MONITORING SOP….

No. Dokumen :
DAFTAR No. Revisi :
TILIK Tgl Terbit :
Halaman :

UPT dr. Kinang Tandirerung

PUSKESMAS NIP.19660413 200112 2 001
MUARA WAHAU II

Unit : ……………………………………………..............
Nama Auditee/Petugas : …………………………………………..................
Nama Auditor/Pelaksana : ...........................................................................
Tanggal Pelaksanaan : ………………………………………………………
No Langkah Kegiatan Ya Tidak Keterangan
1. Apakahpetugas......................................?
1
2. Apakahpetugas......................................?
2
3. Apakahpetugas.................................... ?
2
4. Apakah petugas.................................... ?
3
5. Apakah petugas........ .............................?
6. Apakahpetugas........................................?
7. dst

JUMLAH

Compliance rate (CR) : ………………………%

Muara Wahau,

Auditee/Petugas Auditor/Pelaksana

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(...........................................)