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FORMAT OPERASIONAL LINEN

Ruang : ..................................................................
Hari/Tgl Pengkajian : ..................................................................
Perawat PJ/Bidan PJ/Jaga : ..................................................................

STOK STOK
No NAMA BARANG JLH UNIT TERPAKAI DICUCI Keterangan
DIRUANGAN DIGUDANG
1 2 3 4 5 6 7 8
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
FORMAT PENYERAHAN LINEN KOTOR KE LAUNDRY

Perawat Pj/Jaga Petugas Laundry


UNIT UMUM / BULAN Volume :
LAUNDRY NOVEMBER .........
........................................ .............................................

Ruang : ...............................................................
Hari/Tgl Serah Terima Laundry : ...............................................................
Perawat PJ/Bidan PJ/Jaga : ...............................................................
Petugas Laundry : ...............................................................

No Nama Barang Unit Keterangan


1

10

11

12

13

14

15

16

17

18

19

20
FORMAT PENYERAHAN LINEN BERSIH KE LAUNDRY

Perawat Pj/Jaga Petugas Laundry


UNIT UMUM / BULAN Volume :
LAUNDRY NOVEMBER .........
........................................ .............................................

Ruang : ...............................................................
Hari/Tgl Serah Terima Laundry : ...............................................................
Perawat PJ/Bidan PJ/Jaga : ...............................................................
Petugas Laundry : ...............................................................

No Nama Barang Unit Keterangan


1

10

11

12

13

14

15

16

17

18

19

20
Permasalahan dan Pemecahan Masalah di Pelayanan Gizi
No Permsalahan Pemecahan Masalah
1

10
FORMAT EVALUASI KEBUTUHAN LINEN RS. GRAHA HERMINE KE

Manajer Keperawatan/Kebidanan Manager Umum


UNIT UMUM
BULAN NOVEMBER Halaman : 1
/ LAUNDRY
........................................ .............................................

Hari Pengevaluasian :
Tanggal :
Pukul :
Kebutuhan Laken Rs Graha Hermine
No Immediately Moderat
Nama Barang Biasa Unit Keterangan
(segra) (sedang)
1 2 3 4 5 6 7
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20

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