BULAN : Mei
LOKASI: Rooftank
Item Tanggal Keterangan
No. Pemeriksaan/perawatan 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Sedikit
1 Volume Air : Sedang
Banyak
Bersih
2 Ruangan
Kotor
Automatis Berfungsi
3
Pompa Tidak
Tanjungpandan, 2017
Mengetahui,
Kepala IPSRS Petugas Pengecekan sarana air bersih
1
2
Masri Musa, A.Md 3
NIP.197106112003121002
CEKLIST HARIAN PEMELIHARAAN INCINERATOR
RSUD dr. H. MARSIDI JUDONO TAHUN 2022
BULAN : Januari
LOKASI: Incinerator
Item Tanggal
No. Pemeriksaan/perawatan 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
Berfungsi
1 Burner
Tidak
Baik
2 Sprayer Scruber
Tersumbat
Berfungsi
3 Pompa Scruber
Tidak
Berfungsi
4 Blower
Tidak
Berfungsi
5 Termocouple
Tidak
Lifter Bucket Berfungsi
6
Motor dan Sling Tidak
Piranti Panel Berfungsi
7
Kelistrikan Tidak
Paraf Petugas
Catatan : .........................................................................................................................................................................
.......................................................................................................................................................................................
.......................................................................................................................................................................................
.......................................................................................................................................................................................
.......................................................................................................................................................................................
N INCINERATOR
TAHUN 2022
al
Keterangan
20 21 22 23 24 25 26 27 28 29 30 31
Tanjungpandan, 2023
......................... Ka. Instalasi Sanitasi
.........................
.........................
.........................
Nip.