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  • Contoh Form Absensi

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    Feronika Kurnia
    16 views23 pages
    This document is a list of 60 people who received a COVID-19 vaccine. It includes their name, gender, address, ID number, phone number and signature. The date and location of vaccination and administering health facility are also included at the top of each page.

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    ABSENSI VAKSIN MEMANJANG 2

    Original Title

    CONTOH FORM ABSENSI

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    This document is a list of 60 people who received a COVID-19 vaccine. It includes their name, gender, address, ID number, phone number and signature. The date and location of vaccination and administering health facility are also included at the top of each page.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
    16 views23 pages

    Contoh Form Absensi

    Uploaded by

    Feronika Kurnia
    This document is a list of 60 people who received a COVID-19 vaccine. It includes their name, gender, address, ID number, phone number and signature. The date and location of vaccination and administering health facility are also included at the top of each page.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
    of 23

    DAFTAR TANDA TERIMA VAKSIN COVID-19

    TANGGAL :..................................
    TEMPAT PELAKSANAAN :..................................
    FASKES PELAKSANA :.................................

    JENIS
    NO NAMA ALAMAT NIK NO. HP TTD
    KELAMIN
    1 1.
    2 2.
    3 3.
    4 4.
    5 5.
    6 6.
    7 7.
    8 8.
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    10 10.
    11 11.
    12 12.
    13 13.
    14 14.
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    19 19
    20 20

    DAFTAR TANDA TERIMA VAKSIN COVID-19


    TANGGAL :..................................
    TEMPAT PELAKSANAAN :..................................
    FASKES PELAKSANA :.................................

    JENIS
    NO NAMA ALAMAT NIK NO. HP TTD
    KELAMIN
    21
    1.
    22 2.
    23 3.
    24 4.
    25 5.
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    DAFTAR TANDA TERIMA VAKSIN COVID-19


    TANGGAL :..................................
    TEMPAT PELAKSANAAN :..................................
    FASKES PELAKSANA :.................................

    JENIS
    NO NAMA ALAMAT NIK NO. HP TTD
    KELAMIN
    41
    1.
    42 2.
    43 3.
    44 4.
    45 5.
    46 6.
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    60 20

    DAFTAR TANDA TERIMA VAKSIN COVID-19


    TANGGAL :..................................
    TEMPAT PELAKSANAAN :..................................
    FASKES PELAKSANA :.................................

    JENIS
    NO NAMA ALAMAT NIK NO. HP TTD
    KELAMIN
    61
    1.
    62 2.
    63 3.
    64 4.
    65 5.
    66 6.
    67 7.
    68 8.
    69 9.
    70 10.
    71 11.
    72 12.
    73 13.
    74 14.
    75 15.
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    80 20

    DAFTAR TANDA TERIMA VAKSIN COVID-19


    TANGGAL :..................................
    TEMPAT PELAKSANAAN :..................................
    FASKES PELAKSANA :.................................
    JENIS
    NO NAMA ALAMAT NIK NO. HP TTD
    KELAMIN
    81
    1.
    82 2.
    83 3.
    84 4.
    85 5.
    86 6.
    87 7.
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    89 9.
    90 10.
    91 11.
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    100 20

    DAFTAR TANDA TERIMA VAKSIN COVID-19


    TANGGAL :..................................
    TEMPAT PELAKSANAAN :..................................
    FASKES PELAKSANA :.................................
    JENIS
    NO NAMA ALAMAT NIK NO. HP TTD
    KELAMIN
    101
    1.
    102 2.
    103 3.
    104 4.
    105 5.
    106 6.
    107 7.
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    109 9.
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    120 20

    DAFTAR TANDA TERIMA VAKSIN COVID-19


    TANGGAL :..................................
    TEMPAT PELAKSANAAN :..................................
    FASKES PELAKSANA :.................................
    JENIS
    NO NAMA ALAMAT NIK NO. HP TTD
    KELAMIN
    121
    1.
    122 2.
    123 3.
    124 4.
    125 5.
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    140 20

    DAFTAR TANDA TERIMA VAKSIN COVID-19


    TANGGAL :..................................
    TEMPAT PELAKSANAAN :..................................
    FASKES PELAKSANA :.................................
    JENIS
    NO NAMA ALAMAT NIK NO. HP TTD
    KELAMIN
    141
    1.
    142 2.
    143 3.
    144 4.
    145 5.
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    160 20

    DAFTAR TANDA TERIMA VAKSIN COVID-19


    TANGGAL :..................................
    TEMPAT PELAKSANAAN :..................................
    FASKES PELAKSANA :.................................
    JENIS
    NO NAMA ALAMAT NIK NO. HP TTD
    KELAMIN
    161
    1.
    162 2.
    163 3.
    164 4.
    165 5.
    166 6.
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    180 20

    DAFTAR TANDA TERIMA VAKSIN COVID-19


    TANGGAL :..................................
    TEMPAT PELAKSANAAN :..................................
    FASKES PELAKSANA :.................................
    JENIS
    NO NAMA ALAMAT NIK NO. HP TTD
    KELAMIN
    181
    1.
    182 2.
    183 3.
    184 4.
    185 5.
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    DAFTAR TANDA TERIMA VAKSIN COVID-19


    TANGGAL :..................................
    TEMPAT PELAKSANAAN :..................................
    FASKES PELAKSANA :.................................
    JENIS
    NO NAMA ALAMAT NIK NO. HP TTD
    KELAMIN
    201
    1.
    202 2.
    203 3.
    204 4.
    205 5.
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    DAFTAR TANDA TERIMA VAKSIN COVID-19


    TANGGAL :..................................
    TEMPAT PELAKSANAAN :..................................
    FASKES PELAKSANA :.................................
    JENIS
    NO NAMA ALAMAT NIK NO. HP TTD
    KELAMIN
    221
    1.
    222 2.
    223 3.
    224 4.
    225 5.
    226 6.
    227 7.
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    229 9.
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    DAFTAR TANDA TERIMA VAKSIN COVID-19


    TANGGAL :..................................
    TEMPAT PELAKSANAAN :..................................
    FASKES PELAKSANA :.................................
    JENIS
    NO NAMA ALAMAT NIK NO. HP TTD
    KELAMIN
    241
    1.
    242 2.
    243 3.
    244 4.
    245 5.
    246 6.
    247 7.
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    DAFTAR TANDA TERIMA VAKSIN COVID-19


    TANGGAL :..................................
    TEMPAT PELAKSANAAN :..................................
    FASKES PELAKSANA :.................................
    JENIS
    NO NAMA ALAMAT NIK NO. HP TTD
    KELAMIN
    261
    1.
    262 2.
    263 3.
    264 4.
    265 5.
    266 6.
    267 7.
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    DAFTAR TANDA TERIMA VAKSIN COVID-19


    TANGGAL :..................................
    TEMPAT PELAKSANAAN :..................................
    FASKES PELAKSANA :.................................
    JENIS
    NO NAMA ALAMAT NIK NO. HP TTD
    KELAMIN
    281
    1.
    282 2.
    283 3.
    284 4.
    285 5.
    286 6.
    287 7.
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    DAFTAR TANDA TERIMA VAKSIN COVID-19


    TANGGAL :..................................
    TEMPAT PELAKSANAAN :..................................
    FASKES PELAKSANA :.................................
    JENIS
    NO NAMA ALAMAT NIK NO. HP TTD
    KELAMIN
    301
    1.
    302 2.
    303 3.
    304 4.
    305 5.
    306 6.
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    320 20

    DAFTAR TANDA TERIMA VAKSIN COVID-19


    TANGGAL :..................................
    TEMPAT PELAKSANAAN :..................................
    FASKES PELAKSANA :.................................
    JENIS
    NO NAMA ALAMAT NIK NO. HP TTD
    KELAMIN
    301
    1.
    302 2.
    303 3.
    304 4.
    305 5.
    306 6.
    307 7.
    308 8.
    309 9.
    310 10.
    311 11.
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    314 14.
    315 15.
    316 16
    317 17
    318 18
    319 19
    320 20

    DAFTAR TANDA TERIMA VAKSIN COVID-19


    TANGGAL :..................................
    TEMPAT PELAKSANAAN :..................................
    FASKES PELAKSANA :.................................
    JENIS
    NO NAMA ALAMAT NIK NO. HP TTD
    KELAMIN
    321
    1.
    322 2.
    323 3.
    324 4.
    325 5.
    326 6.
    327 7.
    328 8.
    329 9.
    330 10.
    331 11.
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    333 13.
    334 14.
    335 15.
    336 16
    337 17
    338 18
    339 19
    330 20

    DAFTAR TANDA TERIMA VAKSIN COVID-19


    TANGGAL :..................................
    TEMPAT PELAKSANAAN :..................................
    FASKES PELAKSANA :.................................
    JENIS
    NO NAMA ALAMAT NIK NO. HP TTD
    KELAMIN
    331
    1.
    332 2.
    333 3.
    334 4.
    335 5.
    336 6.
    337 7.
    338 8.
    339 9.
    340 10.
    341 11.
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    344 14.
    345 15.
    346 16
    347 17
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    DAFTAR TANDA TERIMA VAKSIN COVID-19


    TANGGAL :..................................
    TEMPAT PELAKSANAAN :..................................
    FASKES PELAKSANA :.................................
    JENIS
    NO NAMA ALAMAT NIK NO. HP TTD
    KELAMIN
    351
    1.
    352 2.
    353 3.
    354 4.
    355 5.
    356 6.
    357 7.
    358 8.
    359 9.
    360 10.
    361 11.
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    363 13.
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    365 15.
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    370 20

    DAFTAR TANDA TERIMA VAKSIN COVID-19


    TANGGAL :..................................
    TEMPAT PELAKSANAAN :..................................
    FASKES PELAKSANA :.................................
    JENIS
    NO NAMA ALAMAT NIK NO. HP TTD
    KELAMIN
    371
    1.
    372 2.
    373 3.
    374 4.
    375 5.
    376 6.
    377 7.
    378 8.
    379 9.
    380 10.
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    384 14.
    385 15.
    386 16
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    DAFTAR TANDA TERIMA VAKSIN COVID-19


    TANGGAL :..................................
    TEMPAT PELAKSANAAN :..................................
    FASKES PELAKSANA :.................................
    JENIS
    NO NAMA ALAMAT NIK NO. HP TTD
    KELAMIN
    391
    1.
    392 2.
    393 3.
    394 4.
    395 5.
    396 6.
    397 7.
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    399 9.
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    410 20

    DAFTAR TANDA TERIMA VAKSIN COVID-19


    TANGGAL :..................................
    TEMPAT PELAKSANAAN :..................................
    FASKES PELAKSANA :.................................
    JENIS
    NO NAMA ALAMAT NIK NO. HP TTD
    KELAMIN
    411
    1.
    412 2.
    413 3.
    414 4.
    415 5.
    416 6.
    417 7.
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