LEMBAR SURYEY TEMPAT KEMAH

Tanggal Survey : ________________________________________________________________________

Nama Lokasi : ________________________________________________________________________

Alamat : ________________________________________________________________________

Jarak/Durasi Tempuh : ________________________________________________________________________

Narasumber : ________________________________________________________________________

No Contact Person : ________________________________________________________________________

Item Survey :

1. Kondisi Lokasi : _________________________________________________________________

: _________________________________________________________________
: _________________________________________________________________

2. Kamar Mandi & Toilet : _________________________________________________________________

: _________________________________________________________________
: _________________________________________________________________

3. Tempat pendirian : _________________________________________________________________

tenda : _________________________________________________________________
: _________________________________________________________________
: _________________________________________________________________

4. Pendapa : _________________________________________________________________
: _________________________________________________________________
: _________________________________________________________________
: _________________________________________________________________

5. Panggung : _________________________________________________________________
: _________________________________________________________________

6. Sekretariat : _________________________________________________________________
: _________________________________________________________________

7. Air : _________________________________________________________________
: _________________________________________________________________

8. Wahana Permainan : _________________________________________________________________

: _________________________________________________________________
: _________________________________________________________________
: _________________________________________________________________

9. Listrik : _________________________________________________________________
: _________________________________________________________________

10. Roll Kabel : _________________________________________________________________

: _________________________________________________________________

11. Jalur Tracking : _________________________________________________________________

: _________________________________________________________________
: _________________________________________________________________

12. Soundsystem : _________________________________________________________________

: _________________________________________________________________
 13. Tempat Evakuasi : _________________________________________________________________
: _________________________________________________________________
: _________________________________________________________________

14. Dapur (untuk panitia) : _________________________________________________________________

: _________________________________________________________________

15. Peralatan masak : _________________________________________________________________

(untuk panitia) : _________________________________________________________________

16. Peralatan makan : _________________________________________________________________

(untuk panitia) : _________________________________________________________________

17. Area wisata/bersejarah : _________________________________________________________________

: _________________________________________________________________
: _________________________________________________________________

18. Perijinan : _________________________________________________________________

: _________________________________________________________________
: _________________________________________________________________

19. Keamanan : _________________________________________________________________

: _________________________________________________________________

20. Tenda : _________________________________________________________________

: _________________________________________________________________

21. Alokasi tanggal : _________________________________________________________________

: _________________________________________________________________
: _________________________________________________________________

22. Perijinan Kebaktian : _________________________________________________________________

: _________________________________________________________________

23. Biaya : _________________________________________________________________

: _________________________________________________________________
: _________________________________________________________________

Kesimpulan Hasil Survey : _________________________________________________________________

Tim Survey:

1. __________________________________________________

2. __________________________________________________

3. __________________________________________________

4. __________________________________________________