condition
Operator (Sig) Const. Team (Sig) HSE Personnel (Sig)

(Keep the copy of Daily Pre-Start Equipment Checklist on Site for the Job Duration. Submit a copy to the Project HSE Department, if requested/required)
Note: Mark appropriate boxes
with:  Acceptable;  Unacceptable;  Need Further Check; NA Not Applicable

Form: HDEC-HSE-CE-005 (E)

Company:
DAILY PRE-START CHECKLIST FOR HYDRAULIC Equipment No.
(MOBILE) CRANE
MON TUE WED THU FRI SAT SUN REMARKS
NO. ITEM
/ / / / / / /
1 Wire Rope

2 Anti-Two Block

3 Hydraulic Cylinder

4 Hook & Safety Latch

5 Overload Protection

6 Structure/Boom

7 Horn & Rearview Mirror

8 Brake

9 Counterweight

10 Outrigger/Pad
11 Sheave

12 Wire Drum

13 Tire Assembly

14 Certification

15 Permit to Work

16 Oil Leakage

17 Banksman/Signal Man

18 Lifting Gears
19 Overhead & Ground Condition

20 Fire Extinguisher

21 Alcohol Test

22

23

24

25

26

27

Operator (Name: )

Sig. Const. Team (Name: )

HSE Personnel (Name: )

(Keep the copy of Daily Pre-Start Equipment Checklist on Site for the Job Duration. Submit a copy to the Project HSE Department, if requested/required)
Note: Mark appropriate boxes
with:  Acceptable;  Unacceptable;  Need Further Check; NA Not Applicable

Form: HDEC-HSE-CE-005 (E)

COMPANY :
Equipment No.
DAILY PRE-START CHECKLIST FOR HYDRAULIC MOBILE CRANE
MON TUE WED THU FRI SAT SUN REMARKS
No ITEM
/ / / / / / /
1 Wire Rope / Tali Baja
2 Anti-Reserve / Anti Mundur
3 Anti-Two Block / Anti dua blok
4 Load Indicator Function / Fungsi Indikator Beban
5 Hook & Safety Latch / hook dan kunci pengaman
6 Overload Protection / Perlindungan Dari Kelebihan
7 Swing Alarm
8 Wind Speed Indicator / Indikator Kecepatan Angin
9 Structure boom / struktur rangka boom
10 Angle Indicator / Indikator Sudut
11 Flash Beacon / Lampu Rotary
12 Brake / Rem
13 Rearview Mirror / kaca spion
14 Hydraulic Cylinder Condition / Kondisi silinder hidrolik
15 Horn / klakson
16 Sheave / pulley
17 Wire Drum / Tali Baja Drum
18 Counterweight / Pengimbang
19 Out rigger (pad) /
20 Lower Frame Condition / Kondisi casis bawah
21 Certification / Sertifikasi
22 Permit To Work / Surat Ijin Kerja
23 Oil Leakeg / Kebocoran oli
24 Banksman / Signal Man
25 Steel Plate Base / Dasar Plat Baja
26 Lifting Gears / Alat Bantu Angkat
27 Fire Extinguisher / APAR
28 Alcohol Test / Test alkohol
Operator Name / Nama Operator :
Sign Construction Team Name / Nama team konstruksi :
HSE Personnel Name / Nama petugas K3 :
(Keep the copy of Daily Pre-Start Equipment Checklist on Site for the Job Duration. Submit a copy to the Project HSE Department, if requested/required)
Note: Mark appropriate boxes
with:  Acceptable;  Unacceptable;  Need Further Check; NA Not Applicable

Form: HDEC-HSE-CE-005 (E)