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Form. PM. 6.4.

1/L2

PERMINTAAN PERBAIKAN KONDISI


LINGKUNGAN KERJA DAN PEMBELAJARAN

Kepada : Ka.Bidang Sarana dan Prasarana


Dari : ................................
Perihal : Permintaan Perbaikan Kondisi Lingkungan Kerja dan Pembelajaran

1. Uraian Penyimpanan : .................................................................................................................


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2. Sebab-sebab : .................................................................................................................
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3. Perbaikan yang diperlukan : .................................................................................................................
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………….. …………………..
Dibuat oleh,

Guru / Karyawan
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4. Tinjauan permasalahan oleh Kadep Sarpras

Diperbaiki Diganti Pengadaan

5. Rekomendasi yang disarankan :


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Ajibarang, ...........................
Mengetahui,

Khanifudin, S.Ag. Wardi


Kepala Sekolah Ka.Bidang Sarana dan Prasarana

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