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HASIL
Standar / Tolak ukur

1. Berdasarkan desain : ......................................... mm

(.................................)
HASIL

Standar / Tolak ukur

Berdasarkan desain : ......................................... mm

1 / 888 x SPAN (....................................)

1 / 600 x SPAN (....................................)

: ......................................... mm

(Hasil Pengukuran) >/<** (Hasil Perhitungan maks)

KETERANGAN : STANDAR ………….

MEMENUHI SYARAT

TIDAK MEMENUHI SYARAT

......................, ................................................
PENGAWAS KETENAGAKERJAAN SPESIALIS K3 / AHLI K3
BIDANG PESAWAT ANGKAT DAN PESAWAT ANGKUT

.................................................................
NIP. .........................................................
No. REG...................................................