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K3rs HARUE SILAKSANAKAN DENGAN BAIK DI RUMAH SAKIT.

UNTUK MENCEGAH TERJADINYA


KECELAKAAN KERJA DAN PENYAKIT AKIBAT KERJA

FORMULIR PELAPORAN KEJADIAN KECELAKAAN KERJA

I. IDENTITAS
NAMA :
UNIT KERJA :

II. RINCIAN KEJADIAN


TANGGAL :
WAKTU :
LOKASI :
INSIDEN :
DAMPAK :
MEDIA :
KRONOLOGI : ........................................................................................................
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TINDAKAN YANG DILAKUKAN SETELAH KEJADIAN:


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Bengkulu, 2017

Penerima Laporan Pembuat Laporan

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