Laporan Monitoring Kawasan Tanpa Rokok

(KTR)

RINCIAN KEJADIAN

1. Tanggal dan Waktu :

Tanggal :............................... Jam :....................................
2. Lokasi : Seluruh Area Rumah Sakit
3. Temuan :
a. .....................................
b. .....................................
c. .....................................
4. Evaluasi Temuan :
.................................................................................................................................
.................................................................................................................................
.................................................................................................................................
.................................................................................................................................
.................................................................................................................................
.................................................................................................................................
5. Rencana Tindak Lanjut :
.................................................................................................................................
.................................................................................................................................
.................................................................................................................................
.................................................................................................................................
6. Dokumentasi Terlampir

Kesling & RT K3 RS