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PT.

PUTRA TUNGGAL MANDIRITAMA


INSPECTION CHECK LIST
LIST OF MEDICINE

PROJECT SITE : WELCONE


DATE INSPECTION : JANUARI 2021
LOCATION : BARGE SADEWA
UNIT :
CURRENT ACTIVITY :
CLIENT : PT PTM
CONDITION
NO NAMA TANGGAL EXP STOCK AWAL SATUAN STOCK MASUK STOCK KELUAR STOCK AKHIR (V/X)
1 ACITRAL 1-Mar-23 15 BOTOL 0 0 15 v
2 ACYCLOVIR 1-Jan-23 5 SALEP 0 0 5 v
3 ANTIMO 1-Oct-25 20 TABLET 0 0 20 v
4 AQUADEST 4-Feb-23 10 BTL 0 0 10 v
5 BALSEM 1-Oct-23 20 BTL 0 0 20 v
6 BURNAZIN 1-Mar-23 20 SALEP 0 0 20 v
7 CYTYOL 1-Jul-24 2 SALEP 0 0 2 v
8 DEXTROX 5 % 1-Apr-23 20 BOTOL 0 0 20 v
9 ELLAMCYCETIN 1-Oct-23 20 SALEP 0 0 20 v
10 FLAMAR 1-Feb-23 12 SALEP 0 0 12 v
11 FORUMEN 30-Sep-22 10 0 0 10 v
12 GENTAMICIN 1-Dec-23 50 SALEP 0 0 50 v
13 KENALOG 1-Jan-22 20 SALEP 0 0 20 v
14 LIDOCAIN 1-Jan-23 15 AMPUL 0 0 15 v
15 NACL INFUS 1-Apr-25 20 BOTOL 0 0 20 v
16 NEBACETIN 1-Nov-23 20 0 0 20 v
17 NORIT 1-Sep-24 20 BOTOL 0 0 20 v
18 SAGESTAN 20-Sep-22 20 SALEP 0 0 20 v
19 SERENITY 1-Jul-22 20 0 0 20 v
20 SUPRATUL 1-Apr-24 20 BOX 0 0 20 v
21 SUTURE 1-Sep-24 20 TABLET 0 0 20 v
22 TUDERM 1-Nov-23 15 SALEP 0 0 15 v
23 VENARON 1-Oct-24 20 TABLET 0 0 20 v
24 VENTOLIN INHALER 1-Mar-22 20 0 0 20 v
25 VIT B COM 1-Jun-22 20 BOTOL 0 0 20 v

Inspected By: Acknowledged By:


Name : Name :
Position : Position :
Sign : Sign :
PT. PUTRA TUNGGAL MANDIRITAMA
INSPECTION CHECK LIST
LIST OF MEDICINE

PROJECT SITE : WELCONE


DATE INSPECTION : FEBRUARI 2021
LOCATION : BARGE SADEWA
UNIT :
CURRENT ACTIVITY :
CLIENT : PT PTM
CONDITION
NO NAMA TANGGAL EXP STOCK AWAL SATUAN STOCK MASUK STOCK KELUAR STOCK AKHIR
(V/X)
1 ACITRAL 1-Mar-23 15 BOTOL 0 0 15 v
2 ACYCLOVIR 1-Jan-23 5 SALEP 0 0 5 v
3 ANTIMO 1-Oct-25 20 TABLET 0 0 20 v
4 AQUADEST 4-Feb-23 10 BTL 0 0 10 v
5 BALSEM 1-Oct-23 20 BTL 0 0 20 v
6 BURNAZIN 1-Mar-23 20 SALEP 0 0 20 v
7 CYTYOL 1-Jul-24 2 SALEP 0 0 2 v
8 DEXTROX 5 % 1-Apr-23 20 BOTOL 0 0 20 v
9 ELLAMCYCETIN 1-Oct-23 20 SALEP 0 0 20 v
10 FLAMAR 1-Feb-23 12 SALEP 0 0 12 v
11 FORUMEN 30-Sep-22 10 0 0 10 v
12 GENTAMICIN 1-Dec-23 50 SALEP 0 0 50 v
13 KENALOG 1-Jan-22 20 SALEP 0 0 20 v
14 LIDOCAIN 1-Jan-23 15 AMPUL 0 0 15 v
15 NACL INFUS 1-Apr-25 20 BOTOL 0 0 20 v
16 NEBACETIN 1-Nov-23 20 0 0 20 v
17 NORIT 1-Sep-24 20 BOTOL 0 0 20 v
18 SAGESTAN 20-Sep-22 20 SALEP 0 0 20 v
19 SERENITY 1-Jul-22 20 0 0 20 v
20 SUPRATUL 1-Apr-24 20 BOX 0 0 20 v
21 SUTURE 1-Sep-24 20 TABLET 0 0 20 v
22 TUDERM 1-Nov-23 15 SALEP 0 0 15 v
23 VENARON 1-Oct-24 20 TABLET 0 0 20 v
24 VENTOLIN INHALER 1-Mar-22 20 0 0 20 v
25 VIT B COM 1-Jun-22 3 BOTOL 0 0 3 v

Inspected By: Acknowledged By:


Name : Name :
Position : Position :
Sign : Sign :
PT. PUTRA TUNGGAL MANDIRITAMA
INSPECTION CHECK LIST
LIST OF MEDICINE

PROJECT SITE : WELCONE


DATE INSPECTION : MARET 2021
LOCATION : BARGE SADEWA
UNIT :
CURRENT ACTIVITY :
CLIENT : PT PTM
CONDITION
NO NAMA TANGGAL EXP STOCK AWAL SATUAN STOCK MASUK STOCK KELUAR STOCK AKHIR
(V/X)
1 ACITRAL 1-Mar-23 15 BOTOL 0 5 10 v
2 ACYCLOVIR 1-Jan-23 5 SALEP 0 0 5 v
3 ANTIMO 1-Oct-25 20 TABLET 700 0 720 v
4 AQUADEST 4-Feb-23 10 BTL 3 0 13 v
5 BALSEM 1-Oct-23 20 BTL 0 0 20 v
6 BURNAZIN 1-Mar-23 20 SALEP 0 0 20 v
7 CYTYOL 1-Jul-24 2 SALEP 0 0 2 v
8 DEXTROX 5 % 1-Apr-23 20 BOTOL 0 0 20 v
9 ELLAMCYCETIN 1-Oct-23 20 SALEP 0 0 20 v
10 FLAMAR 1-Feb-23 12 SALEP 0 0 12 v
11 FORUMEN 30-Sep-22 10 SALEP 0 0 10 v
12 GENTAMICIN 1-Dec-23 50 SALEP 0 0 50 v
13 KENALOG 1-Jan-22 20 SALEP 0 0 20 v
14 LIDOCAIN 1-Jan-23 15 AMPUL 0 0 15 v
15 NACL INFUS 1-Apr-25 20 BOTOL 0 0 20 v
16 NEBACETIN 1-Nov-23 20 0 0 20 v
17 NORIT 1-Sep-24 20 BOTOL 0 0 20 v
18 SAGESTAN 20-Sep-22 20 SALEP 0 0 20 v
19 SERENITY 1-Jul-22 20 0 0 20 v
20 SUPRATUL 1-Apr-24 20 BOX 0 0 20 v
21 SUTURE 1-Sep-24 20 TABLET 0 0 20 v
22 TUDERM 1-Nov-23 15 SALEP 0 0 15 v
23 VENARON 1-Oct-24 20 TABLET 0 0 20 v
24 VENTOLIN INHALER 1-Mar-22 20 0 0 20 v
25 VIT B COM 1-Jun-22 3 BOTOL 0 0 3 v

Inspected By: Acknowledged By:


Name : Name :
Position Position :
Sign : Sign :
PT. PUTRA TUNGGAL MANDIRITAMA
INSPECTION CHECK LIST
LIST OF MEDICINE

PROJECT SITE : WELCONE


DATE INSPECTION : APRIL 2021
LOCATION : BARGE SADEWA
UNIT :
CURRENT ACTIVITY :
CLIENT : PT PTM
CONDITION
NO NAMA TANGGAL EXP STOCK AWAL SATUAN STOCK MASUK STOCK KELUAR STOCK AKHIR
(V/X)
1 ACITRAL 1-Mar-23 15 BOTOL 0 5 10 v
2 ACYCLOVIR 1-Jan-23 5 SALEP 0 0 5 v
3 ANTIMO 1-Oct-25 20 TABLET 700 10 710 v
4 AQUADEST 4-Feb-23 10 BTL 3 0 13 v
5 BALSEM 1-Oct-23 20 BTL 0 0 20 v
6 BURNAZIN 1-Mar-23 20 SALEP 0 0 20 v
7 CYTYOL 1-Jul-24 2 SALEP 0 0 2 v
8 DEXTROX 5 % 1-Apr-23 20 BOTOL 0 0 20 v
9 ELLAMCYCETIN 1-Oct-23 20 SALEP 0 0 20 v
10 FLAMAR 1-Feb-23 12 SALEP 0 0 12 v
11 FORUMEN 30-Sep-22 10 SALEP 0 0 10 v
12 GENTAMICIN 1-Dec-23 50 SALEP 0 0 50 v
13 KENALOG 1-Jan-22 20 SALEP 0 2 18 v
14 LIDOCAIN 1-Jan-23 15 AMPUL 0 0 15 v
15 NACL INFUS 1-Apr-25 20 BOTOL 0 0 20 v
16 NEBACETIN 1-Nov-23 20 0 0 20 v
17 NORIT 1-Sep-24 20 BOTOL 0 8 12 v
18 SAGESTAN 20-Sep-22 20 SALEP 0 0 20 v
19 SERENITY 1-Jul-22 20 0 0 20 v
20 SUPRATUL 1-Apr-24 20 BOX 0 0 20 v
21 SUTURE 1-Sep-24 20 TABLET 0 0 20 v
22 TUDERM 1-Nov-23 15 SALEP 0 0 15 v
23 VENARON 1-Oct-24 20 TABLET 0 0 20 v
24 VENTOLIN INHALER 1-Mar-22 20 0 0 20 v
25 VIT B COM 1-Jun-22 3 BOTOL 0 1 2 v

Inspected By: Acknowledged By:


Name : Name :
Position : Position :
Sign : Sign :
PT. PUTRA TUNGGAL MANDIRITAMA
INSPECTION CHECK LIST
LIST OF MEDICINE

PROJECT SITE : WELCONE


DATE INSPECTION : MEI 2021
LOCATION : BARGE SADEWA
UNIT :
CURRENT ACTIVITY :
CLIENT : PT PTM
CONDITION
NO NAMA TANGGAL EXP STOCK AWAL SATUAN STOCK MASUK STOCK KELUAR STOCK AKHIR
(V/X)
1 ACITRAL 1-Mar-23 10 BOTOL 0 5 5 v
2 ACYCLOVIR 1-Jan-23 5 SALEP 0 0 5 v
3 ANTIMO 1-Oct-25 710 TABLET 0 0 710 v
4 AQUADEST 4-Feb-23 13 BTL 3 0 16 v
5 BALSEM 1-Oct-23 20 BTL 0 0 20 v
6 BURNAZIN 1-Mar-23 20 SALEP 0 0 20 v
7 CYTYOL 1-Jul-24 2 SALEP 0 0 2 v
8 DEXTROX 5 % 1-Apr-23 20 BOTOL 0 0 20 v
9 ELLAMCYCETIN 1-Oct-23 20 SALEP 0 0 20 v
10 FLAMAR 1-Feb-23 12 SALEP 0 0 12 v
11 FORUMEN 30-Sep-22 10 SALEP 0 0 10 v
12 GENTAMICIN 1-Dec-23 50 SALEP 0 0 50 v
13 KENALOG 1-Jan-22 18 SALEP 0 0 18 v
14 LIDOCAIN 1-Jan-23 15 AMPUL 0 0 15 v
15 NACL INFUS 1-Apr-25 20 BOTOL 0 0 20 v
16 NEBACETIN 1-Nov-23 20 0 0 20 v
17 NORIT 1-Sep-24 12 BOTOL 0 0 12 v
18 SAGESTAN 20-Sep-22 20 SALEP 0 0 20 v
19 SERENITY 1-Jul-22 20 0 0 20 v
20 SUPRATUL 1-Apr-24 20 BOX 0 0 20 v
21 SUTURE 1-Sep-24 20 TABLET 0 0 20 v
22 TUDERM 1-Nov-23 15 SALEP 0 0 15 v
23 VENARON 1-Oct-24 20 TABLET 0 0 20 v
24 VENTOLIN INHALER 1-Mar-22 20 0 0 20 v
25 VIT B COM 1-Jun-22 2 BOTOL 0 0 2 v

Inspected By: Acknowledged By:


Name : Name :
Position : Position :
Sign : Sign :
PT. PUTRA TUNGGAL MANDIRITAMA
INSPECTION CHECK LIST
LIST OF MEDICINE

PROJECT SITE : WELCONE


DATE INSPECTION : JUNI 2021
LOCATION : BARGE SADEWA
UNIT :
CURRENT ACTIVITY :
CLIENT : PT PTM
CONDITION
NO NAMA TANGGAL EXP STOCK AWAL SATUAN STOCK MASUK STOCK KELUAR STOCK AKHIR
(V/X)
1 ACITRAL 1-Mar-23 15 BOTOL 0 5 10 v
2 ACYCLOVIR 1-Jan-23 5 SALEP 0 0 5 v
3 ANTIMO 1-Oct-25 20 TABLET 700 0 720 v
4 AQUADEST 4-Feb-23 10 BTL 3 0 13 v
5 BALSEM 1-Oct-23 20 BTL 0 0 10 v
6 BURNAZIN 1-Mar-23 20 SALEP 0 0 20 v
7 CYTYOL 1-Jul-24 2 SALEP 0 0 2 v
8 DEXTROX 5 % 1-Apr-23 20 BOTOL 0 0 20 v
9 ELLAMCYCETIN 1-Oct-23 20 SALEP 0 0 20 v
10 FLAMAR 1-Feb-23 12 SALEP 0 0 12 v
11 FORUMEN 30-Sep-22 10 SALEP 0 0 10 v
12 GENTAMICIN 1-Dec-23 50 SALEP 0 0 50 v
13 KENALOG 1-Jan-22 20 SALEP 0 0 20 v
14 LIDOCAIN 1-Jan-23 15 AMPUL 0 0 15 v
15 NACL INFUS 1-Apr-25 20 BOTOL 0 0 10 v
16 NEBACETIN 1-Nov-23 20 0 0 20 v
17 NORIT 1-Sep-24 20 BOTOL 0 0 20 v
18 SAGESTAN 20-Sep-22 20 SALEP 0 0 20 v
19 SERENITY 1-Jul-22 20 0 0 20 v
20 SUPRATUL 1-Apr-24 20 BOX 0 0 20 v
21 SUTURE 1-Sep-24 20 TABLET 0 0 20 v
22 TUDERM 1-Nov-23 15 SALEP 0 0 15 v
23 VENARON 1-Oct-24 20 TABLET 0 0 20 v
24 VENTOLIN INHALER 1-Mar-22 20 0 0 20 v
25 VIT B COM 1-Jun-22 3 BOTOL 0 0 3 v

Inspected By: Acknowledged By:


Name : Name :
Position : Position :
Sign : Sign :
PT. PUTRA TUNGGAL MANDIRITAMA
INSPECTION CHECK LIST
LIST OF MEDICINE

PROJECT SITE : WELCONE


DATE INSPECTION : JULI 2021
LOCATION : BARGE SADEWA
UNIT :
CURRENT ACTIVITY :
CLIENT : PT PTM
CONDITION
NO NAMA TANGGAL EXP STOCK AWAL SATUAN STOCK MASUK STOCK KELUAR STOCK AKHIR
(V/X)
1 ACITRAL 1-Mar-23 10 BOTOL 0 5 5 v
2 ACYCLOVIR 1-Jan-23 5 SALEP 0 0 5 v
3 ANTIMO 1-Oct-25 720 TABLET 0 0 720 v
4 AQUADEST 4-Feb-23 13 BTL 0 0 13 v
5 BALSEM 1-Oct-23 10 BTL 0 0 10 v
6 BURNAZIN 1-Mar-23 20 SALEP 0 0 20 v
7 CYTYOL 1-Jul-24 2 SALEP 0 0 2 v
8 DEXTROX 5 % 1-Apr-23 20 BOTOL 0 0 20 v
9 ELLAMCYCETIN 1-Oct-23 20 SALEP 0 0 20 v
10 FLAMAR 1-Feb-23 12 SALEP 0 0 12 v
11 FORUMEN 30-Sep-22 10 SALEP 0 0 10 v
12 GENTAMICIN 1-Dec-23 50 SALEP 0 0 50 v
13 KENALOG 1-Jan-22 20 SALEP 0 0 20 v
14 LIDOCAIN 1-Jan-23 15 AMPUL 0 0 15 v
15 NACL INFUS 1-Apr-25 10 BOTOL 0 0 10 v
16 NEBACETIN 1-Nov-23 20 0 0 20 v
17 NORIT 1-Sep-24 20 BOTOL 0 0 20 v
18 SAGESTAN 20-Sep-22 20 SALEP 0 0 20 v
19 SERENITY 1-Jul-22 20 0 0 20 v
20 SUPRATUL 1-Apr-24 20 BOX 0 0 20 v
21 SUTURE 1-Sep-24 20 TABLET 0 0 20 v
22 TUDERM 1-Nov-23 15 SALEP 0 0 15 v
23 VENARON 1-Oct-24 20 TABLET 0 0 20 v
24 VENTOLIN INHALER 1-Mar-22 20 0 0 20 v
25 VIT B COM 1-Jun-22 3 BOTOL 0 0 3 v

Inspected By: Acknowledged By:


Name : Name :
Position : Position :
Sign : Sign :
PT. PUTRA TUNGGAL MANDIRITAMA
INSPECTION CHECK LIST
LIST OF MEDICINE

PROJECT SITE : WELCONE


DATE INSPECTION : JAN 2021
LOCATION : BARGE SADEWA
UNIT :
CURRENT ACTIVITY :
CLIENT : PT PTM
CONDITION
NO NAMA TANGGAL EXP STOCK AWAL SATUAN STOCK MASUK STOCK KELUAR STOCK AKHIR (V/X)
1 ALPARA 1-Jun-24 100 TABLET 0 0 100 v
2 AMLODIPINE 10MG 1-Nov-24 15 TABLET 0 0 15 v
3 BISOPROLOL 1-May-22 20 TABLET 0 0 20 v
4 BODREX 1-Mar-23 20 TABLET 0 0 20 v
5 BUSCOPAN 1-Dec-22 20 TABLET 0 0 20 v
6 CIMETIDINE 1-Jan-24 9 TABLET 0 0 9 v
7 DEMACOLIN 13-Dec-24 15 TABLET 0 0 15 v
8 DEXTRAL 1-Mar-23 0 TABLET 0 0 0 v
9 DOMPERIDONE 1-May-25 20 TABLET 0 0 20 v
10 FARMALAT/NIFEDIPINE 10MG 1-Apr-23 20 TABLET 0 0 20 v
11 FLAMUR 1-Feb-22 20 TABLET 0 0 20 v
12 FUROSEMID 1-Jun-23 20 TABLET 0 0 20 v
13 GLIMEPIRIDE 1-Jan-23 20 TABLET 0 0 20 v
14 GRAFIX 1-Dec-24 15 TABLET 0 0 15 v
15 HISTIGO 1-May-22 20 TABLET 0 0 20 v
16 HYDROCHLOROTHIAZIDE 1-Jul-23 20 TABLET 0 0 20 v
17 HYPOFIL/GEMFIBROZIL 1-May-22 20 TABLET 0 0 20 v
18 INTERHISTIN 1-Sep-23 20 TABLET 0 0 20 v
19 KETONAZOLE 20MG 1-Nov-21 20 TABLET 0 0 20 v
20 LORATADINE 1-Sep-24 20 TABLET 0 5 15 v
21 MALTIRON PLUS 1-Oct-22 20 TABLET 0 0 20 v
22 MEFIX 1-Nov-21 20 TABLET 0 0 20 v
23 MELOXICAM 1-Feb-22 20 TABLET 0 0 20 v
24 METFORMIN 1-May-25 20 TABLET 0 0 20 v
25 METHILPREDINISOLONE 1-Apr-22 20 TABLET 0 0 20 v
26 NEURALGIN 1-Jun-22 20 TABLET 0 0 20 v
27 NIFEDIPINE 10MG 1-Nov-23 9 TABLET 0 0 9 v
28 PARACETAMOL 1-Nov-23 20 TABLET 0 0 20 v
29 PIROXICAM 1-Jan-24 20 TABLET 0 0 20 v
30 PRIMPERAN 1-Feb-22 20 TABLET 0 0 20 v
31 PRO LIVER 1-Sep-22 20 TABLET 0 5 15 v
32 PROCELES 1-May-22 10 TABLET 0 0 10 v
33 PROHISTIN/ LORATADINE 1-Dec-23 30 TABLET 0 0 30 v
34 SANMOL 1-Feb-23 56 TABLET 0 30 26 v
35 TROLIP 1-Oct-21 20 TABLET 0 0 20 v
36 VOLTADEX 1-Dec-21 20 TABLET 0 0 20 v

Inspected By: Acknowledged By:


Name : Name :
Position : Position :
Sign : Sign :
PT. PUTRA TUNGGAL MANDIRITAMA
INSPECTION CHECK LIST
LIST OF MEDICINE

PROJECT SITE : WELCONE


DATE INSPECTION : FEB 2021
LOCATION : BARGE SADEWA
UNIT :
CURRENT ACTIVITY :
CLIENT : PT PTM
CONDITION
NO NAMA TANGGAL EXP STOCK AWAL SATUAN STOCK MASUK STOCK KELUAR STOCK AKHIR (V/X)
1 ALPARA 1-Jun-24 100 TABLET 0 20 80 v
2 AMLODIPINE 10MG 1-Nov-24 15 TABLET 0 5 10 v
3 BISOPROLOL 1-May-22 20 TABLET 0 0 20 v
4 BODREX 1-Mar-23 20 TABLET 0 3 17 v
5 BUSCOPAN 1-Dec-22 20 TABLET 0 0 20 v
6 CIMETIDINE 1-Jan-24 9 TABLET 0 0 9 v
7 DEMACOLIN 13-Dec-24 15 TABLET 0 10 5 v
8 DEXTRAL 1-Mar-23 0 TABLET 0 5 -5 v
9 DOMPERIDONE 1-May-25 20 TABLET 0 0 20 v
10 FARMALAT/NIFEDIPINE 10MG 1-Apr-23 20 TABLET 0 0 20 v
11 FLAMUR 1-Feb-22 20 TABLET 0 0 20 v
12 FUROSEMID 1-Jun-23 20 TABLET 0 0 20 v
13 GLIMEPIRIDE 1-Jan-23 20 TABLET 0 0 20 v
14 GRAFIX 1-Dec-24 15 TABLET 0 0 15 v
15 HISTIGO 1-May-22 20 TABLET 0 6 14 v
16 HYDROCHLOROTHIAZIDE 1-Jul-23 20 TABLET 0 0 20 v
17 HYPOFIL/GEMFIBROZIL 1-May-22 20 TABLET 0 0 20 v
18 INTERHISTIN 1-Sep-23 20 TABLET 0 0 20 v
19 KETONAZOLE 20MG 1-Nov-21 20 TABLET 0 2 18 v
20 LORATADINE 1-Sep-24 15 TABLET 0 5 10 v
21 MALTIRON PLUS 1-Oct-22 20 TABLET 0 0 20 v
22 MEFIX 1-Nov-21 20 TABLET 0 0 20 v
23 MELOXICAM 1-Feb-22 20 TABLET 0 4 16 v
24 METFORMIN 1-May-25 20 TABLET 0 0 20 v
25 METHILPREDINISOLONE 1-Apr-22 20 TABLET 0 0 20 v
26 NEURALGIN 1-Jun-22 20 TABLET 0 5 15 v
27 NIFEDIPINE 10MG 1-Nov-23 9 TABLET 0 0 9 v
28 PARACETAMOL 1-Nov-23 20 TABLET 0 3 17 v
29 PIROXICAM 1-Jan-24 20 TABLET 0 0 20 v
30 PRIMPERAN 1-Feb-22 20 TABLET 0 0 20 v
31 PRO LIVER 1-Sep-22 15 TABLET 0 5 10 v
32 PROCELES 1-May-22 10 TABLET 0 0 10 v
33 PROHISTIN/ LORATADINE 1-Dec-23 30 TABLET 0 0 30 v
34 SANMOL 1-Feb-23 26 TABLET 0 15 11 v
35 TROLIP 1-Oct-21 20 TABLET 0 0 20 v
36 VOLTADEX 1-Dec-21 20 TABLET 0 0 20 v

Inspected By: Acknowledged By:


Name : Name :
Position : Position :
Sign : Sign :
PT. PUTRA TUNGGAL MANDIRITAMA
INSPECTION CHECK LIST
LIST OF MEDICINE

PROJECT SITE : WELCONE


DATE INSPECTION : MAR 2021
LOCATION : BARGE SADEWA
UNIT :
CURRENT ACTIVITY :
CLIENT : PT PTM
CONDITION
NO NAMA TANGGAL EXP STOCK AWAL SATUAN STOCK MASUK STOCK KELUAR STOCK AKHIR (V/X)
1 ALPARA 1-Jun-24 80 TABLET 0 18 62 v
2 AMLODIPINE 10MG 1-Nov-24 10 TABLET 0 3 7 v
3 BISOPROLOL 1-May-22 20 TABLET 0 0 20 v
4 BODREX 1-Mar-23 17 TABLET 0 0 17 v
5 BUSCOPAN 1-Dec-22 20 TABLET 0 0 20 v
6 CIMETIDINE 1-Jan-24 9 TABLET 0 0 9 v
7 DEMACOLIN 13-Dec-24 5 TABLET 0 0 5 v
8 DEXTRAL 1-Mar-23 -5 TABLET 0 0 -5 v
9 DOMPERIDONE 1-May-25 20 TABLET 0 0 20 v
10 FARMALAT/NIFEDIPINE 10MG 1-Apr-23 20 TABLET 0 0 20 v
11 FLAMUR 1-Feb-22 20 TABLET 0 0 20 v
12 FUROSEMID 1-Jun-23 20 TABLET 0 0 20 v
13 GLIMEPIRIDE 1-Jan-23 20 TABLET 0 0 20 v
14 GRAFIX 1-Dec-24 15 TABLET 0 0 15 v
15 HISTIGO 1-May-22 14 TABLET 0 0 14 v
16 HYDROCHLOROTHIAZIDE 1-Jul-23 20 TABLET 0 0 20 v
17 HYPOFIL/GEMFIBROZIL 1-May-22 20 TABLET 0 0 20 v
18 INTERHISTIN 1-Sep-23 20 TABLET 0 0 20 v
19 KETONAZOLE 20MG 1-Nov-21 18 TABLET 0 2 16 v
20 LORATADINE 1-Sep-24 10 TABLET 0 5 5 v
21 MALTIRON PLUS 1-Oct-22 20 TABLET 0 0 20 v
22 MEFIX 1-Nov-21 20 TABLET 0 0 20 v
23 MELOXICAM 1-Feb-22 16 TABLET 0 4 12 v
24 METFORMIN 1-May-25 20 TABLET 0 0 20 v
25 METHILPREDINISOLONE 1-Apr-22 20 TABLET 0 0 20 v
26 NEURALGIN 1-Jun-22 15 TABLET 0 0 15 v
27 NIFEDIPINE 10MG 1-Nov-23 9 TABLET 0 0 9 v
28 PARACETAMOL 1-Nov-23 17 TABLET 0 0 17 v
29 PIROXICAM 1-Jan-24 20 TABLET 0 0 20 v
30 PRIMPERAN 1-Feb-22 20 TABLET 0 0 20 v
31 PRO LIVER 1-Sep-22 10 TABLET 0 5 5 v
32 PROCELES 1-May-22 10 TABLET 0 0 10 v
33 PROHISTIN/ LORATADINE 1-Dec-23 30 TABLET 0 0 30 v
34 SANMOL 1-Feb-23 11 TABLET 0 5 6 v
35 TROLIP 1-Oct-21 20 TABLET 0 0 20 v
36 VOLTADEX 1-Dec-21 20 TABLET 0 0 20 v

Inspected By: Acknowledged By:


Name : Name :
Position : Position :
Sign : Sign :
PT. PUTRA TUNGGAL MANDIRITAMA
INSPECTION CHECK LIST
LIST OF MEDICINE

PROJECT SITE : WELCONE


DATE INSPECTION : APR 2021
LOCATION : BARGE SADEWA
UNIT :
CURRENT ACTIVITY :
CLIENT : PT PTM
CONDITION
NO NAMA TANGGAL EXP STOCK AWAL SATUAN STOCK MASUK STOCK KELUAR STOCK AKHIR (V/X)
1 ALPARA 1-Jun-24 62 TABLET 0 15 47 v
2 AMLODIPINE 10MG 1-Nov-24 7 TABLET 0 1 6 v
3 BISOPROLOL 1-May-22 20 TABLET 0 0 20 v
4 BODREX 1-Mar-23 17 TABLET 0 0 17 v
5 BUSCOPAN 1-Dec-22 20 TABLET 0 0 20 v
6 CIMETIDINE 1-Jan-24 9 TABLET 0 0 9 v
7 DEMACOLIN 13-Dec-24 5 TABLET 0 0 5 v
8 DEXTRAL 1-Jun-25 -5 TABLET 30 0 25 v
9 DOMPERIDONE 1-May-25 20 TABLET 0 0 20 v
10 FARMALAT/NIFEDIPINE 10MG 1-Apr-23 20 TABLET 0 0 20 v
11 FLAMUR 1-Feb-22 20 TABLET 0 0 20 v
12 FUROSEMID 1-Jun-23 20 TABLET 0 0 20 v
13 GLIMEPIRIDE 1-Jan-23 20 TABLET 0 0 20 v
14 GRAFIX 1-Dec-24 15 TABLET 0 0 15 v
15 HISTIGO 1-May-22 14 TABLET 0 0 14 v
16 HYDROCHLOROTHIAZIDE 1-Jul-23 20 TABLET 0 0 20 v
17 HYPOFIL/GEMFIBROZIL 1-May-22 20 TABLET 0 0 20 v
18 INTERHISTIN 1-Sep-23 20 TABLET 0 0 20 v
19 KETONAZOLE 20MG 1-Nov-21 16 TABLET 0 2 14 v
20 LORATADINE 1-Sep-24 5 TABLET 0 5 0 v
21 MALTIRON PLUS 1-Oct-22 20 TABLET 0 0 20 v
22 MEFIX 1-Nov-21 20 TABLET 0 0 20 v
23 MELOXICAM 1-Feb-22 12 TABLET 0 4 8 v
24 METFORMIN 1-May-25 20 TABLET 0 0 20 v
25 METHILPREDINISOLONE 1-Apr-22 20 TABLET 0 0 20 v
26 NEURALGIN 1-Jun-22 15 TABLET 0 0 15 v
27 NIFEDIPINE 10MG 1-Nov-23 9 TABLET 0 0 9 v
28 PARACETAMOL 1-Nov-23 17 TABLET 0 0 17 v
29 PIROXICAM 1-Jan-24 20 TABLET 0 0 20 v
30 PRIMPERAN 1-Feb-22 20 TABLET 0 0 20 v
31 PRO LIVER 1-Sep-22 5 TABLET 0 5 0 v
32 PROCELES 1-May-22 10 TABLET 0 0 10 v
33 PROHISTIN/ LORATADINE 1-Dec-23 30 TABLET 0 0 30 v
34 SANMOL 1-Feb-23 6 TABLET 0 0 6 v
35 TROLIP 1-Oct-21 20 TABLET 0 0 20 v
36 VOLTADEX 1-Dec-21 20 TABLET 0 0 20 v

Inspected By: Acknowledged By:


Name : Name :
Position : Position :
Sign : Sign :
PT. PUTRA TUNGGAL MANDIRITAMA
INSPECTION CHECK LIST
LIST OF MEDICINE

PROJECT SITE : WELCONE


DATE INSPECTION : MEI 2021
LOCATION : BARGE SADEWA
UNIT :
CURRENT ACTIVITY :
CLIENT : PT PTM
CONDITION
NO NAMA TANGGAL EXP STOCK AWAL SATUAN STOCK MASUK STOCK KELUAR STOCK AKHIR (V/X)
1 ALPARA 1-Jun-24 47 TABLET 0 15 32 v
2 AMLODIPINE 10MG 1-Nov-24 6 TABLET 0 0 6 v
3 BISOPROLOL 1-May-22 20 TABLET 0 0 20 v
4 BODREX 1-Mar-23 17 TABLET 0 5 12 v
5 BUSCOPAN 1-Dec-22 20 TABLET 0 0 20 v
6 CIMETIDINE 1-Jan-24 9 TABLET 0 0 9 v
7 DEMACOLIN 13-Dec-24 5 TABLET 0 0 5 v
8 DEXTRAL 1-Jun-25 25 TABLET 0 5 20 v
9 DOMPERIDONE 1-May-25 20 TABLET 0 0 20 v
10 FARMALAT/NIFEDIPINE 10MG 1-Apr-23 20 TABLET 0 0 20 v
11 FLAMUR 1-Feb-22 20 TABLET 0 0 20 v
12 FUROSEMID 1-Jun-23 20 TABLET 0 0 20 v
13 GLIMEPIRIDE 1-Jan-23 20 TABLET 0 0 20 v
14 GRAFIX 1-Dec-24 15 TABLET 0 0 15 v
15 HISTIGO 1-May-22 14 TABLET 0 0 14 v
16 HYDROCHLOROTHIAZIDE 1-Jul-23 20 TABLET 0 0 20 v
17 HYPOFIL/GEMFIBROZIL 1-May-22 20 TABLET 0 0 20 v
18 INTERHISTIN 1-Sep-23 20 TABLET 0 0 20 v
19 KETONAZOLE 20MG 1-Nov-21 14 TABLET 0 2 12 v
20 LORATADINE 1-Sep-24 0 TABLET 0 0 0 v
21 MALTIRON PLUS 1-Oct-22 20 TABLET 0 0 20 v
22 MEFIX 1-Nov-21 20 TABLET 0 0 20 v
23 MELOXICAM 1-Feb-22 8 TABLET 0 4 4 v
24 METFORMIN 1-May-25 20 TABLET 0 0 20 v
25 METHILPREDINISOLONE 1-Apr-22 20 TABLET 0 0 20 v
26 NEURALGIN 1-Jun-22 15 TABLET 0 0 15 v
27 NIFEDIPINE 10MG 1-Nov-23 9 TABLET 0 0 9 v
28 PARACETAMOL 1-Nov-23 17 TABLET 0 0 17 v
29 PIROXICAM 1-Jan-24 20 TABLET 0 0 20 v
30 PRIMPERAN 1-Feb-22 20 TABLET 0 0 20 v
31 PRO LIVER 1-Sep-22 0 TABLET 0 0 0 v
32 PROCELES 1-May-22 10 TABLET 0 0 10 v
33 PROHISTIN/ LORATADINE 1-Dec-23 30 TABLET 0 0 30 v
34 SANMOL 1-Feb-23 6 TABLET 0 4 2 v
35 TROLIP 1-Oct-21 20 TABLET 0 0 20 v
36 VOLTADEX 1-Dec-21 20 TABLET 0 0 20 v

Inspected By: Acknowledged By:


Name : Name :
Position : Position :
Sign : Sign :
PT. PUTRA TUNGGAL MANDIRITAMA
INSPECTION CHECK LIST
LIST OF MEDICINE

PROJECT SITE : WELCONE


DATE INSPECTION : JUNI 2021
LOCATION : BARGE SADEWA
UNIT :
CURRENT ACTIVITY :
CLIENT : PT PTM
CONDITION
NO NAMA TANGGAL EXP STOCK AWAL SATUAN STOCK MASUK STOCK KELUAR STOCK AKHIR (V/X)
1 ALPARA 1-Jun-24 32 TABLET 0 10 22 v
2 AMLODIPINE 10MG 1-Nov-24 6 TABLET 0 0 6 v
3 BISOPROLOL 1-May-22 20 TABLET 0 0 20 v
4 BODREX 1-Mar-23 12 TABLET 0 0 12 v
5 BUSCOPAN 1-Dec-22 20 TABLET 0 0 20 v
6 CIMETIDINE 1-Jan-24 9 TABLET 0 0 9 v
7 DEMACOLIN 13-Dec-24 5 TABLET 0 0 5 v
8 DEXTRAL 1-Mar-23 20 TABLET 0 0 20 v
9 DOMPERIDONE 1-May-25 20 TABLET 0 0 20 v
10 FARMALAT/NIFEDIPINE 10MG 1-Apr-23 20 TABLET 0 0 20 v
11 FLAMUR 1-Feb-22 20 TABLET 0 0 20 v
12 FUROSEMID 1-Jun-23 20 TABLET 0 0 20 v
13 GLIMEPIRIDE 1-Jan-23 20 TABLET 0 0 20 v
14 GRAFIX 1-Dec-24 15 TABLET 0 0 15 v
15 HISTIGO 1-May-22 14 TABLET 0 0 14 v
16 HYDROCHLOROTHIAZIDE 1-Jul-23 20 TABLET 0 0 20 v
17 HYPOFIL/GEMFIBROZIL 1-May-22 20 TABLET 0 0 20 v
18 INTERHISTIN 1-Sep-23 20 TABLET 0 0 20 v
19 KETONAZOLE 20MG 1-Nov-21 12 TABLET 0 2 10 v
20 LORATADINE 1-Sep-24 0 TABLET 0 0 0 v
21 MALTIRON PLUS 1-Oct-22 20 TABLET 0 0 20 v
22 MEFIX 1-Nov-21 20 TABLET 0 0 20 v
23 MELOXICAM 1-Feb-22 4 TABLET 0 4 0 v
24 METFORMIN 1-May-25 20 TABLET 0 0 20 v
25 METHILPREDINISOLONE 1-Apr-22 20 TABLET 0 0 20 v
26 NEURALGIN 1-Jun-22 15 TABLET 0 0 15 v
27 NIFEDIPINE 10MG 1-Nov-23 9 TABLET 0 0 9 v
28 PARACETAMOL 1-Nov-23 17 TABLET 0 0 17 v
29 PIROXICAM 1-Jan-24 20 TABLET 0 0 20 v
30 PRIMPERAN 1-Feb-22 20 TABLET 0 0 20 v
31 PRO LIVER 1-Sep-22 0 TABLET 0 0 0 v
32 PROCELES 1-May-22 10 TABLET 0 0 10 v
33 PROHISTIN/ LORATADINE 1-Dec-23 30 TABLET 0 0 30 v
34 SANMOL 1-Feb-23 2 TABLET 0 0 2 v
35 TROLIP 1-Oct-21 20 TABLET 0 0 20 v
36 VOLTADEX 1-Dec-21 20 TABLET 0 0 20 v

Inspected By: Acknowledged By:


Name : Name :
Position : Position :
Sign : Sign :
PT. PUTRA TUNGGAL MANDIRITAMA
INSPECTION CHECK LIST
LIST OF MEDICINE

PROJECT SITE : WELCONE


DATE INSPECTION : JULI 2021
LOCATION : BARGE SADEWA
UNIT :
CURRENT ACTIVITY :
CLIENT : PT PTM
CONDITION
NO NAMA TANGGAL EXP STOCK AWAL SATUAN STOCK MASUK STOCK KELUAR STOCK AKHIR (V/X)
1 ALPARA 1-Jun-24 22 TABLET 0 10 12 v
2 AMLODIPINE 10MG 1-Nov-24 6 TABLET 0 0 6 v
3 BISOPROLOL 1-May-22 20 TABLET 0 0 20 v
4 BODREX 1-Mar-23 12 TABLET 0 0 12 v
5 BUSCOPAN 1-Dec-22 20 TABLET 0 0 20 v
6 CIMETIDINE 1-Jan-24 9 TABLET 0 0 9 v
7 DEMACOLIN 13-Dec-24 5 TABLET 0 0 5 v
8 DEXTRAL 1-Jun-25 20 TABLET 0 0 20 v
9 DOMPERIDONE 1-May-25 20 TABLET 0 0 20 v
10 FARMALAT/NIFEDIPINE 10MG 1-Apr-23 20 TABLET 0 0 20 v
11 FLAMUR 1-Feb-22 20 TABLET 0 0 20 v
12 FUROSEMID 1-Jun-23 20 TABLET 0 0 20 v
13 GLIMEPIRIDE 1-Jan-23 20 TABLET 0 0 20 v
14 GRAFIX 1-Dec-24 15 TABLET 0 0 15 v
15 HISTIGO 1-May-22 14 TABLET 0 0 14 v
16 HYDROCHLOROTHIAZIDE 1-Jul-23 20 TABLET 0 0 20 v
17 HYPOFIL/GEMFIBROZIL 1-May-22 20 TABLET 0 0 20 v
18 INTERHISTIN 1-Sep-23 20 TABLET 0 0 20 v
19 KETONAZOLE 20MG 1-Nov-21 10 TABLET 0 2 8 v
20 LORATADINE 1-Sep-24 0 TABLET 0 0 0 v
21 MALTIRON PLUS 1-Oct-22 20 TABLET 0 0 20 v
22 MEFIX 1-Nov-21 20 TABLET 0 0 20 v
23 MELOXICAM 1-Feb-22 0 TABLET 0 0 0 v
24 METFORMIN 1-May-25 20 TABLET 0 0 20 v
25 METHILPREDINISOLONE 1-Apr-22 20 TABLET 0 0 20 v
26 NEURALGIN 1-Jun-22 15 TABLET 0 0 15 v
27 NIFEDIPINE 10MG 1-Nov-23 9 TABLET 0 0 9 v
28 PARACETAMOL 1-Nov-23 17 TABLET 0 0 17 v
29 PIROXICAM 1-Jan-24 20 TABLET 0 0 20 v
30 PRIMPERAN 1-Feb-22 20 TABLET 0 0 20 v
31 PRO LIVER 1-Sep-22 0 TABLET 0 5 -5 v
32 PROCELES 1-May-22 10 TABLET 0 0 10 v
33 PROHISTIN/ LORATADINE 1-Dec-23 30 TABLET 0 0 30 v
34 SANMOL 1-Feb-23 2 TABLET 0 2 0 v
35 TROLIP 1-Oct-21 20 TABLET 0 0 20 v
36 VOLTADEX 1-Dec-21 20 TABLET 0 0 20 v

Inspected By: Acknowledged By:


Name : Name :
Position : Position :
Sign : Sign :
QTY CONDTION
NO Description Unit QTY Remark
AKTUAL (V/X)
1 Abbocath 18 Pcs 2 2 V
2 Abbocath 20 Pcs 2 2 V
3 Abbocath 22 Pcs 2 2 V
4 Alcohol Swab Box 1 1 V 1 box
5 catgut 2-0 Pcs 5 5 V
6 Catgut 3-0 Pcs 5 5 V
7 Silk Braided 3/0 Pcs 2 2 V
8 Silk Braided 2/0 Pcs 2 2 V
9 Needle Terrumo 23 G Pcs 2 2 V
10 Otsu WL ( Sterile Water ) Bottle 2 2 V
11 Scalpel ( Surgical Blade ) Box 2 2 V
12 Snake Bite Pcs 2 2 V
13 Spoit 3 cc Pcs 5 5 V
14 Spoit 5 cc Pcs 5 5 V
15 Stick Asam Urat Btl 1 1 V
16 Stick Cholesterol Btl 1 1 V
17 Stick Glucosa Btl 1 1 V
18 Infus Set Ea 2 2 V
19 Termometer Air Raksa Ea 2 0 V
20 Duk Clothes ( Kain Duk ) Ea 2 0 V
21 Sofratul Ea 5 0 V
22 Pocket Mask Ea 2 2 V
23 spuit 1 cc Ea 5 1 V
24 Surgical Instrument Kit Pcs 2 1 V
25 Neck Collar Pcs 2 4 V
26 Laryngoscospe Pcs 2 0 V
27 Nebulizer Omron Pcs 2 0 V
28 Pulse Oximeter Pcs 2 1 V
29 Pen Light Pcs 2 0 V
30 THT Set Pcs 1 0 V
31 Tensimeter Aneroid Pcs 2 2 V manual
32 Splint Angin SET 1 0 V
33 Sthetoscope Pcs 1 1 V
34 Surgical Instrument Kit Pcs 1 1 V
35 Neck Collar Ea 1 4 V
36 Bioplacenton Tube 1 0 V
37 Ethyl Chloroide Sprai Btl 1 0 V
38 Nostren Tube 1 0 V
39 Oxicam Btl 1 0 V
40 Trombophob gel Tube 1 0 V
41 Ephineprine inj Amp 1 0 V
42 Infus Liquid D5 Btl 1 1 V
43 Infus Liquid NaCl Btl 1 1 V
44 Infus Liquid Ringer Laktat Btl 1 1 V
45 Lidocain Amp 1 4 V
46 Ethyl Chloroide Sprai Btl 1 0 V
47 Alkohol 100 ml Btl 1 0 V
48 Alkohol swab box 1 1 V
49 Bethadine 15 ml Btl 1 0 V
50 Sofra Tulle Strip 1 0 V
51 Elastis Bandage 7.5cm Roll 1 1 V
52 Elastis Bandage 15 cm Roll 1 1 V
53 Hansaplast Ea 1 1 V
54 Hypavix Roll 1 1 V
55 Fire Blanket Ea 1 1 V
56 Kain Segitiga Lmbr 1 1 V
57 Kapas 25 ml Roll 1 1 V
58 Kassa Gulung 5 cm Roll 1 1 V
59 Kassa Gulung 10 cm Roll 1 1 V
60 Kasa Sterile Box 1 1 V
61 Masker Ea 1 1 V
62 Plester Roll 1 1 V
63 Rivanol 100 ml Btl 1 1 V
64 Steril Gloves 7.5 Ea 1 1 V
65 Abbocateh No. 20 Ea 1 1 V
66 Abbocateh No. 22 Ea 1 1 V
67 Abbocateh No. 18 Ea 1 1 V
68 Ambubag/Balon Peniup Unit 1 1 V
69 Catguat Plain Ea 1 1 V
70 Silk Braided No3/0 Ea 1 1 V
71 Gunting Scisor Ea 1 1 V
72 Infus Set Ea 2 1 V
73 Neck Collar Ea 3 3 V
74 Needle heating no 9 Ea 1 1 V
75 Needle heating no 13 Ea 1 1 V
76 Mayo Ea 1 1 V
77 Pocket Mask Ea 1 1 V
78 Steril Surgical Blade Ea 1 1 V
79 Syring 3 cc Ea 1 1 V
80 Syring 5 cc Ea 1 1 V
81 Safety Pin Lusin 1 1 V
82 Wound Dressing Large Ea 1 1 V
83 Wound Dressing Medium Ea 1 1 V
84 Y-rins Btl 2 1 V
85 Spinal Board Ea 1 1 V
86 Basket Stretcher Ea 1 1 V
87 Meja +kursi Ea 1 1 V
88 Lemari obat Ea 1 1 V tiadak layak
89First Aid Kit Bag / Tas Medis Emergency Ea 1 1 V
90 Eye Wash Ea 1 1 V
91 Oxygen Ea 2 2 V Regulator 2
92 Termogan Ea 2 1 V
93 AED Ea 1 1 V Baterray 2

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