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PUSKESMAS BONTANG UTARA II

LAPORAN TEMUAN AUDIT DAN TINDAK LANJUT


Upaya / Unit Kerja Tanggal
[ ] Wawancana [ ] Periksa Dokumen/Rekaman Auditor
Metode
Audit [ ] Observasi/Pengamatan [ ] Lainnya, ............................. Auditee
IDENTIFIKASI TEMUAN
Kriteria Uraian Ketidaksesuaian Bukti Objektif
DIISI OLEH AUDITOR

ANALISA, RENCANA TINDAKAN PERBAIKAN DAN PENCEGAHAN


Analisis Akar Permasalahan :
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DISKUSI BERSAMA ANTARA AUDITOR DAN AUDITEE

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No Tindakan Perbaikan Target Penyelesaian

Tindakan Pencegahan Agar Tidak Terulang :


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Auditee Auditor Verifikasi oleh Auditor/Ketua Tim Audit


Tanggal Status

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Ketua Tim Audit

[ ] Selesai
[ ] Lembar Baru
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