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  • DATA KARYAWAN KECELAKAAN - Kronologis

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    DATA KARYAWAN KECELAKAAN - Kronologis

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    fotocopy rahmad

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    © All Rights Reserved
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    dari 1

    DATA KARYAWAN KECELAKAAN

    Nama : .....................................................................................................................
    No Kartu Peserta : .....................................................................................................................
    Kecelakaan Tgl dan Jam Berapa ? ...................................................................................................
    ...........................................................................................................................................................
    ...........................................................................................................................................................
    Alamat lokasi Kejadian ?
    ...........................................................................................................................................................
    ...........................................................................................................................................................
    Masuk RS Mana ?
    ...........................................................................................................................................................
    ...........................................................................................................................................................
    Kecelakaan Tunggal Atau Berlawanan ?
    ...........................................................................................................................................................
    ...........................................................................................................................................................
    LP Kepolisian Sudah di Proses Atau Belum?
    ...........................................................................................................................................................
    ...........................................................................................................................................................
    Berangkat Kerja, Pulang Kerja Atau Bagaimana ?
    ...........................................................................................................................................................
    ...........................................................................................................................................................
    Alamat Lengkap Berangkat Dari Mana ?
    ...........................................................................................................................................................
    ...........................................................................................................................................................
    Alamat Lengkap Tujuan ?
    ...........................................................................................................................................................
    ...........................................................................................................................................................
    Kronologis kejadian ?
    ...........................................................................................................................................................
    ...........................................................................................................................................................
    ...........................................................................................................................................................
    ...........................................................................................................................................................
    ...........................................................................................................................................................
    ...........................................................................................................................................................
    ...........................................................................................................................................................
    ...........................................................................................................................................................
    ...........................................................................................................................................................
    ...........................................................................................................................................................
    ...........................................................................................................................................................
    ...........................................................................................................................................................

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