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BORANG MAKLUM BALAS DAPATAN PEMANTAUAN

(Diisi oleh lokasi dan diberikan kepada pemantau bersama borang BORANG RUMUSAN
DAPATAN PEMANTAUAN dalam tempoh 14 hari bekerja)

Nama Lokasi :

Tarikh Pemantauan :

Bil MAKLUM BALAS

1 Isu dikenalpasti (merujuk kepada dapatan pemantauan):

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TINDAKAN PEMBETULAN
a) Punca
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b) Tindakan Bagi Selesai Punca


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* Sila gunakan lampiran jika ruangan tidak mencukupi

Tandatangan/ Cap Lokasi

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Tarikh : ……………………….

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