SUMARRY INDUCTION AND DISTRIBUTION PPE

&'%ai )#r*a / Workplace : Garawangi and Sunyaragi (CP-12

Ta+un / Year : 2!1"

A0a P#0indung Diri  Personal Protective Equipment

NO Sa,#y Na$a Di/ii
Ear Pl"g/ overall/ #aety
Num Indu.i'n Name Division Helmet Googles M" Masker est Gloves #hoes Etc R#$ar%

1 19/09/14 Miskiran Penyelidikan Tanah √ √ √

2 19/09/14 nang Penyelidikan Tanah √ √ √
! 19/09/14 M"kri Penyelidikan Tanah √ √ √
4 19/09/14 #"ryana nggar $"s"ma #oil %esistivity √ √ √
& 19/09/14 #ae'"din #oil %esistivity √ √ √
( 19/09/14 g"s Penyelidikan Tanah
Tanah √ √ √
) 19/09/14 se' *ra+an To'ogra'hy √ √ √
, 19/09/14 -ci #an"si To'ogra'hy √ √
9 19/09/14 de karna To'ogra'hy √ √ √
10 19/09/14 Erik Pe.riana To'ogra'hy √ √ √
11
12
1!
14
1&

1(
1)
1,
19
20
21
22
23
24

ckno+ledge .y
.y

(……………………………)
 No Dok :
Revisi : 0

PERNYATAAN PENERIMAAN A&AT PE&INDUNG DIRI (APD

Statement of Acceptance of Personal Protective Equipment (PPE)

Saya yang #randa angan di awa+ ini :

The undersined !ith information "elo! #

Na$a  Name :
5aaan  ccupation :
D#6ar#$#n  Department :

D#ngan ini $#nyaa%an3 a+wa aya #0a+ $#n#ri$a APD d#ngan rin.ian #agai #ri%u :
$ere!ith stated that % have received and accepted the follo!in PPE #

A0a P#0indung Diri (APD

N'$'r Num"er Personal Protective Equipment
(PPE)

1
2
!
4
&
(
 )
,
9
10

D#ngan ini aya #r#dia $#n*aga APD #r#u dari %#rua%an dan %#+i0angan4
5i%a #r*adi %#+i0angan3 aya #r#dia $#nggani APD #r#u3 d#ngan %ua0ia yang a$a4

The undersined aree to keep and secure the assined PPE from an& damae or loss'
%f such events occurred the undersined here"& is responsi"le to replace the respective items'

333332019
Saya yang $#nyaa%an3 Di%#a+ui '0#+3
*ndersined Ackno!lede "&
"&

33333553355556 H#E 7EP%TEME8T6

 STOK ALAT PELINDUNG DIRI (APD) GARAWANGI CP-12

NO PERALATAN SAET! "U#LA$ TOTAL !ANG DIPAKAI PERSEDIAAN (SISA)

1 S%&e'
S%&e' $e
$e*e
*e'' +i, 2. E%
2 S%&e'
S%&e' $e
$e*e
*e'' P/ 1E%
 S%&e'
S%&e' Goo3e
Goo3ess 0 e%
4 E%
E%,, P35
P35 #6
#6 0e%
 #%sk
#%ske,
e, 7e%
7 Cove,% 100e% 2e% .8e%
9 $%; Goves< 20s
8 +oo'
+oo' S%&
S%&e'
e'
 0 E%
. S%
S%&e
&e'
' Soe
Soess
10 +%,,
+%,,i=
i=%;
%;e
e
11 A>%,