Scribd Logo
Upload

Welcome to Scribd!

  • Lembar Kesediaan Karantina

    Uploaded by

    Siti Nur'ain Fatimah
    10 views1 page
    This document is a home quarantine/home care (self-isolation) agreement form. It states that the signed individual agrees to undergo home quarantine/self-isolation as required by the government and will comply with all rules until this period ends. The individual provides their name, age, gender, phone number and address and signs the document agreeing to these terms, with an official witnessing the signature.

    Original Description:

    Original Title

    lembar kesediaan karantina

    Copyright

    © © All Rights Reserved

    Available Formats

    DOCX, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Report this Document
    This document is a home quarantine/home care (self-isolation) agreement form. It states that the signed individual agrees to undergo home quarantine/self-isolation as required by the government and will comply with all rules until this period ends. The individual provides their name, age, gender, phone number and address and signs the document agreeing to these terms, with an official witnessing the signature.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    10 views1 page

    Lembar Kesediaan Karantina

    Uploaded by

    Siti Nur'ain Fatimah
    This document is a home quarantine/home care (self-isolation) agreement form. It states that the signed individual agrees to undergo home quarantine/self-isolation as required by the government and will comply with all rules until this period ends. The individual provides their name, age, gender, phone number and address and signs the document agreeing to these terms, with an official witnessing the signature.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    Lembar Kesediaan Karantina Rumah/Perawatan Di Rumah (Isolasi Diri)

    Yang bertanda tangan di bawah ini:

    Nama :

    Umur :

    Jenis Kelamin :

    Nomor Hp :

    Alamat :

    Menyatakan bersedia untuk dilakukan tindakan karantina rumah/isolasi diri (perawatan


    di rumah)* dan akan mematuhi segala aturan yang di tetapkan oleh pemerintah sampai
    tindakan ini dinyatakan berakhir.

    Demikian pernyataan ini saya buat dengan sebenar-benarnya.

    .................., ......................2021

    Petugas Karantina, Yang membuat pernyataan

    ( ) ( )

    Mengetahui ,
    Koordinator Lapangan

    ( )

    You might also like