Service 

Report
Berita Acara
Report to Customer
Rentokil Indonesia (RI-JK-OS-230-SE-F-8.5-06)
Ref:142143_20220826100513
A. CUSTOMER INFORMATION
Purpose of Treatment Routine Shared Type of Premise Hospitals
Account Number 700022169 Type of Pests Covered Qty Freq
Contract Number 50051177/1 General Pest Plus
: Ants - Other, Cockroaches - Other, Flies, Mosquito, Rodents 0 48
Type of Premise Hospitals (GPP)
Customer Name RS SEPATAN MULIA Cat Control
0 48
Contact Name IBU ARUM : (CATC)

Contact Number +622159371801
Address (Site of application) RS SEPATAN MULIA
JL. RAYA PAKUHAJI RT 02 RW
01
SEPATAN
TANGERANG
INDONESIA
15520
Site Risk Assessment
Terdapat Anak-anak/Orang Tua/Orang Cacat/Keramaian : AREA DALAM Terdapat kendaraan/forklift/mesin pengangkat : PARKIR Bahan kimia/gas/debu/uap
: AREA LUAR, AREA DALAM Mengangkat/mengangkut : AREA LUAR, AREA DALAM Adanya penghisap udara pada sistem ventilasi : AREA DALAM

B. APPLICATOR’S INFORMATION C. CUSTOMER’S SIGNATURE/COMPANY STAMP
I declare the information below is true and
I acknowledge receipt of the report below:
correct:
Signature: Signature:

FIKRI BAMBANG IRAWAN

Name Name ibu nova
FIKRI BAMBANG IRAWAN
License No. Date 26-08-2022 07:02
Date 26-08-2022 07:02
Time In 07:02
Time Out 10:05
Name of other Applicators: Dede Kurniawan Dede Kurniawan

D. PESTICIDES APPLIED
Active Ingredient Trade Name Class Method of Total Area Total
(Conc. Diluted Solution Applied (%)) (Conc. Diluted Solution Applied (%)) Application Treated Qty Used
Cypermethrin Smash 100EC (GPP) Thermal fogging 100 ml
Area Pesticide Applied

Cypermethrin Smash 100EC (GPP) Spraying 100 ml

Area Pesticide Applied

Brodifacoum Talon 0.005 BB (GPP) Baiting 120 gram

Area Pesticide Applied

Trigonal Box (GPP) Monitoring / Trapping 5 Unit

Area Pesticide Applied Pemasangan unit trigonal d ruang panel tiap lantai

Lem Tikus Tube (GPP) Monitoring / Trapping 4 Tube

Area Pesticide Applied

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 Plastic Tray (GPP) Monitoring / Trapping 5 unit
Area Pesticide Applied

Cypermethrin Smash 100EC (GPP) Cold fogging 200 ml

Area Pesticide Applied

Luminos 1 Glue 011 (GPP) Monitoring / Trapping 1 Unit

Area Pesticide Applied

Luminos 1 Glue 011 (GPP) Monitoring / Trapping 1 Unit

Area Pesticide Applied

Luminos 1 Glue 011 (GPP) Monitoring / Trapping 1 Unit

Area Pesticide Applied

Luminos 1 Glue 011 (GPP) Monitoring / Trapping 1 Unit

Area Pesticide Applied

Luminos 1 Glue 011 (GPP) Monitoring / Trapping 1 Unit

Area Pesticide Applied

Luminos 1 Glue 011 (GPP) Monitoring / Trapping 1 Unit

Area Pesticide Applied

Cypermethrin Smash 100EC (GPP) Spraying 100 ml

Area Pesticide Applied

Cypermethrin Smash 100EC (GPP) Thermal fogging 100 ml

Area Pesticide Applied

Cypermethrin Smash 100EC (GPP) Cold fogging 200 ml

Area Pesticide Applied

Cypermethrin Smash 100EC (GPP) Cold fogging 200 ml

Area Pesticide Applied

E. PEST STATUS
Pest Level Location Found Remarks

Flying Insect Other Low - 10 Internal

Building: RS SEPATAN MULIA, Floor: 1st Floor, Zone: 3rd Line Office, Location Found: I4. 5 LUMNIA

Houseflies Low - 3 Internal

Building: RS SEPATAN MULIA, Floor: 1st Floor, Zone: 3rd Line Office, Location Found: I4. 5 LUMNIA

Mosquito Low - 11 Internal

Building: RS SEPATAN MULIA, Floor: 1st Floor, Zone: 3rd Line Office, Location Found: I4. 5 LUMNIA

Flying Insect Other Low - 10 Internal

Building: RS SEPATAN MULIA, Floor: 1st Floor, Zone: 3rd Line Office, Location Found: I4. 4 LUMNIA

Houseflies Low - 4 Internal

Building: RS SEPATAN MULIA, Floor: 1st Floor, Zone: 3rd Line Office, Location Found: I4. 4 LUMNIA

Mosquito Low - 13 Internal

Building: RS SEPATAN MULIA, Floor: 1st Floor, Zone: 3rd Line Office, Location Found: I4. 4 LUMNIA

Flying Insect Other Low - 14 Internal

Building: RS SEPATAN MULIA, Floor: 1st Floor, Zone: 3rd Line Office, Location Found: I4. 6 LUMNIA

Houseflies Low - 2 Internal

Building: RS SEPATAN MULIA, Floor: 1st Floor, Zone: 3rd Line Office, Location Found: I4. 6 LUMNIA

Mosquito Low - 15 Internal

Building: RS SEPATAN MULIA, Floor: 1st Floor, Zone: 3rd Line Office, Location Found: I4. 6 LUMNIA

Flying Insect Other Low - 18 Internal

Building: RS SEPATAN MULIA, Floor: 1st Floor, Zone: 3rd Line Office, Location Found: I4. 2 LUMNIA

Houseflies Low - 6 Internal

Building: RS SEPATAN MULIA, Floor: 1st Floor, Zone: 3rd Line Office, Location Found: I4. 2 LUMNIA

Mosquito Low - 14 Internal

Building: RS SEPATAN MULIA, Floor: 1st Floor, Zone: 3rd Line Office, Location Found: I4. 2 LUMNIA

Flying Insect Other Low - 16 Internal

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 Building: RS SEPATAN MULIA, Floor: 1st Floor, Zone: 3rd Line Office, Location Found: I4. 1 LUMNIA

Houseflies Low - 6 Internal

Building: RS SEPATAN MULIA, Floor: 1st Floor, Zone: 3rd Line Office, Location Found: I4. 1 LUMNIA

Mosquito Low - 14 Internal

Building: RS SEPATAN MULIA, Floor: 1st Floor, Zone: 3rd Line Office, Location Found: I4. 1 LUMNIA

Flying Insect Other Low - 19 Internal

Building: RS SEPATAN MULIA, Floor: 1st Floor, Zone: 3rd Line Office, Location Found: I4. 3 LUMNIA

Houseflies Low - 3 Internal

Building: RS SEPATAN MULIA, Floor: 1st Floor, Zone: 3rd Line Office, Location Found: I4. 3 LUMNIA

Mosquito Low - 18 Internal

Building: RS SEPATAN MULIA, Floor: 1st Floor, Zone: 3rd Line Office, Location Found: I4. 3 LUMNIA

F. RECOMMENDATIONS BY RENTOKIL INITIAL
Type Recommendations Priority

Proofing (GPP) lakukan penutupan akses lubang jalur kabel pada ruang panel lantai 1 Low

Proofing (GPP) lakukan penutupan akses tiap lantai d ruang room panel. Low

G. SERVICE VISIT NOTES
Product (s) Visit Notes

Cat Control - 48

General Pest Plus - 48

Rentokil Indonesia Komplek Pergudangan Multiguna, Duta Indah Iconic, Blok C No.37, Jl. M H Thamrin, Cikokol, Tangerang, 15117
t +622129866707/706 f e rendra.wdriyo@rentokil-initial.com w www.rentokil.co.id

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