REKAMAN PENGAMBILAN CONTOH IKLIM

RECORD OF SAMPLING KERJA

Hari / Tanggal : ............................................. Jam : .........................................

Nama Rumah Sakit : .............................................................................................................

Alamat : .............................................................................................................
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Titik Pengukuran : .............................................................................................................
Kategori Titik :  Di luar ruangan
 Di dalam ruangan
Sumber Panas/Kondisi Ruangan : .............................................................................................................
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Alat ukur : .............................................................................................................
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Pembacaan Termometer Pembacaan Sling Thermometer

No. Pengukuran WB DB GT RH
t (⁰C) t’ (⁰C) (t-t’)
(⁰C) (⁰C) (⁰C) (%)
1. Ruang operasi

2. Ruang
bersalin

3. Ruang
pemulihan/
perawatan
pasien

4. Ruang
observasi

5. Ruang
perawatan
bayi

6. Ruang
perawatan
prematur

7. Ruang ICU
*Kepmenkes No 1335 tahun 2002
 ISBB (⁰C) =

Catatan:
 ISBB di luar ruangan = (0,7 x WB) + (0,2 x GT) + (0,1 x DB)
 ISBB di dalam ruangan = (0,7 x WB) + (0,3 x GT)
 Wet Bulb (WB) = Suhu basah
 Dry Bulb (DB) = Suhu kering
 Globe Thermometer (GT) = Termometer bola/suhu radiasi

Diperiksa Oleh: .............................................................., .....................

Petugas Pengukur,

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NIP.