Geotechnical Hazard Inspection: Yes No Yes No Yes No Yes No Yes No Yes No

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GEOTECHNICAL HAZARD INSPECTION

Nama : Lokasi :
Tanggal : Tipe Inspeksi :
Kondisi Umum
Deskripsi kondisi umum area inspeksi

Material/ Jenis Batuan


Soil Yes No
Sub-soil Yes No
Clay Yes No
Metalimestone Yes No
Vulkanik Yes No
Massive Ore Yes No
Rekahan
Apakah ada tanda-tanda rekahan? Deskripsikan rekahan tersebut
Rekahan akibat struktur geologi Yes No
Rekahan akibat pergerakan tanah Yes No
Rekahan akibat peledakan Yes No
Water
Apakah ada genangan air di lokasi? Yes No
Apakah ada aliran air di dinding, rekahan atau lubang? Yes No
Deskripsikan umum kondisi aliran air

Failure:
Are there any NEW Yes Yes
Are there any OLD
failures? No No
Describe the failures (size, material, type, weathering):
Risk Rating and Recommendations
Consequences : Risk:
Recommendations:
Inspected By: Approved By:
Name: Name:
Position: Position:
Signature: Signature:
Date: Date:

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