LAPORAN KEGIATAN PETUGAS

Tanggal Kunjungan :.......................................

1. Dasar : ……………………………………………………………………………………………
2. Tujuan kunjungan/ rapat :…………………………………………………………………………………………….
3. Hasil kunjungan/ rapat :…………………………………………………………………………………………….

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4. Kesimpulan / saran perbaikan :………………………………………………………………………………………..

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Mengetahui,
Jabatan : Pelapor :

(…………………………………….) (…………………………………….)

NIP. NIP.