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Form Serah Terima Alat & Kendaraan

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Form Serah Terima Alat & Kendaraan Powered By Docstoc
					BERITA ACARA SERAH TERIMA ALAT & KENDARAAN
UPJ .....................................

Pada hari ini ........................ tanggal .......... bulan ................................. tahun ................... pukul .......... : .......... WIB
telah dilakukan serah terima kendaraan dan peralatan kerja yang sebelumnya terlebih dahulu dilakukan proses
pemeriksaan secara bersama-sama antara kedua belah pihak mengenai kondisi kendaraan dan peralatan kerja
dengan rincian sebagai berikut :

A. KENDARAAN
          Jenis Kendaraan                       :       Toyota Avanza                            Trail KLX150S                            Honda Revo 110
         Nomor Polisi                           :                                                            SPIDOMETER (KM) :
B. SISA GANGGUAN
         Belum Tertangani :                             Buah                                                 Gangguan Kembali :                                                  Buah
C. PERALATAN KERJA
                                                                                                                          TIDAK           TIDAK
  NO                 NAMA ALAT KERJA                                 JML                  BAIK           RUSAK                                                   KEBERADAAN ALAT
                                                                                                                         FUNGSI            ADA
   1     Compression Dies                                 (1)    .....................                                                             ..........................................................................................

   2     Fuse Puller                                      (1)    .....................
                                                                                                                                                   ..........................................................................................

   3     Gergaji Besi                                     (1)    .....................
                                                                                                                                                   ..........................................................................................

   4     Gergaji Kayu                                     (1)    .....................
                                                                                                                                                   ..........................................................................................

   5     Grounding Apparatus                              (2)    .....................
                                                                                                                                                   ..........................................................................................

   6     Gunting Kabel Besar                              (1)    .....................
                                                                                                                                                   ..........................................................................................

   7     Handle LBS                                       (1)    .....................
                                                                                                                                                   ..........................................................................................

   8     Helm Pengaman                                    (2)    .....................
                                                                                                                                                   ..........................................................................................

   9     Infra Red Gun                                    (1)    .....................
                                                                                                                                                   ..........................................................................................

  10     Jas Hujan                                        (3)    .....................
                                                                                                                                                   ..........................................................................................

  11     Kunci Connector                                  (1)    .....................
                                                                                                                                                   ..........................................................................................

  12     Kunci Inggris 12”                                (2)    .....................
                                                                                                                                                   ..........................................................................................

  13     Kunci Pipa 3”                                    (1)    .....................
                                                                                                                                                   ..........................................................................................

  14     Kunci Ring/Pas                                   (1)    .....................
                                                                                                                                                   ..........................................................................................

  15     Lampu Sorot Halogen                              (1)    .....................
                                                                                                                                                   ..........................................................................................

  16     Megger 10.000 V                                  (1)    .....................
                                                                                                                                                   ..........................................................................................

  17     Palu 3 Kg                                        (1)    .....................
                                                                                                                                                   ..........................................................................................

  18     Cone Lalu Lintas                                 (1)    .....................
                                                                                                                                                   ..........................................................................................

  19     Parang                                           (1)    .....................
                                                                                                                                                   ..........................................................................................

  20     Phase Squence Indicator                          (1)    .....................
                                                                                                                                                   ..........................................................................................

  21     Sabuk Pengaman                                   (2)    .....................
                                                                                                                                                   ..........................................................................................

  22     Sarung Tangan 1000 V                             (2)    .....................
                                                                                                                                                   ..........................................................................................

  23     Senter                                           (2)    .....................
                                                                                                                                                   ..........................................................................................

  24     Sepatu Karet Listrik 1000 V                      (2)    .....................
                                                                                                                                                   ..........................................................................................

  25     Stick 20 Kv 11 Meter                             (1)    .....................
                                                                                                                                                   ..........................................................................................

  26     Stringing Device 2 Ton                           (2)    .....................
                                                                                                                                                   ..........................................................................................

  27     Tali Baja (Seling)                               (1)    .....................
                                                                                                                                                   ..........................................................................................

  28     Tali Tampar 20 Meter                             (1)    .....................
                                                                                                                                                   ..........................................................................................

  29     Tang Kombinsai                                   (2)    .....................
                                                                                                                                                   ..........................................................................................

  30     Tang Ampere 600 A + Harmonisa                    (1)    .....................
                                                                                                                                                   ..........................................................................................

  31     Teropong                                         (1)    .....................
                                                                                                                                                   ..........................................................................................

  32     Voltase Detector TM                              (1)    .....................
                                                                                                                                                   ..........................................................................................

  33     Tangga Fiber Sliding 9 Meter                     (1)


              Yang Menerima,                                                                Yang Menyerahkan,                                                        Mengetahui,
                                                                                                                                                                     Koordinator




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