LAPORAN HASIL UJI PRAKTEK

Bidang DISTRIBUSI
Tanggal 10 Agustus 2022 s/d 11 Agustus 2022

A. DATA INDENTITAS PESERTA :

 Nama Peserta :
 NIK :
 Tempat, Tgl Lahir :
 No. Absen :

B. DAFTAR ISI :

NO ISIAN STATUS (√)

1 LHP (Laporan Hasil Praktek)

2 Surat Tugas

3 JSA

4 SOP

5 Foto Uji Praktek

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C. JENIS KEGIATAN PRAKTEK :

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D. LOKASI KEGIATAN PRAKTEK :

(Sebutkan Lokasi Daerah, No. Tiang , Nomor Trafo, atau indentitas lokasi lainnya).

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E. DATA TEKNIS PERALATAN YANG DIPERGUNAKAN UNTUK PRAKTEK :

(Misalnya : JTM / JTR / Trafo / ABSW / FCO / PHB / dll )

KAPASITAS/
No NAMA PERALATAN JENIS / TYPE UKURAN .....
KEMAMPUAN

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F. TAHAPAN KEGIATAN PRAKTEK :
(Tuliskan tahapan2 / langkah2 kegiatan Praktek dari awal sampai dengan selesai)

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G. ALAT KERJA yang dipergunakan Praktek :

No NAMA ALAT KERJA JENIS / TYPE KAPASITAS/ .....

KEMAMPUAN

H. ALAT PELINDUNG DIRI yang dipergunakan Praktek :

No NAMA APD JENIS / TYPE KAPASITAS/ .....

KEMAMPUAN

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I. ALAT UKUR yang dipergunakan Praktek :

No NAMA MERK JENIS / TYPE KAPASITAS/ .........

KEMAMPUAN

J. HASIL PENGUKURAN :

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K. LAMPIRAN / DOKUMENTASI :

1) L H P (laporan Hasil Praktek)

2) Surat Tugas Peserta

3) J S A

4) S O P

5) Photo Kegiatan Praktek

6) Photo Alat Ukur

7) Photo Name Plate Peralatan Praktek

………………………….., ……………………………………...

PELAKSANA KEGIATAN PRAKTEK

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