FORMULIR PENETAPAN LOKASI DAN No.

Dokumen FO-JTS-TKS-PKL-003
DOSEN PEMBIMBING JURUSAN Berlaku Sejak Juni 2017
Revisi 00
Program Studi
Teknik Konstruksi Sipil Halaman 1 dari 1

Nama NIM
Mahasiswa
Semester / Kelas ….. / ……. Program Studi
Dosen Wali Jurusan Teknik Sipil

Penetapan Lokasi Proyek

Nama Proyek : ....................................................................................................
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Alamat : ....................................................................................................
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Telepon..................................e-mail ............................................
Nama Pimpinan Proyek : ....................................................................................................
Telepon................................e-mail ............................................
Jabatan : ....................................................................................................
Cakupan Pekerjaan Yang akan Dilaksanakan:

Dosen Pembimbing Jurusan : ............................................................................

Pembimbing Lapangan : ............................................................................

Bandung, .................. 20.......

Mengetahui, Tim Akademik Jurusan Teknik Sipil,
Panitia PKL/Dosen Wali

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