BUKU LOG LAPORAN

HARIAN
SURAT PERAKUAN
PENGGAMBARAN KHAS
NAMA SYARIKAT:

TAJUK:

NO. SPP:

NAMA PENYELIA:
PROTOKOL
PENGGAMBARAN
UNTUK KEGUNAAN FINAS

NAMA PENERIMA:

TARIKH TERIMA:

* Buku Log hendaklah dihantar (2) hari selepas tamat penggambaran

1
 TARIKH: MASA MULA: MASA TAMAT:

NAMA SYARIKAT:____________________________________________________________NO. LESEN:_____________________

TAJUK:___________________________________________________________________________________________________
NO. SPP:_________________________________________________________________________________________________
ALAMAT LOKASI PENGGAMBARAN: ___________________________________________________________________________
_________________________________________________________________________________________________________
*hendaklah mengisi alamat penuh lokasi
SEMAKAN PEMATUHAN PROTOKOL KESIHATAN UMUM
a. QR CODE MYSEJAHTERA ( ) b. IMBASAN SUHU ( ) c. HAND SANITIZER ( )
d. PENJARAKAN SOSIAL ( ) e. DISINFEKSI / NYAHKUMAN ( ) f. PELITUP MUKA ( )
g. PENGURUSAN CATERING ( ) h. SWAB TEST ( ) I. TAKLIMAT SOP ( )
SENARAI TENAGA PRODUKSI TERLIBAT
BIL NAMA NO K/P SUHU MULA TAMAT
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
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18.
19.
20.
*Gunakan lampiran jika tidak mencukupi
WAKTU SANITASI
SEBELUM PENGGAMBARAN: ____________ SEMASA PENGGAMBARAN: __________ SELEPAS PENGGAMBARAN: __________
CATATAN:________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
TANDATANGAN PPP:
NAMA:
NO. K/P:
*Hendaklah diisi setiap hari penggambaran dijalankan.

2
 KEPUTUSAN UJIAN CALITAN COVID-19 (SWAB TEST) SEMASA TEMPOH PENGGAMBARAN

BIL NAMA NO K/P TARIKH UJIAN KEPUTUSAN

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
*Gunakan lampiran jika tidak mencukupi
*Salinan keputusan ujian hendaklah disertakan

TANDATANGAN PPP:

NAMA:

NO. K/P:

TARIKH:

3
 KEPUTUSAN UJIAN CALITAN COVID-19 (SWAB TEST) SELEPAS TEMPOH PENGGAMBARAN
*Hendaklah dibuat 2 hari sebelum tamat penggambaran

BIL NAMA NO K/P TARIKH UJIAN KEPUTUSAN

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
*Gunakan lampiran jika tidak mencukupi
*Salinan keputusan ujian hendaklah disertakan

TANDATANGAN PPP:

NAMA:

NO. K/P:

TARIKH:

4
LAPORAN KESELURUHAN TEMPOH PENGGAMBARAN

1. NAMA SYARIKAT:_____________________________________ 2. NO. LESEN: ______________________________________

3.TAJUK:________________________________________________________________________________________________
4.NO.SPP:_______________________________ 5.BILANGAN TENAGA PRODUKSI:____________________________________
6. TARIKH MULA:__________________________ 7. TARIKH TAMAT:________________________________________________
8. ALAMAT PENGINAPAN:
a)_______________________________________________________________________________________________________
_________________________________________________________________________________________________________
b) ______________________________________________________________________________________________________
_________________________________________________________________________________________________________
c) _______________________________________________________________________________________________________
_________________________________________________________________________________________________________

LAPORAN

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_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________

TANDATANGAN PPP:
NAMA:
NO. K/P:
TARIKH:
5
 LAMPIRAN
GAMBAR PERALATAN PENCEGAHAN COVID-19 YANG DIGUNAKAN.

6
 LAMPIRAN
GAMBAR KERJA-KERJA SANITASI NYAHKUMAN

7
 LAMPIRAN

QR CODE
MYSEJAHTERA
SETIAP LOKASI
PENGGAMBARAN