PEMERINTAH PROVINSI................................

DINAS PENDIDIKAN LOGO &

LOGO
PROVINSI SEKOLAH MENENGAH KEJURUAN ................................. NOMOR
Alamat: .............................................................................................................. ISO (Bila yg
Telpon : .............................,Fax. : ...................................
sdh ber-ISO)
e-mail : ...............................................

PENANGANAN KERUSAKAN ALAT/ MESIN

Unit Kerja: Bengkel ........................................................

Kategori Kegiatan Tindak Pelaksanaan Perbaikkan

Merk/ Jenis
No. Tanggal Jenis Alat/ Mesin Rusak Rusak Lanjut yang
Model Kerusakan Waktu Hasil
Ringan Berat Dilakukan

.................................., .......................................... 20….

WKS Bidang .................... Kaprog .................................. Pembuat Laporan.

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