PT.

INKASA JAYA ALUMINIUM

Office : Kertajaya No.150 Surabaya Tlp. 031 501 7882 Fax (0343) 659550
Factory : Raya Winong Km. 1.5 Talun-Gempol, Pasuruan Telp. 0343 657 606-7

BERITA ACARA KERUSAKAN MESIN

Pada Hari ini ………………….. Tanggal……………Bulan…………………Tahun………………….Telah Terjadi
trouble/Kerusakan Mesin dengan Spesifikasi sebagai berikut :

Nama Alat/Mesin : ……………………………………………Jenis ………..…………………………………………………….

Kapasitas Alat/Mesin : …………………………………………………………………………………………………………………….

Lokasi Alat/ Mesin : …………………………………………………………………………………………………………………….

Pelanggaran Kedisiplinan : …………………………………………………………………………………………………………………….

1. Kronologis Kejadian
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2. Tindakan Yang Di ambil Ka.Bag / Waka.Bag / Maintenance
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3. Saksi-Saksi:
1. ………………………………..
2. ………………………………..

Demikian Berita Acara ini dibuat,sekian dan terima kasih

Pasuruan,………………….20…
Di buat Penanggung Jawab Team Perbaikan,
Oleh, Kabag/Wakabag, MTC

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Verifikasi
HRD :…………………………..
Direksi :………………………….