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  • Form Laporan Tumpahan B3

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    K3RS RSJ Provinsi Jawa Barat
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    50 tayangan1 halaman

    Form Laporan Tumpahan B3

    Diunggah oleh

    K3RS RSJ Provinsi Jawa Barat

    Hak Cipta:

    © All Rights Reserved
    Unduh sebagai DOCX, PDF, TXT atau baca online dari Scribd
    Tandai sebagai konten tidak pantas
    dari 1

    PEMERINTAH DAERAH PROVINSI JAWA BARAT

    DINAS KESEHATAN
    RUMAH SAKIT JIWA
    Jalan Kolonel Masturi KM. 7 – Cisarua Telepon : (022) 2700260
    Faksimil: (022) 2700304 Website : www.rsj.jabarprov.go.id email :rsj@jabarprov.go.id
    KABUPATEN BANDUNG BARAT – 40551

    Laporan Kejadian Tumpahan dan Paparan Bahan Berbahaya dan Beracun (B3)

    1 Nama yang terkena paparan : ......................................................................................


    2 Unit kerja : ......................................................................................
    3 Tanggal dan waktu insiden :
    a. Tanggal : ......................................................................................
    b. Jam : ......................................................................................
    4 Lokasi : ......................................................................................
    5 Jenis bahan : ......................................................................................
    6 Kronologis kejadian : ......................................................................................
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    7 Tindakan yang dilakukan setelah kejadian : ......................................................................................


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    Pembuat Penerima
    : ............................................. : .............................................
    laporan laporan
    Unit : ............................................. Unit : .............................................
    Paraf : ............................................. Paraf : .............................................
    Tanggal lapor : ............................................. Tanggal diterima : .............................................

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