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  • Bap Kerusakan Barang

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    BAP KERUSAKAN BARANG

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
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    14 views1 page

    Bap Kerusakan Barang

    Uploaded by

    Cen Saputra
    CONTOH FORMAT

    Copyright:

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

    RUMAH SAKIT MM INDRAMAYU

    Jl. Letjend. Soeprapto No. 292 Kepandean Indramayu – Jawa Barat 45214
    Email: rumahsakit@rsmm-indramayu.id Telp: (0234) 277632/ 33/ 34 PT. BHARATI PUTRI MANDIRI

    BERITA ACARA KERUSAKAN BARANG

    A. ALAT / BARANG

    Nama Alat / Barang : Unit/Instalasi :


    Merk :
    Jumlah :
    No Inventaris :
    Status Kondisi :
    Kronologi :
    …………………………………………………………………………………………………
    …………………………………………………………………………………………………
    …………………………………………………………………………………………………
    …………………………………………………………………………………………………
    …………………………………………………………………………………………………
    …………………………………………………………………………………………………
    …………………………………………………………………………………………………
    …………………………………………………………………………………………………
    …………………………………………………………………………………………………
    …………………………………………………………………………………………………

    B. PETUGAS

    Nama Petugas Jaga/Shif: Tanda Tangan


    1.
    2.
    3.
    4.

    Telah dilakukan pengecekan oleh Petugas IPSRS RS MM Indramayu, dan Kondisi Alat /
    Barang : …………………………………………………………………………………….

    Mengetahui, Indramayu, 2021


    Ka.Ru IPSRS RS MM Indramayu Petugas IPSRS RS MM
    Indramayu

    (……………………………) (…………..……………….)

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