PT.

PUTRA TUNGGAL MANDIRITAMA

INSPECTION CHECK LIST
LIST OF MEDICINE
PROJECT SITE :
DATE INSPECTION :
LOCATION :
UNIT :
CURRENT ACTIVITY :
CLIENT :

STANDARD ACTUAL CONDITION EXPIRED

NO. ITEM INSPECTED STOCK
STOCK IN STOCK OUT
STOCK (V/X) DATE

COMMENTS :

Inspected By: Acknowledged By:

Name : Name :

Position : Position :

Sign : Sign :
 PT. PUTRA TUNGGAL MANDIRITAMA
INSPECTION CHECK LIST
FIRST AID KIT - TYPE A
PROJECT SITE :
DATE INSPECTION :
LOCATION :
UNIT :
CURRENT ACTIVITY :
CLIENT :

NOMOR UNIT

NO. ITEM INSPECTED REMARK

1 Label or Certificate / meet standard

2 Condition of Webbing Harness
3 Condition of Belt
4 Condition of Chess Strip
5 Condition of Double Lanyard
6 Condition of Hook
7 Condition of Absorber
8 D-ring Condition and Connector or Carabineer

G = Good / F = Fair / X = Broken / NA = Not Appllicable

COMMENTS :

Inspected By: Acknowledged By:

Name : Name :

Position : Position :

Sign : Sign :