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DORMITORY REPAIR FORM REQUEST

WO no/month 4/18/2022

B l o k D o r m ./D o r m B l o c k :
P29-2-4
.

Ketua/Room Leader (Name & Sign) : Eka Nur Ramadhani . Tanggal/Date: . 18-Apr-22

No. Jenis Kerusakan Uraian Pekerjaan/Barang yg Diganti Tgl Kerja-Jam/Work Date-hr Keterangan
Work Done/Spare Parts Used Start Finish Remarks
1 Pipa air bocor dikamar mandi no.1

Veified By (HR Dept.): Repaired By (Fac/Maint): Checked By (Dorm. Person):

Name/Date/hrs: . Name/Date: . Name/Date: Eka Nur Ramadhani 18/04/2022


.

DORMITORY REPAIR FORM REQUEST


WO no/month/year :..…../…./'2020

Blok Dorm./Dorm Block: .

Ketua/Room Leader (Name & Sign) : . Tanggal/Date: .

No. Jenis Kerusakan Uraian Pekerjaan/Barang yg Diganti Tgl Kerja-Jam/Work Date-hr Keterangan
Type of Defect Work Done/Spare Parts Used Start Finish Remarks
Veified By (HR Dept.): Repaired By (Fac/Maint): Checked By (Dorm. Person):

Name/Date/hrs: . Name/Date: . Name/Date: .


Eka Nur Ramadhani 18/04/2022

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