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  • Upt Puskesmas Pakisaji: Pemerintah Kabupaten Malang Dinas Kesehatan

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    Masyfiatul Fikriyah
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    This document is a checklist from the Pakisaji Community Health Center in Malang, East Java for maintaining an ambulance. It contains 20 items to assess monthly including the condition of the engine, horn, lights, tires, brakes, fuel, fire extinguisher, oxygen, and emergency kit. Staff are to check items and mark them as good or bad, reporting any that remain in poor condition after being serviced. The checklist is signed off by the ambulance driver, head of the health center, and ambulance officer.

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    ANTONI

    Original Title

    Cheklist Ambulance

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    This document is a checklist from the Pakisaji Community Health Center in Malang, East Java for maintaining an ambulance. It contains 20 items to assess monthly including the condition of the engine, horn, lights, tires, brakes, fuel, fire extinguisher, oxygen, and emergency kit. Staff are to check items and mark them as good or bad, reporting any that remain in poor condition after being serviced. The checklist is signed off by the ambulance driver, head of the health center, and ambulance officer.

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    © All Rights Reserved
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    15 views3 pages

    Upt Puskesmas Pakisaji: Pemerintah Kabupaten Malang Dinas Kesehatan

    Uploaded by

    Masyfiatul Fikriyah
    This document is a checklist from the Pakisaji Community Health Center in Malang, East Java for maintaining an ambulance. It contains 20 items to assess monthly including the condition of the engine, horn, lights, tires, brakes, fuel, fire extinguisher, oxygen, and emergency kit. Staff are to check items and mark them as good or bad, reporting any that remain in poor condition after being serviced. The checklist is signed off by the ambulance driver, head of the health center, and ambulance officer.

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    © All Rights Reserved
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    of 3

    PEMERINTAH KABUPATEN MALANG

    DINAS KESEHATAN
    UPT PUSKESMAS PAKISAJI
    Jl. Raya Pakisaji no. 19 No telp. 0341-802932
    E-mail. pkm.pakisaji@yahoo.com
    Malang - 65162

    CHECKLIST PERAWATAN PUSLING

    BULAN :……………………………..2019

    N 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 2 3 3
    PENILAIAN 1 2 3 4 5 6 7 8 9 KET
    O 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1
    1. Kondisi mesin
    2. Klakson / sirine
    3. Lampu rotator
    4. Kondisi ban
    5. Kondisi rem
    6. Kondisi bbm
    7. Kondisi brankart
    8. Apar
    9. Emergency kit

    10. Oksigen
    Ttd driver jaga

    KET : Beri tanda “√ “ bila kondisi baik


    Beri tanda “X“ bila kondisi msih buruk setelah di kondisikan,laporkan. Mengetahui,
    Plt Kepala Puskesmas Pakisaji Penanggung Jawab
    Ambulance

    Drg,Dewi Aminah Y.R


    NIP.19720607 200501 2 008 Dwi Yuniar Afandi
    PEMERINTAH KABUPATEN MALANG
    DINAS KESEHATAN
    UPT PUSKESMAS PAKISAJI
    Jl. Raya Pakisaji no. 19 No telp. 0341-802932
    E-mail. pkm.pakisaji@yahoo.com
    Malang - 65162

    CHECKLIST PERAWATAN PUSLING

    BULAN : ……………………2019

    N 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 2 3 3
    PENILAIAN 1 2 3 4 5 6 7 8 9 KET
    O 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1
    11. KONDISI MESIN
    12. KLAKSON / SIRINE
    13. LAMPU ROTATOR
    14. KONDISI BAN
    15. KONDISI REM
    16. KONDISI BBM
    17. KONDISI BRANKART
    18. APAR
    19. EMERGENCY KIT

    20. OKSIGEN
    TTD DRIVER JAGA

    KET : Beri tanda “√ “ bila kondisi baik


    Beri tanda “X“ bila kondisi msih buruk setelah di kondisikan,laporkan. Mengetahui,
    Plt Kepala Puskesmas Pakisaji Penanggung Jawab Ambulace

    Drg,Dewi Aminah Y.R


    NIP.19720607 200501 2 008 Dwi Yuniar Afandi

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