ENGINEERING PROCUREMENT CONSTRUCTION FOR

REFINERY DEVELOPMENT MASTER PLAN (RDMP) RU-V

BALIKPAPAN
CHEKLIST KEBERSIHAN OFFICE
Health Safety Enviroment Page 1 of 1

Date / Time : Week :

Place : Company :
Inspection results
No Inspection Comonents Remarks
Clean Dirty

1 Halaman depan office / The front page of the office

2 Ruang tunggu / The waiting room

3 Ruang kerja karyawan / Employee work space

4 Ruang/ tempat mushola / Room / place of prayer

5 Ruang dapur / Kitchen space

6 Toilet / closet

7 Lantai semua ruangan / Floor all rooms

8 Tempat sampah / trashcan

9 Tempat wudhu / Ablution place

Tempat cuci tangan

10
/ hands washing facilities
Tempat cuci alat-alat dapur (perlengkapan alat
11 makan dan minum) / The kitchen sink (cutlery
and drinkware)
NB : (√) Done(x) Not Done

Prepared, Checked by, Acknowledged by,