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# PERTAMINAGAS KONTRAK PAYUNG PEMELIHARAAN KONSTRUKSI RINGAN

PT PERTAMINA GAS WESTERN JAVA AREA.


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DATA FORMULIR DAILY CHECK UP (DCU)
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Geiala COVID-19 Dallv Check Un 1DCUl
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NO TANGGAL,TAH NAMA PEKERJA Sakit
POSIS! (THN Suhu sesak Konsums Riwayat Kesadara Tekanan Keseimb
UN. Batuk Pilek tenggor Diare Mual Muntah Keluhan Nadi Nafas Mata Napza Keterangan
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okan

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Ya/Tdk Ya/Tdk Ya/Tdk Ya/Tdk Ya/Tdk Ya/Tdk Ya/Tdk Ya/Tdk Ya/Tdk Fit/Non Fit
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Ya/Tdk Ya(Tdk Ya(Tdk Ya/Tdk Ya/Tdk Ya(Tdk Ya/Tdk Ya(Tdk Ya/Tdk Fit/Non Fit

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Nama:
Nama:
Jabatan:
Jabatan :

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