LAPORAN SANITASI PROSES PEMBENTUKAN

RECORD OF SANITATION FORMING PROCESS

FOR:
PT. ARDENA ATHA MULIA BY: PRODUCTION DEPARTMENT
SANITATION
Jl. Cempaka Putih Utara No. 285 Document No : Date Effective: Revision No :
Kemayoran-Jakarta Pusat
QC/AAM/04 Januari’ 19 00
Tanggal:
Date
Waktu :
Time
KeadaanKebersihan Keterangan TindakanPerbaikan
Hygiene Condition Remark Corrective Action
No Item
Good Not Good
1 Conveyor
2 Mesin Bakso
3 Mesin Adonan
4 Mesin Cetak Kulit
5 Meja/ Troly
6 Timbangan
7 Lantai
8 Dinding
9 Plafon
10 Selang
11 Tirai Curtain

Checked By : Reviewed By : Keterangan :

( ) ( )

NOTE:
Kondisi: Bersih (V), Kurang bersih(- ), Kotor (X)