CHECK LIST INSPECTION REPORT

Project Title

Job No Report No.

Client Date
Contractor PT. Zoomindo Inti Perkasa Page of
References : _____________________________________ Location : SPBG MERAK
Drawing No. : _______________________________________
Revision :
Sheet :
RESULT APPROVED REVIEWED

NO INSPECTION ITEMS ZIP REMARKS

Accepted Rejected Pertamina
TSC

1
2
3
4
5

Equipment
Total Unit : Running Unit : pc(s)
Running Unit : pc(s)
Accepted Rejected
Stand Unit : pc(s)

Total Unit : pc(s)

Running Unit : pc(s) Accepted Rejected

Stand Unit pc(s)

COMMENT

Performed By Reviewed / Approved By

Involvement Zoomindo Inti Perkasa Pertamina TPI
Party

Signature

Name
Sign Date
Job Title