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CECK LIST PETUGAS CLEANING SERVICES

(RAHMAH)

HARI : ..................................................

TGL : ..................................................

KAMAR Mengganti Menyapu Mengepel Mengelap Mengelap TTD Supervisor NAMA & TTD KLG PASIEN
linen Lantai lantai Meja Kaca
KUSUMA I

KUSUMA II

KAMELIAI

KAMELIA II

KAMELIA III

KAMELIA IV

WARDAH I

WARDAH II

WARDAH III

WARDAH IV

WARDAH V

WARDAH VI

WARDAH
VII
CECK LIST PETUGAS CLEANING SERVICES

(KAMAR MANDI)

HARI : ..................................................

TGL : ..................................................

KAMAR ZAINI KUS ARIFIN TTD Supervisor NAMA & TTD KLG PASIEN
KUSUMA I

KUSUMA II

KAMELIAI

KAMELIA II

KAMELIA III

KAMELIA IV

VK

DIREKSI

KM UMUM
CECK LIST PETUGAS CLEANING SERVICES

(AC &KIPAS)

HARI : ..................................................

TGL : ..................................................

KAMAR ZAINI KUS ARIFIN TTD Supervisor NAMA & TTD KLG PASIEN
KUSUMA I

KUSUMA II

KAMELIAI

KAMELIA II

KAMELIA III

KAMELIA IV

WARDAH I

WARDAH II

WARDAH III

WARDAH IV

WARDAH V

WARDAH VI

WARDAH
VII
CECK LIST PETUGAS GIZI

HARI : ..................................................

TGL : ..................................................

KAMAR NAMA PASIEN JENIS DIET PAGI JENIS DIET SIANG JENIS DIET SORE TTD Supervisor NAMA & TTD KLG PASIEN
KUSUMA I

KUSUMA II

KAMELIAI

KAMELIA II

KAMELIA III

KAMELIA IV

WARDAH I

WARDAH II

WARDAH III

WARDAH IV

WARDAH V

WARDAH VI

WARDAH VII

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