PEMERINTAH KABUPATEN PEMALANG

DINAS TENAGA KERJA

SURAT PERINTAH TUGAS

Nomor : 094/ /Disnaker.
Dasar
: 1. Undang-undang No. 13 Tahun 2003 tentang Ketenagakerjaan;
2. Undang-undang No. 2 Tahun 2004 tentang Penyelesaian Perselisihan
Hubungan Industrial

MEMERINTAH KAN
Kepada : 1. N a m a
TITIK WIDYASTUTI , S.Sos. M.Si
NIP 19741028 199303 2 002
PangkaUGolongan Pembina (IV/a)
Jabatan Kabid. Pembinaan Hubinsyaker dan Jamsostek
Disnaker. Kab. Pemalang
2. Nam a ADRIAN TAUFIQ JATIWIJAYA, SH
NIP 19651224 199408 1 008
PangkaUGolongan Penata Tk. I (111/d)
Jabatan Mediator HI / Sub Kor Hubinsyaker
Disnaker. Kab. Pemalang
3. Nam a KARTINI SUKMAWATI
NIP 19710421199803 2 011
PangkaUGolongan Penata (111/c)
Jabatan Pengelola Keuangan Disnaker. Kab. Pml
4. Nam a TIRTA SANTIKA NUGROHO, ST
NIP 19890424 202012 1 007
PangkaUGolongan Penata Muda (Ill/a)
Jabatan Analis Tenaga Kerja Disnaker. Kab. Pemalang

Untuk : Pembinaan dan pendataan PHI/PHK di PT. Bringin Gigantara, Pemalang

Hari / Tanggal : Jum' at, 26 Mei 2023

Demikian Surat Perintah ini dibuat untuk dapat dilaksanakan dengan penuh tanggung
jawab.

Dikeluarkan di : Pemalang
Pada tanggal : 26 Mei 2023

An. Kepala Dinas Tenaga Kerja

Kabupaten Pemalang
Kabid. Pembinaan Hubinsyaker dan Jamsostek

TITIK WIDYASTUTI, S.Sos.MSi

Pembina
NIP. 19741028 199303 2 002

Alamat: Jalan Jend. Gatot Subroto No. 35 Telp. (0284) 321278 Pemalang
Ii
Tanggal
,la PEMERINTAHKABUPATEN PEMALANG
DINAS 'PENA:GN-l@RJA
BERITA ACARA, PENANGANAN/KL!ARIFIKASI
1

II(lASUSIBERMASALAHAN,KETENAG.AlffiRJAAN
01 ... ,.r:.. ~.~l-~-~ ..~.~~~---····
Bahwa dalam rangka melaksanakan ketentuan ,peraturan penmdang-undangan tentang
· ketenagake~aan clan adanya laporan pengad1,1aI1 ,pe1111as~ah·ketenagakerjaan di p e ~ sau~
ole? pekeI'ja maka perlu adanya penyampaianfklarifikasi dari pihak perusahaan yaitu sebagai
berikut:
I. IDENTITAS PERUSAHAAN:
Nama Perusahaan • Vt • ~12JNlMt.1 i!1 ... _....... _.............. .
· ········ ··· ············ ···· ················"'· . (p
....
0
;:,~~::;~~:::~i~;~:t:.,.~~······-··········
. f\Jtt.A. \?l.l~\',~ ..
Nama Pimpinan Perusahaan
Alamat Perusahaan
II. IDENTIAS PEKERJA/PELAPOR :
Nama Pekerja/Pelapor : A~.!::1:Y.~.l~~~............................ .. ......... ·····
Alamat Pekerja/Pelapor : .. ........................ -- ... -- ...
Status Pekerja/Pelapor =·--~~~-·----------··--·---·-···---···---·-·-·-····-·-·--··--
. Met 2.&tl~
III. TANGGAL PENGADUAN . ·········································································
IV. PERMASALAHAN
- ~'t'P.IM!ttN \Q;,J\M.AI,(_ 9 ~ / ~ ~ \ Po&tt < \$t11. I
·························································································································································
\ , . ~ ~ 6P>l<IAA ,$1"½( ~ f l " ' - - 2- C>\/l.AJ' ~ I \i3eLVM
········································.··....
M~CU~~~I
·························································································································································
·········································································································································•···············
··························································································································································
y_ KETERANGAN PIHAK PERUSAHAAN/ UPAYA YANG DILAKUKAN PERUSAHAAN :
• \<::o~\(._ '? ~vuw <?pw fAQ.l B ~ ~111(__ t ~
··································································································································il-.................... .
<2..13vl.AA Y.f!.'> ~~>sv\.eAN ( ) ~ f l . A , , / Om.f
································ ························ ·······································································•····················•··
11.0Av--. ~~,--- C>-6'1 t € t l 1 r ) ~
······················································································································································••·
- \JiA<¾ \ .J-v9~ P\ ~ltl\eAW,
·························································································································································
Demikian Berita Acara penanganan / Kalrifikasi permasalahan ketenagakerjaan ini dibuat serta
ditantangani oleh yang bersangkutan. ·
Pemalang, 20
I Petugas/Mediator,

.........1~ Mengetahui :
Kabid Bina Hubinsyaker dan Jamsotek

( Titik Widyastuti., S.Sos, M.Si )