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CEKLIST AC

Tanggal : Maret 2019


Lantai : Ground

Ukur Ampere Run = Ampere Nominal


Kebersihan Filter Evapurator

Ukur Temperatur Ruangan


Kebersihan Evapurator

Insulating Pipa Kapiler

Kebersihan Condesor
Terminal Kelistrikan

Kebersihan difusser
UNIT AC KET

Tanlang Drain AC

Terminal Drain
Pipa Drain
OK NOK OK NOK OK NOK OK NOK OK NOK OK NOK OK NOK OK NOK OK NOK °C A

Koridor Kasir

Kor.Lab dan Farmasi

AC Lab. Depan

AC Lab. Belakang

CT Scan

CT Scan

X Ray

X Ray

Mammograph

Fluroscopy

Kor.Belakang Rad

Kor. Bed Lift

UGD

Loby Lift

Diperiksa Oleh,

Nama :
TTD :
CEKLIST AC

Tanggal : Maret 2019


Lantai : Ground

Kebersihan Filter Evapurator

Kebersihan Evapurator
UNIT AC

Tanlang Drain AC

Terminal Drain
Pipa Drain

OK NOK OK NOK OK NOK OK NOK OK NOK


Chamber
MCU
HD
Depan HD
RO HD
Gudang RO
dr.Johnson
T AC
Terminal Kelistrikan

Kebersihan difusser

Insulating Pipa Kapiler

Kebersihan Condesor

OK NOK OK NOK OK NOK OK NOK ° C


Ukur Temperatur Ruangan

A
Ukur Ampere Run = Ampere Nominal
KET
CEKLIST AC

Tanggal : September
Lantai : LANTAI 3

Ukur Ampere Run = Ampere Nominal


Kebersihan Filter Evapurator

Ukur Temperatur Ruangan


Kebersihan Evapurator

Insulating Pipa Kapiler

Kebersihan Condesor
Terminal Kelistrikan

Kebersihan difusser
Tanlang Drain AC

UNIT AC KET

Terminal Drain
Pipa Drain

OK NOK OK NOK OK NOK OK NOK OK NOK OK NOK OK NOK OK NOK OK NOK ° C A

ESWL

R.Rawat ESWL

Ruang Kontrol

Koridor Endoscopy

Kor.ICU ESWL

Kor.ICU

ICU

Komite medik

Kor OK

OK 1

OK 2

OK 3

Pantry OK

Admin OK

Nur Station OK

Pre Operasi 1

Pre Operasi 2

Recovery Medik

Diperiksa Oleh,

TTD :
Nama:
HCU
Lantai :
Tanggal :

Nur Station
Kor.Belakang HCU
UNIT AC

Kor.Nur Sta ke HCU

Kor.Nur Sta ke Tangga blk

511
510
509
508
507
506
505
504
503
502
501
Kebersihan Filter Evapurator
LANTAI 3

Kebersihan Evapurator
September

Tanlang Drain AC

Pipa Drain

Terminal Drain
CEKLIST AC

Terminal Kelistrikan

Kebersihan difusser

Insulating Pipa Kapiler

Kebersihan Condesor
OK NOK OK NOK OK NOK OK NOK OK NOK OK NOK OK NOK OK NOK OK NOK ° C

Ukur Temperatur Ruangan


A

Ukur Ampere Run = Ampere Nominal


512

513

514

515
KET

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