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Kode Dok : F-TRT-025

Revisi :1

USULAN PERBAIKAN BARANG/ALAT

KODE UNIT/RUANG : .....................................................

JENIS KERUSAKAN (Beri tanda) ..................................

KELISTRIKAN MESIN

BANGUNAN MEBEULAIR

LAIN-LAIN

PENJELASAN KERUSAKAN :

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KESIMPULAN DAN USULAN:

Bisa Diperbaiki, Pengadaan Jasa Perbaikan

Rusak Total, Pengadaan Barang Baru

Diterima tanggal: ............................... Batu, .....................................


Pengadministrasi Kerumahtanggaan, Teknisi,

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NIP NIP

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