REKAMAN PENGAMBILAN CONTOH KEBISINGAN

TEMPAT
RECORD OF SAMPLING KERJA

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

Nama Perusahaan : ..........................................................................................................................................
Alamat : ..........................................................................................................................................
..........................................................................................................................................
Alat ukur : ..........................................................................................................................................
Hasil Pengukuran : ..........................................................................................................................................

Jumlah Jumlah
Sumber Kebisingan APD yang
No. Lokasi/Ruang Naker Jam Kerja
Bising (dBA) digunakan
(Orang) (Jam)

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

Petugas Pengukur,

..................................................................... .....................................................................
NIP.