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    Form Dispensing

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    Aliya Arkana Ghaniyah
    The document is a form used to record daily cleaning checks of sterile and non-sterile rooms over the month of September. It includes a table with rows for each date and columns to mark the cleanliness status of the floor, garbage, table, preparation area, and walls in both sterile and non-sterile areas during morning and afternoon checks, along with spaces for the checker's name and signature. Notes at the bottom specify that morning checks are at 8am and afternoon checks are at 5pm.

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    Form Dispensing

    Uploaded by

    Aliya Arkana Ghaniyah
    8 views2 pages
    The document is a form used to record daily cleaning checks of sterile and non-sterile rooms over the month of September. It includes a table with rows for each date and columns to mark the cleanliness status of the floor, garbage, table, preparation area, and walls in both sterile and non-sterile areas during morning and afternoon checks, along with spaces for the checker's name and signature. Notes at the bottom specify that morning checks are at 8am and afternoon checks are at 5pm.

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    FORM

    Original Title

    FORM DISPENSING

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    The document is a form used to record daily cleaning checks of sterile and non-sterile rooms over the month of September. It includes a table with rows for each date and columns to mark the cleanliness status of the floor, garbage, table, preparation area, and walls in both sterile and non-sterile areas during morning and afternoon checks, along with spaces for the checker's name and signature. Notes at the bottom specify that morning checks are at 8am and afternoon checks are at 5pm.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as xlsx, pdf, or txt
    8 views2 pages

    Form Dispensing

    Uploaded by

    Aliya Arkana Ghaniyah
    The document is a form used to record daily cleaning checks of sterile and non-sterile rooms over the month of September. It includes a table with rows for each date and columns to mark the cleanliness status of the floor, garbage, table, preparation area, and walls in both sterile and non-sterile areas during morning and afternoon checks, along with spaces for the checker's name and signature. Notes at the bottom specify that morning checks are at 8am and afternoon checks are at 5pm.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as xlsx, pdf, or txt
    of 2

    FORM KEBERSIHAN RUANGAN STERIL & NON STERIL (AGUSTUS)

    PEMBERSIHAN JAM PERIKSA NAMA PARAF


    MEJA PETUGAS PETUGAS
    TANGGAL LANTAI SAMPAH
    PENYIAPAN
    DINDING
    STATUS
    B K B K B K B K P S P S P S
    STERIL Keterangan
    1
    NON STERIL Pagi : 08.00
    STERIL Sore : 17.00
    2
    NON STERIL B : Bersih
    STERIL K : Kotor
    3
    NON STERIL
    STERIL
    4
    NON STERIL
    STERIL
    5
    NON STERIL
    STERIL
    6
    NON STERIL
    STERIL
    7
    NON STERIL
    STERIL
    8
    NON STERIL
    STERIL
    9
    NON STERIL
    STERIL
    10
    NON STERIL
    STERIL
    11
    NON STERIL
    STERIL
    12
    NON STERIL
    STERIL
    13
    NON STERIL
    STERIL
    14
    NON STERIL
    STERIL
    15
    NON STERIL
    STERIL
    16
    NON STERIL
    STERIL
    17
    NON STERIL
    STERIL
    18
    NON STERIL
    STERIL
    19
    NON STERIL
    STERIL
    20
    NON STERIL
    STERIL
    21
    NON STERIL
    STERIL
    22
    NON STERIL
    STERIL
    23
    NON STERIL
    STERIL
    24
    NON STERIL
    STERIL
    25
    NON STERIL
    STERIL
    26
    NON STERIL
    STERIL
    27
    NON STERIL
    STERIL
    28
    NON STERIL
    STERIL
    29
    NON STERIL
    STERIL
    30
    NON STERIL
    STERIL
    31
    NON STERIL
    FORM KEBERSIHAN RUANGAN STERIL & NON STERIL (SEPTEMBER)

    Tanggal 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
    Waktu P S P S P S P S P S P S P S P S P S P S P S P S P S P S P S P S P S P S P S P S P S P S P S P S P S P S P S P S P S P S

    Bersih
    Lantai
    Kotor
    Bersih
    Sampah
    Kotor
    Area Pembersihan STERIL
    Meja Bersih
    Penyiapan
    Kotor
    Bersih
    Dinding
    Kotor

    Nama Petugas

    FORM KEBERSIHAN RUANGAN STERIL & NON STERIL (SEPTEMBER)

    Tanggal 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
    Waktu P S P S P S P S P S P S P S P S P S P S P S P S P S P S P S P S P S P S P S P S P S P S P S P S P S P S P S P S P S P S

    Bersih
    Lantai
    Kotor
    Bersih
    Sampah
    Kotor
    Area Pembersihan NON STERIL
    Meja Bersih
    Penyiapan
    Kotor
    Bersih
    Dinding
    Kotor

    Nama Petugas

    KETERANGAN :
    Pagi : 08.00
    Sore : 17.00

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