Lampiran 4

BKS 03/04

LAPORAN SIASATAN ADUAN PELANGGAN

1. Jenis Aduan (Bertulis/Lisan) : .......................................................................

2. No. Aduan : .........................................................................

3. Nama Pengadu : .........................................................................

4. Alamat : .........................................................................

5. Tarikh Aduan : .........................................................................

6. Lampiran (Borang Aduan Pelanggan ) :

7. Laporan Siasatan :

7.1 Perkara / Isu yang

berlaku : .............................................................................................................
....................
………………………………………………………………………………………………
7.2 Pihak yang terlibat (Pelajar / Pensyarah / AKP / Lain-lain)
7.2.1 Nama : ……………………………………………………………
7.2.2 No. Kad Pengenalan: ……………………………………………………………
7.2.3 Jantina : ……………………………………………………………
7.2.4 Kelas (Jika Pelajar) : ……………………………………………………………
7.2.5 No. Fail Jabatan (Jika Pensyarah/AKP) : …………………………………….
7.3 Tarikh : ......................................................................................
7.4 Masa : ......................................................................................
7.5 Tempat : ......................................................................................
7.6 Punca dan Latar Belakang Kejadian :
.................................................................................................................................
7.7 Tindakan yang telah dan akan dijalankan/dilaksanakan oleh pihak kolej :
....................................................................................................................................
7.8 Nama Pegawai Penyiasat : ..............................................................................
7.9 Tarikh Siasatan : .......................................................................
8. Syor / Cadangan : ..........................................................................................................
9. Hal-hal lain (Jika ada) : ........................................................................................................
10. Lampiran (Jika ada) : .........................................................................................................

Disediakan oleh: Disahkan oleh:

................................................. ............................................
( ) ( )
TPA/TPSA/KJK Pengarah
Tarikh:
* Potong yang tidak berkenaan