Medical Examination Pre-Flight Health Check List Airline: Id Date / Month: Juli 2022 Location: Sta

Safety, Security & Quality
MEDICAL EXAMINATION
PRE-FLIGHT HEALTH CHECK LIST
AIRLINE : ID
DATE / MONTH : JULI 2022
LOCATION : STA.
Total
Total Total Pilot Total Pilot Total FO Total FO Total FA Total FA Not
No Date Maintenance
Flight Check Not Check Check Not Check Check Check
check
1 1-Jul-22 6 1 0 1 0 5 0 7
2 2-Jul-22 5 1 0 1 0 5 0 7
3 3-Jul-22 6 1 0 1 0 5 0 7
4 4-Jul-22 4 1 0 1 0 5 0 7
5 5-Jul-22 4 2 0 2 0 10 0 14
6 6-Jul-22 6 2 0 2 0 10 0 14
7 7-Jul-22 5 2 0 2 0 10 0 14
8 8-Jul-22 6 2 0 2 0 10 0 14
9 9-Jul-22 5 1 0 1 0 5 0 7
10 10-Jul-22 4 1 0 1 0 5 0 7
G
R
A
P
11 11-Jul-22 5 1 0 1 0 5 0 7
H
12 12-Jul-22 5 1 0 1 0 5 0 7
I
C
13 13-Jul-22 6 1 0 1 0 5 0 7
R
E
F
L
I
14 14-Jul-22 5 1 0 1 0 5 0 7
G
H
T 15 15-Jul-22 6 1 0 1 0 5 0 7
H
E
A
L
16 16-Jul-22 5 1 0 1 0 5 0 7
T
H
C
17 17-Jul-22 5 1 0 1 0 5 0 7
H
18 18-Jul-22 5 1 0 1 0 5 0 7
E
C
K
A
T
S
19 19-Jul-22 4 1 0 1 0 5 0 7
T
A
. 20 20-Jul-22 5 1 0 1 0 5 0 7
C
G
K 21 21-Jul-22 5 1 0 1 0 5 0 7
D
U
R
I
22 22-Jul-22 5 1 0 1 0 5 0 7
N
23 23-Jul-22 4 1 0 1 0 5 0 7
G
A
P
R
I
L 24 24-Jul-22 5 1 0 1 0 5 0 7
2
0
2
2
25 25-Jul-22 5 1 0 1 0 5 0 7
26 26-Jul-22 4 1 0 1 0 5 0 7
27 27-Jul-22 4 1 0 1 0 5 0 7
28 28-Jul-22 4 1 0 1 0 5 0 7
29 29-Jul-22 4 1 0 1 0 5 0 7
30 30-Jul-22 4 1 0 1 0 5 0 7
31 31-Jul-22 5 1 0 1 0 5 0 7
TOTAL 151 35 0 35 0 175 0 245
y & Quality
MINATION
LTH CHECK LIST
NURSE
ON DUTY No Description Summary
PAGI
D 1 Total Crew on Flight Duty 187
D 2 Total Crew Checked (PIC, SIC, and FA) 245
D 3 Total Maintenance Check (Morning & Night Shift) 245

B 4 Total Crew Not Checked (PIC, SIC, and FA) 0
B
B
D FLIGHT PIC SIC
D 151 35 35
D
B
B GRAPHIC PRE - FLIGHT HEALTH CHECK AT STA. CGK DURING MAY 2022
B 12000
D
10000
D
D
8000
B
B 6000
B
D 4000
D
D 2000
B
B 0
FLIGHT PIC SIC FA MAINTENANCE
B
D
D
D
B
B
B
D
FA MAINTENANCE
175 245
G MAY 2022
MAINTENANCE
Safety &
PRE
Flight
No Date Name ID Number
Number
1 7/1/2022 ID 6711 MEMED ALIBASYAH 144680
2 7/1/2022 ID 6711 ATTHARIQ GIBRAL RIVA 200951
3 7/1/2022 ID 6711 ANJELINA SIBUEA 52127112
4 7/1/2022 ID 6711 IZMI NIDYA 144708
5 7/1/2022 ID 6711 ANISA HIDIR 182515
6 7/1/2022 ID 6711 AYU MAYURA 193329
7 7/1/2022 ID 6711 NADA SHUBHIYAH 180641
8 7/2/2022 ID 6711 SENDY IZAZI DIVIA 146844
9 7/2/2022 ID 6711 BAMPHY ADYA PERMANA 190490
10 7/2/2022 ID 6711 KURNIA DEWI 151416
11 7/2/2022 ID 6711 ZELIN FIKA COPANDA 182594
12 7/2/2022 ID 6711 VIOLA MONALISA 182724
13 7/2/2022 ID 6711 RISA SITI NURANISA 200049
14 7/2/2022 ID 6711 SRI WAHYUNI 200922
15 7/3/2022 ID 6711 MAHERDA EKA NANDA 52113003
16 7/3/2022 ID 6711 DANDI PRIMA OKTARINO 192768
17 7/3/2022 ID 6711 BILYARTA EGA DARMASANTI 183057
18 7/3/2022 ID 6711 SARI RATNA ZUHRI 170611
19 7/3/2022 ID 6711 BELLA SEPTIANA 181343
20 7/3/2022 ID 6711 MOH GILANG ARYO SAPUTRO 213210
21 7/3/2022 ID 6711 CINDI MEISTRI WIDIYANTI 201680
22 7/4/2022 ID 6711 KHRISNA DEWA YUDHA 52113002
23 7/4/2022 ID 6711 JOSHUA SEBASTIAN BOENTORO 212445
24 7/4/2022 ID 6711 ROKA HAYATI 144701
25 7/4/2022 ID 6711 PUTU ARI MAS DINDA PERTIWI 191978
26 7/4/2022 ID 6711 IKA DEWI KAHANI 220773
27 7/4/2022 ID 6711 NAZIA 213423
28 7/4/2022 ID 6711 AULIA FATUL FUADAH 212532
29 7/5/2022 ID 6711 DANIEL BENYAMIN ERING 62083669
30 7/5/2022 ID 6711 MUHAMMAD DANIEL RUKMANA 193017
31 7/5/2022 ID 6711 INTAN PERTIWI 141478
32 7/5/2022 ID 6711 TRIHARTIKA DEWI 193051
33 7/5/2022 ID 6711 TUTUT IKA WINDARLIN 193955
34 7/5/2022 ID 6711 AYA CHANDRA 201689
35 7/5/2022 ID 6711 FIFI YUNITA SARI 212025
36 7/5/2022 ID 6713 IMAM ISNAIN SANTOSO 142993
37 7/5/2022 ID 6713 RAKA ILHAM PRATAMA 190448
38 7/5/2022 ID 6713 KIKIET TEGUH SEPTARIANTO 194189
39 7/5/2022 ID 6713 AYUNITA TRIASTIKA PRATIWI 221483
40 7/5/2022 ID 6713 YUNITA ISLAMIATI SETIAWANDI 211851
41 7/5/2022 ID 6713 AMANDA 213416
42 7/5/2022 ID 6713 YULIDA HANDAYANI 220785
43 7/6/2022 ID 6711 DANNY ARIA SAPUTRA 151218
44 7/6/2022 ID 6711 ANDHIKA AKBARI PERDANA 171824
45 7/6/2022 ID 6711 ABDUL AZIS 52105427
46 7/6/2022 ID 6711 MONICA SANIA TANONE 194205
47 7/6/2022 ID 6711 ANGGRENI YULI ASIH PASARIBU 200439
48 7/6/2022 ID 6711 DELA AYU LARASATI 201913
49 7/6/2022 ID 6711 NABILA SUCI AMELIA 212031
50 7/6/2022 ID 6113 EDWARD R WENEHEN 143002
51 7/6/2022 ID 6113 Y ADITYA KURNIAWAN 150701
52 7/6/2022 ID 6113 KURNIA DEWI 151416
53 7/6/2022 ID 6113 ADRIANI MARISKA WONDAL 191285
54 7/6/2022 ID 6113 MEITRIANNE LUBIS 220825
55 7/6/2022 ID 6113 ADELINE OLIVIA RAPANG 211847
56 7/6/2022 ID 6113 DELLA NURDIANTY 220771
57 7/7/2022 ID 6711 BENJAMIN P NATAWARDAJA 52040296
58 7/7/2022 ID 6711 ALDOFINNO IMANUEL K M S 201601
59 7/7/2022 ID 6711 KIKIET TEGUH SEPTARIANTO 194189
60 7/7/2022 ID 6711 NEVI NURPIAH 170773
61 7/7/2022 ID 6711 KARIN ARIFIN 193617
62 7/7/2022 ID 6711 ARISTA RAMADHANA HARRIS 213193
63 7/7/2022 ID 6711 GESSY RAMADHIANI 172619
64 7/7/2022 ID 6713 ADITYA DJUANDA 52105266
65 7/7/2022 ID 6713 MUHAMMAD EMYR HIRZI DJ 183177
66 7/7/2022 ID 6713 FARAH YEANITA ANASTASYA 161820
67 7/7/2022 ID 6713 ROBERT B LATUPEIRISSA 220701
68 7/7/2022 ID 6713 KUMALA PUSPASARI 220774
69 7/7/2022 ID 6713 AMILIA DHARMAWAN 220822
70 7/7/2022 ID 6713 ARSIKA DEVI LURIANSARI 221626
71 7/8/2022 ID 6711 RUSMONO 141640
72 7/8/2022 ID 6711 HABIB MUHAMMAD LUBIS 150232
73 7/8/2022 ID 6711 NOVIA SARASWATI 161865
74 7/8/2022 ID 6711 WETTI OKTAVIA 201691
75 7/8/2022 ID 6711 TARYSHA FITRIA SUGANDI 201908
76 7/8/2022 ID 6711 EKKY DHIYA ULHAQ 220161
77 7/8/2022 ID 6711 BUDI PAMUNGKAS 221518
78 7/8/2022 ID 6713 AKMAL MADRID 52062962
79 7/8/2022 ID 6713 IMAM DUKHAERI 192950
80 7/8/2022 ID 6713 BILYARTA EGA DARMASANTI 183057
81 7/8/2022 ID 6713 ASFIAH FANANI 211846
82 7/8/2022 ID 6713 NIDAH ROSALINDA 211850
83 7/8/2022 ID 6713 RANI WIDIYARTI 171487
84 7/8/2022 ID 6713 FEET SEALIAN RAHIM 221521
85 7/9/2022 ID 6711 SRIYANTO 147248
86 7/9/2022 ID 6711 DHEAVISA PUTRA MANDALA 151950
87 7/9/2022 ID 6711 ADE CHRISTA CONSTATIA JAMA 155101
88 7/9/2022 ID 6711 ADE FINA NURAFIAH 162836
89 7/9/2022 ID 6711 HERLIN SRI RAHAYU 193855
90 7/9/2022 ID 6711 YUNIKA SRI ENDAH LESTARI 181316
91 7/9/2022 ID 6711 REPUBLIKA TUNGGA DEWI 170618
92 7/10/2022 ID 6711 YOGA BHUANA SAMUDRA 144674
93 7/10/2022 ID 6711 ALEX TOHATTA 201637
94 7/10/2022 ID 6711 ROSYANA RASMIN 154960
95 7/10/2022 ID 6711 MERCY WIDYA BOJOH 183048
96 7/10/2022 ID 6711 FIKI NOVITALIA 191981
97 7/10/2022 ID 6711 JESIKA RUDIANTI 193862
98 7/10/2022 ID 6711 DEFI PUSPITA SARI 201906
99 7/11/2022 ID 6711 SUPRIYONO HARJO 52082726
100 7/11/2022 ID 6711 IVAN SAHENDRI 180047
101 7/11/2022 ID 6711 RAHMA ANGGRAINI 152860
102 7/11/2022 ID 6711 TUTUT IKA WINDARLIN 193955
103 7/11/2022 ID 6711 NABILA SUCI AMELIA 212031
104 7/11/2022 ID 6711 FAISAL 213202
105 7/11/2022 ID 6711 NI GUSTI AYU ALIT ELI ALISA 220778
106 7/12/2022 ID 6711 ARI PRIYATMOKO 160893
107 7/12/2022 ID 6711 REZA PUTRA PRATAMA 171628
108 7/12/2022 ID 6711 DEA PUTRI NESIA 148335
109 7/12/2022 ID 6711 NURUL JANAH 184700
110 7/12/2022 ID 6711 NUR SALSABIL ADRIYANDRA 200704
111 7/12/2022 ID 6711 SELLY DESTIANI 183745
112 7/12/2022 ID 6711 SRI RAHAYU INDRIYANI 191677
113 7/13/2022 ID 6711 IQRA MUHAMMAD FARGHAB 146214
114 7/13/2022 ID 6711 MUHAMMAD IVAN OCTAVIAN ADAMY 192729
115 7/13/2022 ID 6711 WILLINGLY AGATHA SWEETLY TUMEWU 151303
116 7/13/2022 ID 6711 JESIKA LINDSAY WAROUW 181636
117 7/13/2022 ID 6711 IDHA AMBARWATI 201564
118 7/13/2022 ID 6711 SHAFA REGITA AWALIYAH 201401
119 7/13/2022 ID 6711 YULIYAN KRISTIYANTI 212039
120 7/14/2022 ID 6711 ABDUL RAHMAN 151951
121 7/14/2022 ID 6711 DANIEL F J WONGSOADMODJO 201606
122 7/14/2022 ID 6711 GADIS ELGHI AISYAH AULIA 162409
123 7/14/2022 ID 6711 VINA RAHMA DIANTI 193052
124 7/14/2022 ID 6711 SARLY ADELYTHA IRFANY 201791
125 7/14/2022 ID 6711 ENDAH KURNIATI 201901
126 7/14/2022 ID 6711 PUTRA BAGUS MAULANA 213274
127 7/15/2022 ID 6711 DANNY ARIA SAPUTRA 151218
128 7/15/2022 ID 6711 KEVIN FERLYANTO 180523
129 7/15/2022 ID 6711 PUTU INTAN REZA ASTIKA AYU 161440
130 7/15/2022 ID 6711 REKHA TRI RAHAYU 193950
131 7/15/2022 ID 6711 PUTRI ALLYA RAMADANI 194207
132 7/15/2022 ID 6711 LARA PERMATA ANJELIANI 170349
133 7/15/2022 ID 6711 SRI RAHAYU INDRIYANI 191677
134 7/16/2022 ID 6711 HEBERT EVAN LAHUNDUITAN 146263
135 7/16/2022 ID 6711 JODI PRIYADHIKA PERKASA 182307
136 7/16/2022 ID 6711 WELDA PUSPITA 146812
137 7/16/2022 ID 6711 RISMA DEWI SOLAWATI 171752
138 7/16/2022 ID 6711 ANGGI MEIDITAMA ANGGONO 171809
139 7/16/2022 ID 6711 RISMA RISMAYANTI 192001
140 7/16/2022 ID 6711 ALDI OCTAVIADI 213240
141 7/17/2022 ID 6711 I PUTU CANTYAWAN 62092772
142 7/17/2022 ID 6711 SETIAWAN BIANDARU 151208
143 7/17/2022 ID 6711 INTAN PERTIWI 141478
144 7/17/2022 ID 6711 VENTY DHEA NIRA HANUM 182726
145 7/17/2022 ID 6711 SELLY DESTIANI 183745
148 7/18/2022 ID 6711 HANSTIO STEYR 151945
149 7/18/2022 ID 6711 DERYL VALIAN AKBAR 172093
150 7/18/2022 ID 6711 PUTRI INDRA MAYANI 163107
151 7/18/2022 ID 6711 EFA ANING LESTARI 193039
152 7/18/2022 ID 6711 JATI KESUMA 201257
153 7/18/2022 ID 6711 ENDAH KURNIATI 201901
154 7/18/2022 ID 6711 ERIENA OLIVIANTI 183061
155 7/19/2022 ID 6711 BENJAMIN P NATAWARDAJA 52040296
156 7/19/2022 ID 6711 ARDIAN BUDIWANTHORO 200950
157 7/19/2022 ID 6711 RIZKI KURNIAWAN 146841
158 7/19/2022 ID 6711 PRATIWI KARISMA 200694
159 7/19/2022 ID 6711 MENAKSI PRISYLIA HAYATUN NUFUS 193050
160 7/19/2022 ID 6711 MELISA PUTRIANI 170506
161 7/19/2022 ID 6711 DETARIA CRISTIN BR TAMBUNAN 200443
162 7/20/2022 ID 6711 SRI HANANDYO ERSAL 143063
163 7/20/2022 ID 6711 ADAM BRAMANTIO 184723
164 7/20/2022 ID 6711 HERINA PUTRI 150825
165 7/20/2022 ID 6711 SARAH RAMADHANTY 181005
166 7/20/2022 ID 6711 BELLA SEPTIANA 181343
167 7/20/2022 ID 6711 NOVITASARI 182721
168 7/20/2022 ID 6711 SELLYNA DAFAA PUTRI 201688
169 7/21/2022 ID 6711 M DHIKI FIRMANSYAH 172873
170 7/21/2022 ID 6711 MUHAMMAD ANDHIKA RACHMAN 181243
171 7/21/2022 ID 6711 IKA RACHMA WIDIARNI 151756
173 7/21/2022 ID 6711 MONICA SANIA TANONE 194205
174 7/21/2022 ID 6711 FENIKA 200044
175 7/21/2022 ID 6711 DEVIANA ANISSA 181336
176 22-Jul-2022 ID 6711 ALBERTUS BUDI PRASETYO 172963
177 22-Jul-2022 ID 6711 SAMUEL LEONARDO SANTOSO 212734
178 22-Jul-2022 ID 6711 ANGGUN CYNTIA 148011
179 22-Jul-2022 ID 6711 SERENA META RIVAI 191987
180 22-Jul-2022 ID 6711 AYU MAYURA 193329
181 22-Jul-2022 ID 6711 AQDA ANDELLA 194195
182 22-Jul-2022 ID 6711 HERVINA NUR AINI HANITA PUTRI 201917
183 23-Jul-2022 ID 6711 DOLLY NICODEMUS PASARIBU 62073142
184 23-Jul-2022 ID 6711 ATTHARIQ GIBRAL RIVA 200951
185 23-Jul-2022 ID 6711 DIAN ANDRIYANTI HIDAYAT 143144
186 23-Jul-2022 ID 6711 SRI WAHYUNI ASRI 193953
187 23-Jul-2022 ID 6711 ZAZQIA SALSA DILA SUCI RAHMADANI 183754
188 23-Jul-2022 ID 6711 K M SYARIF HIDAYATULLAH 213207
189 23-Jul-2022 ID 6711 KENINDU ANGRAINI 212028
190 24-Jul-2022 ID 6711 DIMAS AGUNG SUGIATMA 131994
191 24-Jul-2022 ID 6711 M AVIRIANSYAH ZAHRI WARDANA 201541
192 24-Jul-2022 ID 6711 CLAUDIA STEFANI WINDRA 143182
193 24-Jul-2022 ID 6711 ANDHINI MEITRI HAPSARI 173670
194 24-Jul-2022 ID 6711 NURUL QOMARIYAH 200646
195 24-Jul-2022 ID 6711 SRIDEVI SAFITRI 181642
196 24-Jul-2022 ID 6711 ADITYA RESTU YOGA ARDHIKA 213026
197 25-Jul-2022 ID 6711 TRI WIDYATMOKO 140491
198 25-Jul-2022 ID 6711 MOHAMAD HARIS HIDAYAT KARIM 201008
199 25-Jul-2022 ID 6711 PUTU INTAN REZA ASTIKA AYU 161440
200 25-Jul-2022 ID 6711 DELA AYU LARASATI 201913
201 25-Jul-2022 ID 6711 GEA ARSENDYS PRATIKA 200447
202 25-Jul-2022 ID 6711 ARISTA RAMADHANA HARRIS 213193
203 25-Jul-2022 ID 6711 DELVIA RESTU KHORINA 171391
204 26-Jul-2022 ID 6711 WIJANARKO TRI ISTIADI 52040295
205 26-Jul-2022 ID 6711 NORMAN OLDYNOV 151953
206 26-Jul-2022 ID 6711 DHIAQDRA CHEEANU SV 154952
207 26-Jul-2022 ID 6711 SISKA NATALIANA PANDIANGAN 191679
208 26-Jul-2022 ID 6711 LIZA PUTRI ADITYA 193618
209 26-Jul-2022 ID 6711 SITI NIRMALA SARI 170242
210 26-Jul-2022 ID 6711 VENTI MEILINIA PUTRI 211842
211 27-Jul-2022 ID 6711 MARTWIN WESSY DHARTA RIYADI 52073448
212 27-Jul-2022 ID 6711 MUHAMMAD DIANTAMA SUDIAR 182544
213 27-Jul-2022 ID 6711 AGNES THERESIA H 150819
214 27-Jul-2022 ID 6711 ANISA HIDIR 182515
215 27-Jul-2022 ID 6711 ZHASQIA PUTRI FARIZHA 170776
216 27-Jul-2022 ID 6711 DETARIA CRISTIN BR TAMBUNAN 200443
217 27-Jul-2022 ID 6711 ELIN ERFANDA SARI 193045
218 28-Jul-2022 ID 6711 NOVAN KURNIAWAN 143750
219 28-Jul-2022 ID 6711 WIBI FRINO ARBI 180391
220 28-Jul-2022 ID 6711 SHINTA YULIASMI 160570
221 28-Jul-2022 ID 6711 JESIKA RUDIANTI 193862
222 28-Jul-2022 ID 6711 VENY ANSETA NOVALYN 200923
223 28-Jul-2022 ID 6711 GLADY LIYANA DEWI 201916
224 28-Jul-2022 ID 6711 KEIKO KEISHA 191669
225 29-Jul-2022 ID 6711 RENATO CARERA JUNIOR 180538
226 29-Jul-2022 ID 6711 RIDHO AFIARO 171917
227 29-Jul-2022 ID 6711 DEA PUTRI NESIA 148335
228 29-Jul-2022 ID 6711 BELLA ROSALINA 182017
229 29-Jul-2022 ID 6711 NATASYA NAJWA 200452
230 29-Jul-2022 ID 6711 BUDI PAMUNGKAS 221518
231 29-Jul-2022 ID 6711 LENNY 221523
232 30-Jul-2022 ID 6711 PANDENYOMAN ANDHIKO SURYO 143972
233 30-Jul-2022 ID 6711 SULTHAN FARAS ZAFRAN 201638
234 30-Jul-2022 ID 6711 YOGI DZULFIQAR ASHFAHANY 145033
235 30-Jul-2022 ID 6711 OCTA ERNANDA 212033
236 30-Jul-2022 ID 6711 RESTIANA PEBRIANTI 173035
237 30-Jul-2022 ID 6711 DWI KIRANA 200702
238 30-Jul-2022 ID 6711 AJENG AZ ZAHRA SALSABILA 191673
239 31-Jul-2022 ID 6711 RENATO CARERA JUNIOR 180538
240 31-Jul-2022 ID 6711 AHMAD ADIYAN 201640
241 31-Jul-2022 ID 6711 NATASYA OKTAVIANI 154951
242 31-Jul-2022 ID 6711 ASTRI MAYLINDA 172631
243 31-Jul-2022 ID 6711 AYU MAYURA 193329
244 31-Jul-2022 ID 6711 DENI SAFITRI 200697
245 31-Jul-2022 ID 6711 VENTI MEILINIA PUTRI 211842
246
247
248
249
250
251
252
253
254
255
256
257
258
259
260
261
262
263
264
265
266
267
268
269
270
271
272
273
274
275
276
277
278
279
280
281
282
283
284
285
286
287
288
289
290
291
292
293
294
295
296
297
298
299
300
301
302
303
304
305
306
307
308
309
310
311
312
313
314
315
316
317
318
319
320
321
322
323
324
325
326
327
328
329
330
331
332
333
334
335
336
337
338
339
340
341
342
343
344
345
346
347
348
349
350
351
352
353
354
355
356
357
358
359
360
361
362
363
364
365
366
367
368
369
370
371
372
373
374
375
376
377
378
379
380
381
382
383
384
385
386
387
388
389
390
391
392
393
394
395
396
397
398
399
400
401
402
403
404
405
406
407
408
Safety & Security Directorate
MEDICAL EXAMINATION
PRE FLIGHT HEALTH CHECK LIST
Blood
Job Title Alcohol Test Result Remaks
Pressure
PIC 120/80 - NORMAL FIT

FO 110/70 - NORMAL FIT
SFA 110/70 - NORMAL FIT
FA 100/70 - NORMAL FIT
PIC 130/80 - PREHIPERTENSI FIT
PIC 130/80 - PREHIPERTENSI FIT
Time Nurse on Duty
06.50 WIB DINI AYU PERMATA SARI S.Tr.Keb

06.50 WIB BELLA YOLANDIA SARI S.Tr.Keb
TOTAL PILOT FA EOB
MELAKUKAN BLOOD PRESSURE 62 155

TIDAK MELAKUKAN BLOOD PRESSURE 0 0
GRAND TOTAL
TOTAL PILOT FA EOB

MEKALUKAN ALCOHOL TEST
TIDAK MELAKUKAN ALCOHOL TEST
GRAND TOTAL
TOTAL PILOT FA EOB

NORMAL 60 245
HIPOTENSI 0 0
PRE HIPERTENSI 2 0
HIPERTENSI STAGE 1 0 0
GRAND TOTAL
Kategori TDS (mmHg) TDD (mmHg)

Normal < 120 dan < 80
Pra-hipertensi 120 - 139 atau 80 - 89
Hipertensi tingkat 1 140 - 159 atau 90 - 99
Hipertensi tingkat 2 > 160 atau > 100
Remaks
Remaks
Remaks
MEDICAL EXAMINATION
AIRLINE : ID
DATE / MONTH : AGUSTUS 2022
LOCATION : STA.
Total
No Date Maintenance
check
1 1-Aug-22 5 1 0 1 0 5 0 7
2 2-Aug-22 4 1 0 1 0 5 0 7
3 3-Aug-22 6 1 0 1 0 5 0 7
4 4-Aug-22 4 1 0 1 0 5 0 7
5 5-Aug-22 5 1 0 1 0 5 0 7
6 6-Aug-22 4 1 0 1 0 5 0 7
7 7-Aug-22 4 1 0 1 0 5 0 7
8 8-Aug-22 4 1 0 1 0 5 0 7
9 9-Aug-22 4 1 0 1 0 5 0 7
10 10-Aug-22 4 1 0 1 0 5 0 7
G
R
A
P
11 11-Aug-22 4 1 0 1 0 5 0 7
H
12 12-Aug-22 4 1 0 1 0 5 0 7
I
C
13 13-Aug-22 4 1 0 1 0 5 0 7
R
E
F
L
I
14 14-Aug-22 4 1 0 1 0 5 0 7
G
H
T 15 15-Aug-22 4 2 0 1 0 5 0 8
H
E
A
L
16 16-Aug-22 4 1 0 1 0 5 0 7
T
H
C
17 17-Aug-22 4 1 0 1 0 5 0 7
H
18 18-Aug-22 4 1 0 1 0 5 0 7
E
C
K
A
T
S
19 19-Aug-22 4 1 0 1 0 5 0 7
T
A
. 20 20-Aug-22 4 1 0 1 0 5 0 7
C
G
K 21 21-Aug-22 4 1 0 1 0 5 0 7
D
U
R
I
22 22-Aug-22 4 1 0 1 0 5 0 7
N
23 23-Aug-22 4 1 0 1 0 5 0 7
G
A
P
R
I
L 24 24-Aug-22 4 1 0 1 0 5 0 7
2
0
2
2
25 25-Aug-22 5 1 0 1 0 5 0 7
26 26-Aug-22 4 1 0 1 0 5 0 7
27 27-Aug-22 4 1 0 1 0 5 0 7
28 28-Aug-22 4 1 0 1 0 5 0 7
29 29-Aug-22 4 1 0 1 0 5 0 7
30 30-Aug-22 4 1 0 1 0 5 0 7
31 31-Aug-22 4 1 0 1 0 5 0 7
TOTAL 129 32 0 31 0 155 0 218
y & Quality
MINATION
LTH CHECK LIST
NURSE
PAGI
B 3 Total Maintenance Check (Morning & Night Shift) 218

B
D
D FLIGHT PIC SIC
D 129 32 31
B
B
B GRAPHIC PRE - FLIGHT HEALTH CHECK AT S
D 12000
D
D 10000
B
B 8000
B
6000
D
D
4000
D
B 2000
B
B 0
FLIGHT PIC SIC
D
D
D
B
B
B
D
D
FA MAINTENANCE
155 218
HT HEALTH CHECK AT STA. CGK DURING MAY 2022
C SIC FA MAINTENANCE
Safe
Flight
No Date Name ID Number
Number
1 8/1/2022 ID 6711 IQRA MUHAMMAD FARGHAB 146214
2 8/1/2022 ID 6711 MELDIEGO ARMANDO 171896
3 8/1/2022 ID 6711 MELIA FRASANKI 52116904
4 8/1/2022 ID 6711 HELENA AURELLIA GITA ANJANI 181011
5 8/1/2022 ID 6711 DYAJENG HAZIZAH NUR ILAHI 193937
6 8/1/2022 ID 6711 PUTRI ALLYA RAMADANI 194207
7 8/1/2022 ID 6711 LARAS SETIAWATI 201566
8 8/2/2022 ID 6711 RANGGA TRIADI MUKRIM 150697
9 8/2/2022 ID 6711 EMERALDO BAMBANG PERDANA 200280
10 8/2/2022 ID 6711 DHEA NOFIANI 163477
11 8/2/2022 ID 6711 BELLA HANDAYANI 170494
12 8/2/2022 ID 6711 TIWY ANTIKASARI 183752
13 8/2/2022 ID 6711 RISMA RISMAYANTI 192001
14 8/2/2022 ID 6711 FHRISKA NAZULMA PUTRI 201694
15 8/3/2022 ID 6711 YOGA BHUANA SAMUDRA 144674
16 8/3/2022 ID 6711 MUHAMMAD DANIEL RUKMANA 193017
17 8/3/2022 ID 6711 FITRI AYU ARUM PUSPITA 161878
18 8/3/2022 ID 6711 EVANIA AZARAH 181020
19 8/3/2022 ID 6711 RESI SEKAR WANGI 181643
20 8/3/2022 ID 6711 SERI HELEN SIMANJUNTAK 191995
21 8/3/2022 ID 6711 RAKHA SIWI CAHYA PEROSITA SARI 192121
22 8/4/2022 ID 6711 BIDI SEMBADA 144382
23 8/4/2022 ID 6711 JODI PRIYADHIKA PERKASA 182307
24 8/4/2022 ID 6711 MEYDITA ANGGRAENI 153789
25 8/4/2022 ID 6711 DINDA ANGGUN PUTRI PERTIWI 172060
26 8/4/2022 ID 6711 GEADARA PERMATA SYAQINAH 184692
27 8/4/2022 ID 6711 REGITA NUR INDAH PAULANI 200748
28 8/4/2022 ID 6711 NI MADE RIZKA ERWINDA SARI 220165
29 8/5/2022 ID 6711 HABIB MUHAMMAD LUBIS 150232
30 8/5/2022 ID 6711 ARFIANTO ANUGRAH WIBOWO 153809
31 8/5/2022 ID 6711 NINING DWI PRASETYA WATI 150820
32 8/5/2022 ID 6711 BETARI BAGJA PERSADA 183769
33 8/5/2022 ID 6711 AYU MAYURA 193329
34 8/5/2022 ID 6711 AINUN SALMATIKA 193607
36 8/6/2022 ID 6711 SRI HANANDYO ERSAL 143063
37 8/6/2022 ID 6711 IZHAR NASRULLAH 180995
38 8/6/2022 ID 6711 ROBIANSYAH KAMIL 131586
39 8/6/2022 ID 6711 CHELSY LIDYAWATI 163371
40 8/6/2022 ID 6711 BUNGA FITRIANA RAMADHAN 171796
41 8/6/2022 ID 6711 SISKA PRASETYA 193624
42 8/6/2022 ID 6711 GLEDYS ANGGRAINI PURBA 200743
43 8/7/2022 ID 6711 DWI ISWAHYUDI 143312
44 8/7/2022 ID 6711 INTAN ARIFIYAN SAPUTRA 160425
45 8/7/2022 ID 6711 FITRI AYU ARUM PUSPITA 161878
46 8/7/2022 ID 6711 MADE PERMATA WULANDARI DEWI 193863
47 8/7/2022 ID 6711 FITRIANI 170766
48 8/7/2022 ID 6711 KEZIA NOPELIA TARIGAN 220163
49 8/7/2022 ID 6711 RESTIANA DWI SANTI 171814
50 8/8/2022 ID 6711 THEODORES EKO RACHMATDIONO 52040294
51 8/8/2022 ID 6711 HANIF HUZAIRI PUTRA 180310
52 8/8/2022 ID 6711 KURNIA DEWI 151416
53 8/8/2022 ID 6711 MAYA ALFISYAH 192113
54 8/8/2022 ID 6711 ROLANDA LIMAHELUW 181325
55 8/8/2022 ID 6711 ZHASQIA PUTRI FARIZHA 170776
56 8/8/2022 ID 6711 FAISAL 213202
57 8/9/2022 ID 6711 I PUTU CANTYAWAN 62092772
58 8/9/2022 ID 6711 AGUSTINA 160575
59 8/9/2022 ID 6711 AGATHA WAHYU PUTRI GUNAWAN 193046
60 8/9/2022 ID 6711 FAJAR PRAYOGA 173289
61 8/9/2022 ID 6711 DEFI PUSPITA SARI 201906
62 8/9/2022 ID 6711 ASFIAH FANANI 211846
63 8/9/2022 ID 6711 FRIZILIA PUTRI FIRANA 212026
64 8/10/2022 ID 6711 I KADEK DWI ATMAJA 141499
65 8/10/2022 ID 6711 NATALINO JOSHUA EKARISTO 171895
66 8/10/2022 ID 6711 EDWIN VAN PRATAMA S 52116591
67 8/10/2022 ID 6711 RESI SEKAR WANGI 181643
68 8/10/2022 ID 6711 KOMANG BONITA BERLIANI 201695
69 8/10/2022 ID 6711 MELISA ERVINA PONDAAG 212030
70 8/10/2022 ID 6711 DESAK MADE NATASYA 220160
71 8/11/2022 ID 6711 DANA MEIDISTANTRA 62092777
72 8/11/2022 ID 6711 KEVIN HADYAN R KRESHNAPATY 192714
73 8/11/2022 ID 6711 GABRIELLA ENDRIENI MARPAUNG 147977
74 8/11/2022 ID 6711 REZA GHENISA YOULANDHINI 170614
75 8/11/2022 ID 6711 NABILAH PUTRI MUBARAMAH 181330
76 8/11/2022 ID 6711 SEPTY VELISTA PANGESTU 181654
77 8/11/2022 ID 6711 DYAJENG HAZIZAH NUR ILAHI 193937
78 8/12/2022 ID 6711 KESOWO HARKAV JUNIANTO 142232
79 8/12/2022 ID 6711 GUSTIFAR PURNAMA ALLADIJA 190486
80 8/12/2022 ID 6711 LARASITI MAESAROH 150435
81 8/12/2022 ID 6711 YULIA SRI UTAMI 163370
82 8/12/2022 ID 6711 AFRITA SRI SULISTIOWATI 170764
83 8/12/2022 ID 6711 M GHIBRAN AL RAJIB ARON 222179
84 8/12/2022 ID 6711 FATMA KHARISMA WULANDARI 183762
85 8/13/2022 ID 6711 SYUKUR HANDAYA BARKA 133224
86 8/13/2022 ID 6711 MUHAMMAD HADI NUGROHO 182539
87 8/13/2022 ID 6711 WINES ZUMNIS SARANTIKA 143179
88 8/13/2022 ID 6711 OCTA ERNANDA 212033
89 8/13/2022 ID 6711 SEPTY VELISTA PANGESTU 181654
90 8/13/2022 ID 6711 DIAH CANDRA RINI 170512
92 8/14/2022 ID 6711 MADE HYANG WIKANANDA 151210
93 8/14/2022 ID 6711 HIMAWAN FIRDAUS 62083755
94 8/14/2022 ID 6711 FIRSTCA MARINDHA GUNARYANTI 163487
95 8/14/2022 ID 6711 ASTRID FERNANDA KHAIRUNNISA 183770
96 8/14/2022 ID 6711 BELLA REGITHA TIFFANY RONALDO 192115
97 8/14/2022 ID 6711 HERVINA NUR AINI HANITA PUTRI 201917
98 8/14/2022 ID 6711 SUSJATI RAHMA PERTIWI 170762
99 8/15/2022 ID 6711 NORTHFLINT R WUNGKANA 144383
100 8/15/2022 ID 6711 DAVID BANGSAWAN SE AK 220423
101 8/15/2022 ID 6711 ADITYA NUSA BASKORO 183922
102 8/15/2022 ID 6711 PUTU INTAN REZA ASTIKA AYU 161440
103 8/15/2022 ID 6711 LIA LIANA 172234
104 8/15/2022 ID 6711 VENTY DHEA NIRA HANUM 182726
105 8/15/2022 ID 6711 TASYA ANDARINI MARSAULINA 193854
106 8/15/2022 ID 6711 GABRILLE NATALIA 201897
107 8/16/2022 ID 6711 KOTET PRAMAIDARMA 52138718
108 8/16/2022 ID 6711 ACHDIAN FIRDAUS 200948
109 8/16/2022 ID 6711 SILMAWATI 154963
110 8/16/2022 ID 6711 DESTI ASRESTY 170348
111 8/16/2022 ID 6711 DINDA ANGGUN PUTRI PERTIWI 172060
112 8/16/2022 ID 6711 ELIN ERFANDA SARI 193045
113 8/16/2022 ID 6711 VINA PRATIWI 201783
114 8/17/2022 ID 6711 ADITYA DIYAN DWI PUTRA 52105841
115 8/17/2022 ID 6711 BRILLIAN ARDINDA NOVA 181444
116 8/17/2022 ID 6711 NADIA AFRILIANTI 163110
117 8/17/2022 ID 6711 AJENG NOVI YANI SARI FAUZIAH 201910
121 8/18/2022 ID 6711 MADE HYANG WIKANANDA 151210
122 8/18/2022 ID 6711 BAMBANG TRIYANTO 190480
123 8/18/2022 ID 6711 RR RAHMA TRI AGUSTINI 162834
124 8/18/2022 ID 6711 SARLY ADELYTHA IRFANY 201791
125 8/18/2022 ID 6711 MARGARETH ZEFANYA EBBENHAEZER 181009
126 8/18/2022 ID 6711 FIQRI ARDIANSYAH 213203
127 8/18/2022 ID 6711 FEBY ROSITA 170350
128 8/19/2022 ID 6711 MUHAMMAD RIFQY NUZA 52115981
129 8/19/2022 ID 6711 ANDIKA DWI SETYAWAN 192739
130 8/19/2022 ID 6711 SEPTI VERA MARTHI NOVA 151757
131 8/19/2022 ID 6711 DESAK MADE NATASYA 220160
133 8/19/2022 ID 6711 PUTU TANIA SARASWATI OKA P 220696
134 8/19/2022 ID 6711 NIKMATUL AIDHA PUTRI EDI 193860
135 8/20/2022 ID 6711 SUGENG SISWOYOSIDI W 144683
136 8/20/2022 ID 6711 SULTHAN FARAS ZAFRAN 201638
137 8/20/2022 ID 6711 ELYSIA MARIA 151038
138 8/20/2022 ID 6711 FATHIAH NUR ANDINI 222188
139 8/20/2022 ID 6711 GLADY LIYANA DEWI 201916
140 8/20/2022 ID 6711 DIAN ASMORO CAHYANINGTYAS S PD 220398
141 8/20/2022 ID 6711 ANGGI MEIDITAMA ANGGONO 171809
142 8/21/2022 ID 6711 MUHAMMAD FADIL INDRAYANTO 146212
143 8/21/2022 ID 6711 BINTANG KHATON 171894
144 8/21/2022 ID 6711 DEA PUTRI NESIA 148335
145 8/21/2022 ID 6711 VIOLA MONALISA 182724
146 8/21/2022 ID 6711 PUTRI ANDRIANI 183767
148 8/21/2022 ID 6711 IDHA AMBARWATI 201564
149 8/22/2022 ID 6711 RINO ALFANTRIS 131782
150 8/22/2022 ID 6711 MELVIN ARTHUR RISNANTHA 180364
151 8/22/2022 ID 6711 REKA WULANDARI PUTRI 162821
152 8/22/2022 ID 6711 LIA LIANA 172234
153 8/22/2022 ID 6711 REGA AYU PANESSA 181018
154 8/22/2022 ID 6711 MAYA ALFISYAH 192113
155 8/22/2022 ID 6711 BERLIAN FEBRIYANA LOVEZ 193610
156 8/23/2022 ID 6711 ADRIAN RAMADHANI 143482
157 8/23/2022 ID 6711 WINDY MEIDA YANTI 170760
158 8/23/2022 ID 6711 SITI SARAH 193033
159 8/23/2022 ID 6711 ALVIAN CHANDRA MOCHAMAD KURNIAWAN 213189
161 8/23/2022 ID 6711 YAHYA ALAYDROES 200959
162 8/23/2022 ID 6711 CINDY CLAUDYA N RIUWPASSA 132106
163 8/24/2022 ID 6711 EDI KOMARI 151173
164 8/24/2022 ID 6711 KEMAS MUHAMMAD FATUR RAHMANDA GIOVANNI 190483
165 8/24/2022 ID 6711 MELISA FEBRIATI 161695
166 8/24/2022 ID 6711 EKA FEBRIANA 193323
168 8/24/2022 ID 6711 DEA ANUGRAH 222187
169 8/24/2022 ID 6711 NIKEN PUTRI HERNANDA 182430
170 8/25/2022 ID 6711 BIDI SEMBADA 144382
171 8/25/2022 ID 6711 YUDISTIRA PRATAMA 183364
172 8/25/2022 ID 6711 CINDRA AYU KARLA NINGTYAS 146365
173 8/25/2022 ID 6711 LINA DESIANTI 172061
174 8/25/2022 ID 6711 EKAPUTRI MARYANALOSA K 171813
175 8/25/2022 ID 6711 KIFTIA 172228
177 26-Aug-2022 ID 6711 THEODORES EKO RACHMATDIONO 52040294
178 26-Aug-2022 ID 6711 RIDHO AFIARO 171917
179 26-Aug-2022 ID 6711 DEA PUTRI NESIA 148335
180 26-Aug-2022 ID 6711 OLGA RAHMAWATI 191990
181 26-Aug-2022 ID 6711 INDAH DWI ROECMANA 193037
182 26-Aug-2022 ID 6711 ASFIAH FANANI 211846
183 26-Aug-2022 ID 6711 PUTU ARI MAS DINDA PERTIWI 191978
184 27-Aug-2022 ID 6711 HENGKY STENLY EVERLY LOLOWANG 143084
185 27-Aug-2022 ID 6711 KEVIN HADYAN R KRESHNAPATY 192714
186 27-Aug-2022 ID 6711 MALINDA OKTAVIANI MANALU 144171
187 27-Aug-2022 ID 6711 RESI SEKAR WANGI 181643
188 27-Aug-2022 ID 6711 MELISA EKA PUTRI 184704
189 27-Aug-2022 ID 6711 EKKY DHIYA ULHAQ 220161
190 27-Aug-2022 ID 6711 SOFIA FITRIANA 212038
191 28-Aug-2022 ID 6711 ROMIE WIDYANTO 153960
192 28-Aug-2022 ID 6711 GALANG GAGUNG PRAMONO A 150691
193 28-Aug-2022 ID 6711 BETRIC ARUAN 160390
194 28-Aug-2022 ID 6711 NABILAH PUTRI MUBARAMAH 181330
195 28-Aug-2022 ID 6711 IIS IMELDA JUNAID 181638
196 28-Aug-2022 ID 6711 MILA DELVI ARYANTO 191986
197 28-Aug-2022 ID 6711 RIZKA DEWI INDAH P 200693
198 29-Aug-2022 ID 6711 MIRGA BUDI DARMAWAN 144244
199 29-Aug-2022 ID 6711 MUHAMMAD IVAN OCTAVIAN ADAMY 192729
200 29-Aug-2022 ID 6711 RAVISCA DEA ELVARA 162192
201 29-Aug-2022 ID 6711 DIAN KUMALA SARI 182732
202 29-Aug-2022 ID 6711 OLGA RAHMAWATI 191990
203 29-Aug-2022 ID 6711 CINDY FLORENCIA 201785
204 29-Aug-2022 ID 6711 MELISA EKA PUTRI 184704
205 30-Aug-2022 ID 6711 ARRIE ADHITYA 133275
206 30-Aug-2022 ID 6711 ADITYA NUSA BASKORO 183922
207 30-Aug-2022 ID 6711 ROSYANA RASMIN 154960
208 30-Aug-2022 ID 6711 DIANA SETYOWATI 171489
209 30-Aug-2022 ID 6711 TIWY ANTIKASARI 183752
210 30-Aug-2022 ID 6711 INTAN AULINA HANDAYANI 172622
211 30-Aug-2022 ID 6711 JESSICA VANNESSA 182011
212 31-Aug-2022 ID 6711 RENDRA TEGUH DWIUTOMO 133018
213 31-Aug-2022 ID 6711 MAKMUR 180894
214 31-Aug-2022 ID 6711 MAISSY RARA PERMATASARI 145194
215 31-Aug-2022 ID 6711 SISKA NATALIANA PANDIANGAN 191679
216 31-Aug-2022 ID 6711 SUNDARI MOKODONGAN 183749
217 31-Aug-2022 ID 6711 DWI KIRANA 200702
218 31-Aug-2022 ID 6711 RESTIANA DWI SANTI 171814
219
220
221
222
223
224
225
226
227
228
229
230
231
232
233
234
235
236
237
238
239
240
241
242
243
244
245
246
247
248
249
250
251
252
253
254
255
256
257
258
259
260
261
262
263
264
265
266
267
268
269
270
271
272
273
274
275
276
277
278
279
280
281
282
283
284
285
286
287
288
289
290
291
292
293
294
295
296
297
298
299
300
301
302
303
304
305
306
307
308
309
310
311
312
313
314
315
316
317
318
319
320
321
322
323
324
325
326
327
328
329
330
331
332
333
334
335
336
337
338
339
340
341
342
343
344
345
346
347
348
349
350
351
352
353
354
355
356
357
358
359
360
361
362
363
364
365
366
367
368
369
370
371
372
373
374
375
376
377
378
379
380
381
382
383
384
385
386
387
388
389
390
391
392
393
394
395
396
397
398
399
400
401
402
403
404
405
406
407
408
MEDICAL EXAMINATION
Blood
Job Title Alcohol Test Result Remaks
Pressure

PIC 120/80 NORMAL FIT
Time Nurse on Duty

TOTAL PILOT FA EOB

GRAND TOTAL
TOTAL PILOT FA EOB

GRAND TOTAL
TOTAL PILOT FA EOB

NORMAL 56 133
HIPOTENSI 0 0
PRE HIPERTENSI 4 0
GRAND TOTAL

Remaks
Remaks
Remaks
MEDICAL EXAMINATION
AIRLINE : ID
DATE / MONTH : SEPTEMBER 2022
LOCATION : STA.
Total
No Date Maintenance
check
1 1-Sep-22 5 1 0 1 0 5 0 7
2 2-Sep-22 5 1 0 1 0 5 0 7
3 3-Sep-22 5 1 0 1 0 5 0 7
4 4-Sep-22 5 1 0 1 0 5 0 7
5 5-Sep-22 5 1 0 1 0 5 0 7
6 6-Sep-22 5 1 0 1 0 5 0 7
7 7-Sep-22 5 1 0 1 0 5 0 7
8 8-Sep-22 5 1 0 1 0 5 0 7
9 9-Sep-22 5 1 0 1 0 5 0 7
10 10-Sep-22 6 1 0 1 0 5 0 7
G
R
A
P
11 11-Sep-22 5 1 0 1 0 5 0 7
H
12 12-Sep-22 5 1 0 1 0 5 0 7
I
C
13 13-Sep-22 5 1 0 1 0 5 0 7
R
E
F
L
I
14 14-Sep-22 5 1 0 2 0 5 0 8
G
H
T 15 15-Sep-22 5 1 0 1 0 5 0 7
H
E
A
L
16 16-Sep-22 6 1 0 1 0 5 0 7
T
H
C
17 17-Sep-22 5 1 0 1 0 5 0 7
H
18 18-Sep-22 5 1 0 1 0 5 0 7
E
C
K
A
T
S
19 19-Sep-22 5 1 0 1 0 5 0 7
T
A
. 20 20-Sep-22 5 1 0 1 0 5 0 7
C
G
K 21 21-Sep-22 5 1 0 1 0 5 0 7
D
U
R
I
22 22-Sep-22 5 1 0 1 0 5 0 7
N
23 23-Sep-22 6 1 0 1 0 5 0 7
G
A
P
R
I
L 24 24-Sep-22 6 1 0 1 0 5 0 7
2
0
2
2
25 25-Sep-22 5 1 0 1 0 5 0 7
26 26-Sep-22 5 1 0 1 0 5 0 7
27 27-Sep-22 5 1 0 1 0 5 0 7
28 28-Sep-22 5 1 0 1 0 5 0 7
29 29-Sep-22 5 1 0 1 0 5 0 7
30 30-Sep-22 5 1 0 1 0 5 0 7
31
TOTAL 154 30 0 31 0 150 0 211
y & Quality
MINATION
LTH CHECK LIST
NURSE
PAGI
B 2 Total Crew Checked (PIC, SIC, and FA) 211

D
D
D FLIGHT PIC SIC
B 154 30 31
B
B
D GRAPHIC PRE - FLIGHT HEALTH CHECK AT S
D 12000
D
B 10000
B
B 8000
D
6000
D
B
4000
B
B 2000
D
D 0
FLIGHT PIC SIC
D
D
B
B
B
D
FA MAINTENANCE
150 211
Safe
Flight
No Date Name
Number
1 9/1/2022 ID 6711 BENJAMIN P NATAWARDAJA
2 9/1/2022 ID 6711 RADEN GILANG PANJI BUONO
3 9/1/2022 ID 6711 AMANDA BERNICE
4 9/1/2022 ID 6711 AYU SETIANA
5 9/1/2022 ID 6711 KHALILA PRAMUWATI
6 9/1/2022 ID 6711 MONICA SANIA TANONE
7 9/1/2022 ID 6711 SARI RATNA ZUHRI
8 9/2/2022 ID 6711 IQRA MUHAMMAD FARGHAB
9 9/2/2022 ID 6711 ARFIANTO ANUGRAH WIBOWO
10 9/2/2022 ID 6711 ANJELINA SIBUEA
11 9/2/2022 ID 6711 MADE PERMATA WULANDARI DEWI
12 9/2/2022 ID 6711 KOMANG BONITA BERLIANI
13 9/2/2022 ID 6711 RIDWAN PRIHADI
14 9/2/2022 ID 6711 LIKE APRILIA
15 9/3/2022 ID 6711 TEGUH DUTO PRAYITNO
16 9/3/2022 ID 6711 NAUFAL INDIANA ALFATH
17 9/3/2022 ID 6711 AGREVINA DWI PUTRI
18 9/3/2022 ID 6711 LATIFAH NUR ISNAINI
19 9/3/2022 ID 6711 JESIKA RUDIANTI
20 9/3/2022 ID 6711 AYA CHANDRA
21 9/3/2022 ID 6711 RESTIFANI WULAN RAHIMA
23 9/4/2022 ID 6711 FABRIANO RIZKY BOESTAMI
24 9/4/2022 ID 6711 DWITA ARYUDHANI
25 9/4/2022 ID 6711 INTAN AULINA HANDAYANI
26 9/4/2022 ID 6711 RUSTIYAWATI SRI RIZKI
27 9/4/2022 ID 6711 NI KOMANG NOVANIA SUKAYANTI
28 9/4/2022 ID 6711 DARIUS
29 9/5/2022 ID 6711 MUKHAMMAD FATKUL YASIR
30 9/5/2022 ID 6711 KEVIN FERLYANTO
31 9/5/2022 ID 6711 DILLA PERMATA EDRA
32 9/5/2022 ID 6711 LIKE APRILIA
33 9/5/2022 ID 6711 LENNY
34 9/5/2022 ID 6711 IIS IMELDA JUNAID
35 9/5/2022 ID 6711 AFIFAH SHAFIYAH KOMARAWANTI
36 9/6/2022 ID 6711 MUHAMMAD FEBRIANSYAH
37 9/6/2022 ID 6711 GARI REVA WAHYU SETIAWAN
38 9/6/2022 ID 6711 WILLINGLY AGATHA SWEETLY TUMEWU
39 9/6/2022 ID 6711 BERLIAN FEBRIYANA LOVEZ
40 9/6/2022 ID 6711 AJENG AZ ZAHRA SALSABILA
41 9/6/2022 ID 6711 EKKY DHIYA ULHAQ
42 9/6/2022 ID 6711 DEA KRISMONICA
43 9/7/2022 ID 6711 R MAULUDDIN NURSYAHAR
44 9/7/2022 ID 6711 M YURIKO HANAKA
45 9/7/2022 ID 6711 INDRIANTI
46 9/7/2022 ID 6711 NI PUTU PERISKA ERDITA SARI
47 9/7/2022 ID 6711 NADYA RIZKA ARELLYA
48 9/7/2022 ID 6711 AYU MAYURA
49 9/7/2022 ID 6711 MONICA TRI WIDIASTUTI
50 9/8/2022 ID 6711 I PUTU CANTYAWAN
51 9/8/2022 ID 6711 MUHAMMAD REZA TAMSIL
52 9/8/2022 ID 6711 NI KADEK ERI AYU KRISTIYANTI D
53 9/8/2022 ID 6711 OLGA RAHMAWATI
54 9/8/2022 ID 6711 BRILIANA DELIAPUTRI
55 9/8/2022 ID 6711 SOFIA FITRIANA
56 9/8/2022 ID 6711 SRI RAHAYU INDRIYANI
57 9/9/2022 ID 6711 DENNY LEONARD SIMANDJUNTAK
58 9/9/2022 ID 6711 PANJHI WIJAYA
59 9/9/2022 ID 6711 ERLIK HARIYATI
60 9/9/2022 ID 6711 ALKHONIYU ISMA RERA
62 9/9/2022 ID 6711 DENNISA CHRISTIE
63 9/9/2022 ID 6711 NABILA SUCI AMELIA
64 9/10/2022 ID 6711 WIDODO
65 9/10/2022 ID 6711 AZHAR PAMUNGKAS
66 9/10/2022 ID 6711 YUMNI ANINGSARI
67 9/10/2022 ID 6711 FIKI NOVITALIA
68 9/10/2022 ID 6711 KEIKO KEISHA
69 9/10/2022 ID 6711 DARIUS
70 9/10/2022 ID 6711 WAHIDA LANA YULFI
71 9/11/2022 ID 6711 BAYNAFRAH
72 9/11/2022 ID 6711 BIMANTORO
73 9/11/2022 ID 6711 TRI REJEKI WIDADA NINGSIH
74 9/11/2022 ID 6711 LENNY
75 9/11/2022 ID 6711 MARIA LISTYANINGTYAS
76 9/11/2022 ID 6711 CINDY FLORENCIA
77 9/11/2022 ID 6711 YOLANDA LISYANA PADILAH
78 9/12/2022 ID 6711 MADE HYANG WIKANANDA
79 9/12/2022 ID 6711 IBNU SAFARI
80 9/12/2022 ID 6711 KARIN SEPTIANA PUTRI
81 9/12/2022 ID 6711 FAYAKUN SWAMUSTIKA
82 9/12/2022 ID 6711 CAHYA MUTMAINAH
84 9/12/2022 ID 6711 MIESELLY GOTAMIE
85 9/13/2022 ID 6711 MUHAMMAD SYAKIR
87 9/13/2022 ID 6711 AGNES THERESIA H
88 9/13/2022 ID 6711 TITA ROSILAWATI
89 9/13/2022 ID 6711 NOVIKA ARIYANTI
91 9/13/2022 ID 6711 LENNY
92 9/14/2022 ID 6711 RINO ALFANTRIS
93 9/14/2022 ID 6711 FEBTIAN SURYA PERDANA
94 9/14/2022 ID 6711 RESPATI AYU PRIMASWARI
95 9/14/2022 ID 6711 JODI PRIYADHIKA PERKASA
96 9/14/2022 ID 6711 ANDHINI MEITRI HAPSARI
97 9/14/2022 ID 6711 ASTRI MAYLINDA
98 9/14/2022 ID 6711 ADHIKA RANGGA NOVERIA
99 9/14/2022 ID 6711 I GUSTI AGUNG DARA AGUNG ARIANI STHY J
100 9/15/2022 ID 6711 JASON
101 9/15/2022 ID 6711 MATTHEW ALEXANDER
102 9/15/2022 ID 6711 DEA PUTRI NESIA
103 9/15/2022 ID 6711 ANNISA NUR FAUZIA
104 9/15/2022 ID 6711 ANNISA DWI UTAMI
105 9/15/2022 ID 6711 RISA SITI NURANISA
106 9/15/2022 ID 6711 KARIN ARIFIN
107 9/16/2022 ID 6711 ADRIAN RAMADHANI
108 9/16/2022 ID 6711 M AVIRIANSYAH ZAHRI WARDANA
109 9/16/2022 ID 6711 FERLINA DWI ARNANDA
110 9/16/2022 ID 6711 ROHMAH AZIZAH
111 9/16/2022 ID 6711 MARTA ANGGRAINI MARIA
112 9/16/2022 ID 6711 M RAFLI J PUTRA
113 9/16/2022 ID 6711 ARZETTI FAIRUZ UFAIRAH MUMTAZ
115 9/17/2022 ID 6711 ERDI RACHMEIDI
116 9/17/2022 ID 6711 ANDHIKA YUDHISTIRA
117 9/17/2022 ID 6711 CHERLY MEGA VEOLITA
118 9/17/2022 ID 6711 WINANDA SYAHRINA
119 9/17/2022 ID 6711 NI LUH AYU RISKA DEWI
120 9/17/2022 ID 6711 AZIZAH NORMA HIDAYATI
121 9/18/2022 ID 6711 TAUFAN WIDYA KUSUMA D A
122 9/18/2022 ID 6711 HERDYAN PERDANA
124 9/18/2022 ID 6711 EVA FATHIA
125 9/18/2022 ID 6711 MAYA ALFISYAH
128 9/19/2022 ID 6711 ANDIKA DWITYA
129 9/19/2022 ID 6711 ARDIAN BUDIWANTHORO
130 9/19/2022 ID 6711 LARASITI MAESAROH
131 9/19/2022 ID 6711 RANI WIDIYARTI
132 9/19/2022 ID 6711 RESI SEKAR WANGI
133 9/19/2022 ID 6711 RIKA SEPTIA RAHMASARI
136 9/20/2022 ID 6711 IZHAR NASRULLAH
137 9/20/2022 ID 6711 FHAUZAN
138 9/20/2022 ID 6711 NI MADE ADE IRMA PRAMESTI
139 9/20/2022 ID 6711 BUDI DARMAWAN
140 9/20/2022 ID 6711 PUTU TANIA SARASWATI OKA P
141 9/20/2022 ID 6711 RANI SARI INTAN
142 9/21/2022 ID 6711 ZAENOL PUJIANTO
143 9/21/2022 ID 6711 BAMPHY ADYA PERMANA
144 9/21/2022 ID 6711 SHERLY HAPPY PERMATASARI
145 9/21/2022 ID 6711 KUSMIATI
146 9/21/2022 ID 6711 VENTY DHEA NIRA HANUM
147 9/21/2022 ID 6711 MARSALINA SUSANA
148 9/21/2022 ID 6711 SILVIANA CITRA AYU PANCARANI
149 9/22/2022 ID 6711 DANIK ANDHIKA
150 9/22/2022 ID 6711 GHEA DENY SAPUTRA
151 9/22/2022 ID 6711 SITI SHOLICHAH
152 9/22/2022 ID 6711 DWI MARTINA ADENI
154 9/22/2022 ID 6711 ADITYA RESTU YOGA ARDHIKA
155 9/22/2022 ID 6711 RENDI DWI PUTRA
156 9/23/2022 ID 6711 M SATRIA AFANTI
157 9/23/2022 ID 6711 MARTHEN MATHEIS DONALD MUGUJAI
158 9/23/2022 ID 6711 TRI RACHMA DEWI
159 9/23/2022 ID 6711 FIONNA JOLLY TAMARINDANG
160 9/23/2022 ID 6711 NI LUH AYU RISKA DEWI
161 9/23/2022 ID 6711 SEPTIANI ARUM PRIDINA
162 9/23/2022 ID 6711 ALDI OCTAVIADI
163 9/24/2022 ID 6711 ALBERTUS BUDI PRASETYO
165 9/24/2022 ID 6711 NATASYA OKTAVIANI
166 9/24/2022 ID 6711 NICE GUSMAN
167 9/24/2022 ID 6711 ROBERT B LATUPEIRISSA
168 9/24/2022 ID 6711 AGUS SUBAKIR
169 9/24/2022 ID 6711 TUTUT IKA WINDARLIN
170 9/25/2022 ID 6711 HELMY SAPUTRA
172 9/25/2022 ID 6711 FHAUZAN
173 9/25/2022 ID 6711 TIWY ANTIKASARI
174 9/25/2022 ID 6711 DYAJENG HAZIZAH NUR ILAHI
175 9/25/2022 ID 6711 PRATIWI KARISMA
176 9/25/2022 ID 6711 THASYA AYU FEBRIANTY
177 26-Sep-2022 ID 6711 R ANGGI JENHARTO M
178 26-Sep-2022 ID 6711 IDA BAGUS DWIJA PUTRA
179 26-Sep-2022 ID 6711 SENI SITI SELVIA NUR
180 26-Sep-2022 ID 6711 EKA FEBRIANA
181 26-Sep-2022 ID 6711 SYAVUNG INRI MAMAHIT
182 26-Sep-2022 ID 6711 HERVINA NUR AINI HANITA PUTRI
183 26-Sep-2022 ID 6711 WILLIAM AK
184 27-Sep-2022 ID 6711 DANIK ANDHIKA
185 27-Sep-2022 ID 6711 YOHANES PANDU JATMIKO
186 27-Sep-2022 ID 6711 SITI SHOLICHAH
187 27-Sep-2022 ID 6711 SAHARA SYALWA ANDINA
188 27-Sep-2022 ID 6711 REKHA TRI RAHAYU
189 27-Sep-2022 ID 6711 NIMAS AYU KUMALA DEWI
190 27-Sep-2022 ID 6711 AYU APRILIA
191 28-Sep-2022 ID 6711 KESOWO HARKAV JUNIANTO
192 28-Sep-2022 ID 6711 MUHAMMAD IVAN OCTAVIAN ADAMY
193 28-Sep-2022 ID 6711 REKA WULANDARI PUTRI
194 28-Sep-2022 ID 6711 YOSI PUSPA DEWI
195 28-Sep-2022 ID 6711 BUDI PAMUNGKAS
196 28-Sep-2022 ID 6711 ROLANDA LIMAHELUW
197 28-Sep-2022 ID 6711 SITI MULYANI
198 29-Sep-2022 ID 6711 ANGGRIAN DEVITA KAHAR
199 29-Sep-2022 ID 6711 ALDOFINNO IMANUEL K M S
200 29-Sep-2022 ID 6711 INDIRA CAHYANY
201 29-Sep-2022 ID 6711 AYU WULANDARI
202 29-Sep-2022 ID 6711 MARGARETH ZEFANYA EBBENHAEZER
203 29-Sep-2022 ID 6711 AINUN SALMATIKA
204 29-Sep-2022 ID 6711 NI LUH AYU RISKA DEWI
205 30-Sep-2022 ID 6711 MUHAMMAD FEBRIANSYAH
206 30-Sep-2022 ID 6711 INTAN ARIFIYAN SAPUTRA
207 30-Sep-2022 ID 6711 RESPATI AYU PRIMASWARI
208 30-Sep-2022 ID 6711 PUTRI CINTYA JYOTISCHA
209 30-Sep-2022 ID 6711 CINDI MEISTRI WIDIYANTI
210 30-Sep-2022 ID 6711 RESTIFANI WULAN RAHIMA
211 30-Sep-2022 ID 6711 SUSRINAH TREE APRITA
212
213
214
215
216
217
218
219
220
221
222
223
224
225
226
227
228
229
230
231
232
233
234
235
236
237
238
239
240
241
242
243
244
245
246
247
248
249
250
251
252
253
254
255
256
257
258
259
260
261
262
263
264
265
266
267
268
269
270
271
272
273
274
275
276
277
278
279
280
281
282
283
284
285
286
287
288
289
290
291
292
293
294
295
296
297
298
299
300
301
302
303
304
305
306
307
308
309
310
311
312
313
314
315
316
317
318
319
320
321
322
323
324
325
326
327
328
329
330
331
332
333
334
335
336
337
338
339
340
341
342
343
344
345
346
347
348
349
350
351
352
353
354
355
356
357
358
359
360
361
362
363
364
365
366
367
368
369
370
371
372
373
374
375
376
377
378
379
380
381
382
383
384
385
386
387
388
389
390
391
392
393
394
395
396
397
398
399
400
401
402
403
404
405
406
407
408
MEDICAL EXAMINATION
Blood
ID Number Job Title Alcohol Test Result
Pressure
52040296 PIC 120/80 - NORMAL

201111 FO 120/80 - NORMAL
162804 SFA 100/70 - NORMAL
133559 FA 110/70 - NORMAL
172624 FA 100/70 - NORMAL
194205 FA 110/70 - NORMAL
170611 FA 110/70 - NORMAL
146214 PIC 110/70 - NORMAL
153809 FO 110/70 - NORMAL
52127112 SFA 110/80 - NORMAL
193863 FA 100/70 - NORMAL
201695 FA 100/70 - NORMAL
213035 FA 100/80 - NORMAL
182513 FA 120/80 - NORMAL
144853 PIC 120/80 - NORMAL
190481 FO 110/70 - NORMAL
194183 SFA 110/70 - NORMAL
193328 FA 100/70 - NORMAL
193862 FA 100/70 - NORMAL
201689 FA 100/80 - NORMAL
201919 FA 100/70 - NORMAL
52040296 PIC 110/70 - NORMAL
184348 FO 110/80 - NORMAL
170233 SFA 110/80 - NORMAL
172622 FA 100/80 - NORMAL
191680 FA 100/70 - NORMAL
201797 FA 110/70 - NORMAL
213198 FA 110/70 - NORMAL
62102868 PIC 120/70 - NORMAL
180523 FO 120/80 - NORMAL
161688 SFA 110/70 - NORMAL
182513 FA 100/70 - NORMAL
221523 FA 100/70 - NORMAL
181638 FA 110/80 - NORMAL
222336 FA 100/70 - NORMAL
141511 PIC 110/80 - NORMAL
182541 FO 120/80 - NORMAL
151303 SFA 110/70 - NORMAL
193610 FA 100/80 - NORMAL
191673 FA 100/70 - NORMAL
220161 FA 110/70 - NORMAL
194197 FA 100/70 - NORMAL
52094826 PIC 120/80 - NORMAL
140013 FO 120/80 - NORMAL
151034 SFA 100/70 - NORMAL
182520 FA 100/70 - NORMAL
201681 FA 110/70 - NORMAL
193329 FA 110/70 - NORMAL
183059 FA 110/70 - NORMAL
62092772 PIC 110/70 - NORMAL
201530 FO 120/80 - NORMAL
170235 SFA 110/70 - NORMAL
191990 FA 110/70 - NORMAL
191668 FA 110/70 - NORMAL
212038 FA 100/80 - NORMAL
191677 FA 100/70 - NORMAL
52062733 PIC 120/80 - NORMAL
151718 FO 120/80 - NORMAL
170352 SFA 100/80 - NORMAL
151420 FA 110/70 - NORMAL
193862 FA 110/70 - NORMAL
200752 FA 100/70 - NORMAL
212031 FA 110/70 - NORMAL
160628 PIC 120/80 - NORMAL
171626 FO 120/80 - NORMAL
151805 SFA 110/70 - NORMAL
191981 FA 110/80 - NORMAL
191669 FA 100/80 - NORMAL
213198 FA 110/80 - NORMAL
193627 FA 120/80 - NORMAL
142530 PIC 120/80 - NORMAL
180897 FO 120/80 - NORMAL
151635 SFA 110/70 - NORMAL
221523 FA 100/70 - NORMAL
173034 FA 110/70 - NORMAL
201785 FA 100/70 - NORMAL
180999 FA 100/80 - NORMAL
151210 PIC 120/70 - NORMAL
170250 FO 120/80 - NORMAL
143078 SFA 110/70 - NORMAL
151409 FA 100/70 - NORMAL
163379 FA 100/80 - NORMAL
170611 FA 110/70 - NORMAL
191998 FA 110/70 - NORMAL
131783 PIC 120/80 - NORMAL
190481 FO 110/80 - NORMAL
150819 SFA 110/70 - NORMAL
171819 FA 100/80 - NORMAL
170779 FA 100/70 - NORMAL
220161 FA 100/70 - NORMAL
221523 FA 110/70 - NORMAL
131782 PIC 120/80 - NORMAL
146849 FO 110/80 - NORMAL
141470 SFA 120/80 - NORMAL
182307 FO 100/70 - NORMAL
173670 FA 110/80 - NORMAL
172631 FA 110/70 - NORMAL
222185 FA 120/80 - NORMAL
192119 FA 110/80 - NORMAL
151946 PIC 110/70 - NORMAL
200947 FO 120/80 - NORMAL
148335 SFA 110/80 - NORMAL
193320 FA 110/70 - NORMAL
193608 FA 110/80 - NORMAL
200049 FA 100/70 - NORMAL
193617 FA 110/80 - NORMAL
143482 PIC 120/80 - NORMAL
201541 FO 110/70 - NORMAL
162823 SFA 110/80 - NORMAL
182015 FA 100/80 - NORMAL
200754 FA 120/80 - NORMAL
213209 FA 100/70 - NORMAL
200695 FA 100/70 - NORMAL
52094826 PIC 130/80 - PREHIPERTENSI
212899 FO 120/80 - NORMAL
200915 SFA 110/70 - NORMAL
160389 FA 110/80 - NORMAL
171393 FA 100/80 - NORMAL
192120 FA 100/70 - NORMAL
201784 FA 110/70 - NORMAL
131993 PIC 120/80 - NORMAL
200278 FO 120/80 - NORMAL
151303 SFA 110/70 - NORMAL
180645 FA 100/70 - NORMAL
192113 FA 110/80 - NORMAL
201681 FA 110/70 - NORMAL
201797 FA 100/70 - NORMAL
52127459 PIC 120/80 - NORMAL
200950 FO 120/70 - NORMAL
150435 SFA 110/80 - NORMAL
171487 FA 100/70 - NORMAL
181643 FA 110/70 - NORMAL
181656 FA 100/70 - NORMAL
200695 FA 120/80 - NORMAL
151210 PIC 120/80 - NORMAL
180995 FO 110/80 - NORMAL
200643 SFA 100/70 - NORMAL
201792 FA 110/80 - NORMAL
213195 FA 120/80 - NORMAL
220696 FA 110/70 - NORMAL
201902 FA 110/80 - NORMAL
153294 PIC 120/80 - NORMAL
190490 FO 120/80 - NORMAL
162414 SFA 110/80 - NORMAL
184698 FA 100/70 - NORMAL
182726 FA 110/70 - NORMAL
201568 FA 100/70 - NORMAL
193952 FA 110/70 - NORMAL
147158 PIC 110/70 - NORMAL
201107 FO 120/80 - NORMAL
163374 SFA 110/70 - NORMAL
192002 FA 100/70 - NORMAL
201785 FA 100/70 - NORMAL
213026 FA 120/80 - NORMAL
220408 FA 120/80 - NORMAL
147219 PIC 120/80 - NORMAL
201612 FO 120/70 - NORMAL
140544 SFA 110/70 - NORMAL
151637 FA 110/70 - NORMAL
192120 FA 100/70 - NORMAL
212537 FA 110/70 - NORMAL
213240 FA 120/70 - NORMAL
172963 PIC 120/80 NORMAL
200278 FO 120/80 - NORMAL
154951 SFA 100/70 - NORMAL
221525 FA 100/70 - NORMAL
220701 FA 110/70 - NORMAL
220396 FA 110/70 - NORMAL
193955 FA 110/70 - NORMAL
146334 PIC 120/80 - NORMAL
200950 FO 110/80 - NORMAL
200643 SFA 120/70 - NORMAL
183752 FA 100/80 - NORMAL
193937 FA 110/80 - NORMAL
200694 FA 100/70 - NORMAL
212340 FA 100/70 - NORMAL
143468 PIC 110/80 - NORMAL
171629 FO 110/70 - NORMAL
52127233 SFA 110/70 - NORMAL
193323 FA 110/80 - NORMAL
201687 FA 100/70 - NORMAL
201917 FA 120/80 - NORMAL
222182 FA 120/80 - NORMAL
147158 PIC 110/70 - NORMAL
171897 FO 120/80 - NORMAL
163374 SFA 110/80 - NORMAL
193330 FA 100/80 - NORMAL
193950 FA 110/80 - NORMAL
200749 FA 100/80 - NORMAL
193852 FA 110/70 - NORMAL
142232 PIC 120/80 - NORMAL
192729 FO 110/80 - NORMAL
162821 SFA 110/70 - NORMAL
172617 FA 120/80 - NORMAL
221518 FA 120/80 - NORMAL
181325 FA 110/70 - NORMAL
193044 FA 120/80 - NORMAL
201601 FO 120/80 - NORMAL
162838 SFA 110/80 - NORMAL
181015 FA 100/70 - NORMAL
181009 FA 110/70 - NORMAL
193607 FA 110/70 - NORMAL
192120 FA 100/80 - NORMAL
141511 PIC 120/80 - NORMAL
160425 FO 130/90 - PREHIPERTENSI
141470 SFA 110/70 - NORMAL
171407 FA 100/70 - NORMAL
201680 FA 110/80 - NORMAL
201919 FA 100/70 - NORMAL
194211 FA 110/70 - NORMAL
Remaks Time Nurse on Duty
FIT 06.50 WIB DINI AYU PERMATA SARI S.Tr.Keb

FIT 06.50 WIB BELLA YOLANDIA SARI S.Tr.Keb
TOTAL PILOT FA EOB

GRAND TOTAL
TOTAL PILOT FA EOB

GRAND TOTAL
TOTAL PILOT FA EOB

NORMAL 58 150
HIPOTENSI 0 0
PRE HIPERTENSI 4 0
GRAND TOTAL

Remaks
Remaks
Remaks
MEDICAL EXAMINATION
AIRLINE : ID
DATE / MONTH : SEPTEMBER 2022
LOCATION : STA.
Total
No Date Maintenance
check
1 1-Oct-22 5 1 0 1 0 5 0 7
2 2-Oct-22 5 1 0 1 0 5 0 7
3 3-Oct-22 5 1 0 1 0 5 0 7
4 4-Oct-22 5 1 0 1 0 5 0 7
5 5-Oct-22 5 1 0 1 0 5 0 7
6 6-Oct-22 6 1 0 1 0 5 0 7
7 7-Oct-22 5 1 0 1 0 5 0 7
8 8-Oct-22 5 1 0 1 0 5 0 7
9 9-Oct-22 6 1 0 1 0 5 0 7
10 10-Oct-22 6 1 0 1 0 5 0 7
G
R
A
P
11 11-Oct-22 6 1 0 1 0 5 0 7
H
12 12-Oct-22 6 1 0 1 0 5 0 7
I
C
13 13-Oct-22 5 1 0 1 0 5 0 7
R
E
F
L
I
14 14-Oct-22 5 1 0 1 0 5 0 7
G
H
T 15 15-Oct-22 5 1 0 1 0 5 0 7
H
E
A
L
16 16-Oct-22 6 1 0 1 0 5 0 7
T
H
C
17 17-Oct-22 5 1 0 1 0 5 0 7
H
18 18-Oct-22 5 1 0 1 0 5 0 7
E
C
K
A
T
S
19 19-Oct-22 6 1 0 1 0 5 0 7
T
A
. 20 20-Oct-22 6 1 0 1 0 5 0 7
C
G
K 21 21-Oct-22 7 1 0 1 0 5 0 7
D
U
R
I
22 22-Oct-22 6 1 0 1 0 5 0 7
N
23 23-Oct-22 6 1 0 1 0 5 0 7
G
A
P
R
I
L 24 24-Oct-22 6 2 0 2 0 10 0 14
2
0
2
2
25 25-Oct-22 6 2 0 2 0 10 0 14
26 26-Oct-22 7 2 0 2 0 10 0 14
27 27-Oct-22 6 2 0 2 0 10 0 14
28 28-Oct-22 6 2 0 2 0 10 0 14
29 29-Oct-22 6 2 0 2 0 10 0 14
30 30-Oct-22 6 2 0 2 0 10 0 14
31 31-Oct-22 6 2 0 2 0 10 0 14
TOTAL 176 39 0 39 0 195 0 273
y & Quality
MINATION
LTH CHECK LIST
NURSE
PAGI

D
D
D FLIGHT PIC SIC
B 176 39 39
B
B
D 12000
D
B 10000
B
B 8000
D
6000
D
D
4000
B
B 2000
B
D 0
FLIGHT PIC SIC
D
D
B
B
B
D
D
D
FA MAINTENANCE
195 273
Safe
Flight
No Date Name
Number
1 10/1/2022 ID 6711 FEBRI KURNIAWAN
3 10/1/2022 ID 6711 DIAN ANDRIYANTI HIDAYAT
4 10/1/2022 ID 6711 OCTA ERNANDA
5 10/1/2022 ID 6711 SERI HELEN SIMANJUNTAK
6 10/1/2022 ID 6711 NIDAH ROSALINDA
7 10/1/2022 ID 6711 MUHAMAD RIZAL ZULKARNAIN
8 10/2/2022 ID 6711 IMAM SUSANTO
9 10/2/2022 ID 6711 IGNATIUS KUSMA SATRIA
10 10/2/2022 ID 6711 LARA PERMATA ANJELIANI
11 10/2/2022 ID 6711 SHOFI ADELIA PRAMESTI
12 10/2/2022 ID 6711 BETARI BAGJA PERSADA
13 10/2/2022 ID 6711 ADELYTA PRASETYONINGSIH
14 10/2/2022 ID 6711 YUDHA ASHARI
15 10/3/2022 ID 6711 TAUFAN AUSTRAMAN
16 10/3/2022 ID 6711 KEMAS MUHAMMAD FATUR RAHMANDA GIOVANNI
17 10/3/2022 ID 6711 AYU SETIANA
18 10/3/2022 ID 6711 UNESI SEKAR EDITYA
19 10/3/2022 ID 6711 JESIKA LINDSAY WAROUW
20 10/3/2022 ID 6711 LIA SULISTYANING PAMUNGKAS
21 10/3/2022 ID 6711 YULIYAN KRISTIYANTI
22 10/4/2022 ID 6711 BIDI SEMBADA
23 10/4/2022 ID 6711 DERRY YURHADI
24 10/4/2022 ID 6711 PUTU INTAN REZA ASTIKA AYU
25 10/4/2022 ID 6711 VIOLA MONALISA
26 10/4/2022 ID 6711 VINA RAHMA DIANTI
27 10/4/2022 ID 6711 NITA MULYASARI
28 10/4/2022 ID 6711 SELY SETIAWATI
30 10/5/2022 ID 6711 MUHAMMAD HADI NUGROHO
31 10/5/2022 ID 6711 NI PUTU RAHMA ALVIONITA
33 10/5/2022 ID 6711 HERAWATI NUR WAHYUNI
34 10/5/2022 ID 6711 RAIHANI NURFATHIN ARIEDI
35 10/5/2022 ID 6711 JANUBA AZ ZAHRA PUTRI
36 10/6/2022 ID 6711 TAUFAN AUSTRAMAN
37 10/6/2022 ID 6711 ERDI RACHMEIDI
38 10/6/2022 ID 6711 WELDA PUSPITA
39 10/6/2022 ID 6711 NOOR AHDIANTI
40 10/6/2022 ID 6711 LIVIA ANGGRAINI
41 10/6/2022 ID 6711 SELY SETIAWATI
42 10/6/2022 ID 6711 SARAH MEYSITA SALMAN
43 07/010/2022 ID 6711 MUHAMMAD RIFQY NUZA
44 07/010/2022 ID 6711 HANIF HUZAIRI PUTRA
45 07/010/2022 ID 6711 DEVITA SARI
46 07/010/2022 ID 6711 SISKA NATALIANA PANDIANGAN
47 07/010/2022 ID 6711 BERLIAN FEBRIYANA LOVEZ
48 07/010/2022 ID 6711 LIYA SURYANI
49 07/010/2022 ID 6711 AJENG NOVI YANI SARI FAUZIAH
50 10/8/2022 ID 6711 ARIF HIDAYAT
51 10/8/2022 ID 6711 IGNATIUS KUSMA SATRIA
52 10/8/2022 ID 6711 PRATIWI PUJI LESTARI
53 10/8/2022 ID 6711 PRATIWI KARISMA
54 10/8/2022 ID 6711 FRIZILIA PUTRI FIRANA
55 10/8/2022 ID 6711 RIBKA CUSNY OKTAVIANY
56 10/8/2022 ID 6711 RANITA
57 10/9/2022 ID 6711 RUSTAM YUNUS
58 10/9/2022 ID 6711 MUHAMMAD ANDHIKA RACHMAN
59 10/9/2022 ID 6711 RR RAHMA TRI AGUSTINI
62 10/9/2022 ID 6711 SELLYNA DAFAA PUTRI
63 10/9/2022 ID 6711 ANNA AYU OKTAVIA
64 10/10/2022 ID 6711 BENJAMIN PERKASA NATAWARDAJA
65 10/10/2022 ID 6711 SAMUDRA FADHIL ISKANDAR
66 10/10/2022 ID 6711 RATNA SARI
67 10/10/2022 ID 6711 DENNISA SUKMA
68 10/10/2022 ID 6711 NUR FEBRINALDA SYAFRI
69 10/10/2022 ID 6711 TARYSHA FITRIA SUGANDI
70 10/10/2022 ID 6711 PRABU AIRLANGGA BHARATA SURYA
71 10/11/2022 ID 6711 KESOWO HARKAV JUNIANTO
72 10/11/2022 ID 6711 DHEAVISA PUTRA MANDALA
73 10/11/2022 ID 6711 DHIAN INDAHSARI
74 10/11/2022 ID 6711 NURUL JANAH
75 10/11/2022 ID 6711 KUSMIATI
76 10/11/2022 ID 6711 RIZKI AMANDA PUTRI
77 10/11/2022 ID 6711 FENIKA
78 10/12/2022 ID 6711 M DHIKI FIRMANSYAH
80 10/12/2022 ID 6711 ABDUL AZIS
81 10/12/2022 ID 6711 DIAH CANDRA RINI
82 10/12/2022 ID 6711 AUGUSTA CITRA KIRANA
83 10/12/2022 ID 6711 ROHMAH AZIZAH
84 10/12/2022 ID 6711 TIYAS UNGGUL PALUPI
85 10/13/2022 ID 6711 THEODORES EKO RACHMATDIONO
86 10/13/2022 ID 6711 M GATRA ASENA HIKMANA
87 10/13/2022 ID 6711 NANDA NIDYA
88 10/13/2022 ID 6711 NINGKA NELINDA AMELIA
89 10/13/2022 ID 6711 ANA NURJANA
90 10/13/2022 ID 6711 NIKO SATYA PRADANA
91 10/13/2022 ID 6711 TITAH PRAMESTI WULANDARI
92 10/14/2022 ID 6711 IMAM SUSANTO
93 10/14/2022 ID 6711 YOHANES PANDU JATMIKO
94 10/14/2022 ID 6711 SEPTI PUTRI ARINI
95 10/14/2022 ID 6711 BETARI BAGJA PERSADA
96 10/14/2022 ID 6711 YESSICA DEWI NATHALY
97 10/14/2022 ID 6711 HENY WULANDARI
98 10/14/2022 ID 6711 KEZIA NOPELIA TARIGAN
99 10/15/2022 ID 6711 ARIF HIDAYAT
100 10/15/2022 ID 6711 VICTOR IMANUEL MAWIKERE
101 10/15/2022 ID 6711 ANINDYA PUTRI
102 10/15/2022 ID 6711 ANISA HIDIR
103 10/15/2022 ID 6711 NI KOMANG SRI PUSPASARI
104 10/15/2022 ID 6711 NI NYOMAN BELLA SINTHYA
105 10/15/2022 ID 6711 DIAZ SANDRA DENISSA
108 10/16/2022 ID 6711 PITIN PEBRI LESTARI
109 10/16/2022 ID 6711 I GUSTI AYU PUTRI WULANDARI
110 10/16/2022 ID 6711 DIAH AYU WULAN INDARI
111 10/16/2022 ID 6711 DELA AYU LARASATI
112 10/16/2022 ID 6711 FATHIAH NUR ANDINI
113 10/17/2022 ID 6711 MUHAMMAD ALVIN AKBAR
114 10/17/2022 ID 6711 MELVIN ARTHUR RISNANTHA
115 10/17/2022 ID 6711 MELISA FEBRIATI
117 10/17/2022 ID 6711 DESI ALFITRI NATALIA ASRI
118 10/17/2022 ID 6711 SAIRAH SAVAIRAH ANSORI
119 10/17/2022 ID 6711 NI MADE ARINA DWI PUTRI
120 10/18/2022 ID 6711 SRI HANANDYO ERSAL
121 10/18/2022 ID 6711 DANIEL F J WONGSOADMODJO
122 10/18/2022 ID 6711 ADINDA PRAWITA
123 10/18/2022 ID 6711 RIKA SEPTIA RAHMASARI
124 10/18/2022 ID 6711 AQDA ANDELLA
125 10/18/2022 ID 6711 NOVIANI
126 10/18/2022 ID 6711 M GHIBRAN AL RAJIB ARON
127 10/19/2022 ID 6711 ANDIKA DWITYA
129 10/19/2022 ID 6711 DIKA DWI ASTUTI
130 10/19/2022 ID 6711 AYA CHANDRA
131 10/19/2022 ID 6711 IZZA AINUN NISA NUR ROHMAH
132 10/19/2022 ID 6711 RAKHA SIWI CAHYA PEROSITA SARI
134 10/20/2022 ID 6711 BHAGAVATGITA RAHARDIAN F
136 10/20/2022 ID 6711 NURUL AWALIA RAMADHANI
137 10/20/2022 ID 6711 REGITTA FATMAWATI OCKTARINA
138 10/20/2022 ID 6711 SAHARA SYALWA ANDINA
139 10/20/2022 ID 6711 CINDI MEISTRI WIDIYANTI
140 10/20/2022 ID 6711 ADELINE OLIVIA RAPANG
141 10/21/2022 ID 6711 LUCKY ORISTIADI
142 10/21/2022 ID 6711 REZA SIDIQ PRASETYA
143 10/21/2022 ID 6711 AGNES MIRA KUSUMA WARDANI
144 10/21/2022 ID 6711 YUNIKA SRI ENDAH LESTARI
145 10/21/2022 ID 6711 KIKIET TEGUH SEPTARIANTO
146 10/21/2022 ID 6711 KHOIRUN NISA INTAN ALKUBRO
147 10/21/2022 ID 6711 DETARIA CRISTIN BR TAMBUNAN
148 10/22/2022 ID 6711 ARI PRIYATMOKO
150 10/22/2022 ID 6711 NISA AZKA KHOURANI
152 10/22/2022 ID 6711 CLARA JESSICA
153 10/22/2022 ID 6711 ANISHA FARLIANI
154 10/22/2022 ID 6711 AFIFAH SHAFIYAH KOMARAWANTI
155 10/23/2022 ID 6711 MEGAH PUTRA PERKASA
156 10/23/2022 ID 6711 MAS BIMANTYO SAMPOERNO
157 10/23/2022 ID 6711 KIKI KUMALA SARI
158 10/23/2022 ID 6711 LIKE APRILIA
159 10/23/2022 ID 6711 JULIA TASYA DERINA
160 10/23/2022 ID 6711 WILLIAM AK
161 10/23/2022 ID 6711 RANITA
163 10/24/2022 ID 6711 YAHYA ALAYDROES
164 10/24/2022 ID 6711 LARA PERMATA ANJELIANI
165 10/24/2022 ID 6711 ADE FINA NURAFIAH
166 10/24/2022 ID 6711 DIAN IRMAWATY
167 10/24/2022 ID 6711 DWI KIRANA
168 10/24/2022 ID 6711 SYAVUNG INRI MAMAHIT
169 10/24/2022 ID 6717 NOVAN KURNIAWAN
170 10/24/2022 ID 6717 JOHN VICTOR OSIPATAR SITUNGKIR
171 10/24/2022 ID 6717 MELISA FEBRIATI
172 10/24/2022 ID 6717 YOLANDA LISYANA PADILAH
174 10/24/2022 ID 6717 FIFI YUNITA SARI
175 10/24/2022 ID 6717 ICHA FRAMUHTY EFENDY
176 10/25/2022 ID 6711 HARDY RATNA TRIDARTA
178 10/25/2022 ID 6711 SYARIFAH SARI DEWI YURI A
179 10/25/2022 ID 6711 ANDHINI NINDYA PUTRI
180 10/25/2022 ID 6711 AYU MAYURA
181 10/25/2022 ID 6711 AYU APRILIA
183 10/25/2022 ID 6113 BIDI SEMBADA
184 10/25/2022 ID 6113 DIO MAULANA PUTRA
186 10/25/2022 ID 6113 DENI SAFITRI
187 10/25/2022 ID 6113 DHEA AMALIA SAFITRI
188 10/25/2022 ID 6113 BUDI PAMUNGKAS
189 10/25/2022 ID 6113 ANNA AYU OKTAVIA
192 10/26/2022 ID 6711 DINI ARISTA
194 10/26/2022 ID 6711 GHINA RIZQYAMALIA
195 10/26/2022 ID 6711 FHRISKA NAZULMA PUTRI
196 10/26/2022 ID 6711 DIFI AYUNING PALUPI
197 10/26/2022 ID 6113 AGUSTA HEDDI ZULKARNAEN
198 10/26/2022 ID 6113 DANDI PRIMA OKTARINO
199 10/26/2022 ID 6113 ELYSIA MARIA
201 10/26/2022 ID 6113 ELIN ERFANDA SARI
202 10/26/2022 ID 6113 NIKMATUL AIDHA PUTRI EDI
205 10/27/2022 ID 6113 IRWAN KURNIAWAN
206 10/27/2022 ID 6113 ANES AYU THEFANY
207 10/27/2022 ID 6113 MARSHANDA GITA CAROLINA
208 10/27/2022 ID 6113 FIKI NOVITALIA
209 10/27/2022 ID 6113 RICCO RUKANDAHADI SAPUTRA
210 10/27/2022 ID 6113 BUDI DARMAWAN
211 10/27/2022 ID 6711 SENDY IZAZI DIVIA
212 10/27/2022 ID 6711 HASBI SYAHABUDIN HANAFI
214 10/27/2022 ID 6711 DIANA SETYOWATI
215 10/27/2022 ID 6711 PUTRI NADIA
216 10/27/2022 ID 6711 DIERGHA BUANA SAKTI
217 10/27/2022 ID 6711 EINSTEINDORO KLEBOS SALSABILA
218 28-Oct-2022 ID 6717 ALBERTUS BUDI PRASETYO
219 28-Oct-2022 ID 6717 REZA SIDIQ PRASETYA
220 28-Oct-2022 ID 6717 NANDA LIA AHMAD
221 28-Oct-2022 ID 6717 GLADY LIYANA DEWI
222 28-Oct-2022 ID 6717 PUTRI AYU TIRTO KENCONO
223 28-Oct-2022 ID 6717 RIZA MAULIA
224 28-Oct-2022 ID 6717 ANNA AYU OKTAVIA
225 28-Oct-2022 ID 6711 SENDY IZAZI DIVIA
226 28-Oct-2022 ID 6711 HASBI SYAHABUDIN HANAFI
227 28-Oct-2022 ID 6711 RR RAHMA TRI AGUSTINI
228 28-Oct-2022 ID 6711 DIANA SETYOWATI
229 28-Oct-2022 ID 6711 PUTRI NADIA
230 28-Oct-2022 ID 6711 DIERGHA BUANA SAKTI
231 28-Oct-2022 ID 6711 EINSTEINDORO KLEBOS SALSABILA
232 29-Oct-2022 ID 6711 LUCKY ORISTIADI
233 29-Oct-2022 ID 6711 BIMANTORO
234 29-Oct-2022 ID 6711 TANTRI NIRMALASARI PUTRI
235 29-Oct-2022 ID 6711 ANNISA ANASTHASYA
236 29-Oct-2022 ID 6711 ASFIAH FANANI
237 29-Oct-2022 ID 6711 ADHIKA RANGGA NOVERIA
238 29-Oct-2022 ID 6711 SUCI WULANDARI
239 29-Oct-2022 ID 6113 RAHADHIAN ARGA KUSUMA
240 29-Oct-2022 ID 6113 MARTHEN MATHEIS DONALD MUGUJAI
241 29-Oct-2022 ID 6113 SERVINDA APRILIA
242 29-Oct-2022 ID 6113 FATMA KHARISMA WULANDARI
243 29-Oct-2022 ID 6113 INTANIA PERMATA SARI
244 29-Oct-2022 ID 6113 GREACE MAY ANGEL SIANTURI
245 29-Oct-2022 ID 6113 DESAK MADE NATASYA
246 30-Oct-2022 ID 6711 I KADEK DWI ATMAJA
247 30-Oct-2022 ID 6711 RIAN FAHMI PANJAITAN
248 30-Oct-2022 ID 6711 GALUH PERMATA SARI
249 30-Oct-2022 ID 6711 AYU APRILIA
250 30-Oct-2022 ID 6711 DETARIA CRISTIN BR TAMBUNAN
251 30-Oct-2022 ID 6711 NILA NOVIANTIKA PUTRI
252 30-Oct-2022 ID 6711
253 30-Oct-2022 ID 6113 HARDY RATNA TRIDARTA
254 30-Oct-2022 ID 6113 YEHEZKIEL ASTONORWANDI
255 30-Oct-2022 ID 6113 DITA FEBRIANTI
256 30-Oct-2022 ID 6113 SARAH RAMADHANTY
257 30-Oct-2022 ID 6113 PUTRI NADIA
258 30-Oct-2022 ID 6113 CHRISTIE
259 30-Oct-2022 ID 6113 KENNOLDY SEPTIAN NURFIRDAUS
260 31-Oct-2022 ID 6711 RUSTAM YUNUS
261 31-Oct-2022 ID 6711 GARI REVA WAHYU SETIAWAN
262 31-Oct-2022 ID 6711 ISNENIA VEGA H
263 31-Oct-2022 ID 6711 SHEREN XENA LEVINA MAMBO
264 31-Oct-2022 ID 6711 LAMTIUR KRISTINA BR SITANGGANG
265 31-Oct-2022 ID 6711 SUCI WULANDARI
266 31-Oct-2022 ID 6711 AFIFAH SHAFIYAH KOMARAWANTI
267 31-Oct-2022 ID 6113 MUHAMMAD FEBRIANSYAH
268 31-Oct-2022 ID 6113 IRWAN KURNIAWAN
269 31-Oct-2022 ID 6113 BUDIYANTI
270 31-Oct-2022 ID 6113 DIAH AYU WULAN INDARI
271 31-Oct-2022 ID 6113 JESIKA RUDIANTI
272 31-Oct-2022 ID 6113 MARTA ANGGRAINI MARIA
273 31-Oct-2022 ID 6113 RESTIFANI WULAN RAHIMA
274
275
276
277
278
279
280
281
282
283
284
285
286
287
288
289
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291
292
293
294
295
296
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299
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301
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305
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310
311
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313
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320
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329
330
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333
334
335
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338
339
340
341
342
343
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345
346
347
348
349
350
351
352
353
354
355
356
357
358
359
360
361
362
363
364
365
366
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398
399
400
401
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403
404
405
406
407
408
MEDICAL EXAMINATION
Blood
Pressure
133022 PIC 120/80 - NORMAL

182541 FO 120/80 - NORMAL
143144 SFA 110/70 - NORMAL
212033 FA 100/70 - NORMAL
191995 FA 100/70 - NORMAL
211850 FA 100/70 - NORMAL
220404 FA 100/70 - NORMAL
62092821 PIC 130/80 - NORMAL
153808 FO 120/80 - NORMAL
170349 SFA 110/70 - NORMAL
171761 FA 110/80 - NORMAL
183769 FA 100/80 - NORMAL
212589 FA 110/70 - NORMAL
220411 FA 120/80 - NORMAL
144679 PIC 120/80 - NORMAL
190483 FO 120/70 - NORMAL
133559 SFA 110/70 - NORMAL
170768 FA 100/80 - NORMAL
181636 FA 110/70 - NORMAL
212606 FA 100/70 - NORMAL
212039 FA 100/80 - NORMAL
144382 PIC 110/80 - NORMAL
135746 FO 120/80 - NORMAL
161440 SFA 110/710 - NORMAL
182724 FA 100/80 - NORMAL
193052 FA 110/80 - NORMAL
212609 FA 110/70 - NORMAL
191993 FA 100/70 - NORMAL
147158 PIC 120/70 - NORMAL
182539 FO 120/80 - NORMAL
151273 SFA 100/70 - NORMAL
182726 FA 110/70 - NORMAL
193939 FA 100/70 - NORMAL
212041 FA 110/80 - NORMAL
222485 FA 100/70 - NORMAL
144679 PIC 110/80 - NORMAL
212899 FO 120/70 - NORMAL
146812 SFA 110/70 - NORMAL
172257 FA 110/70 - NORMAL
184686 FA 100/80 - NORMAL
191993 FA 100/70 - NORMAL
201693 FA 100/70 - NORMAL
52115981 PIC 110/80 - NORMAL
180310 FO 120/80 - NORMAL
144711 SFA 100/70 - NORMAL
191679 FA 110/70 - NORMAL
193610 FA 100/80 - NORMAL
184702 FA 110/70 - NORMAL
201910 FA 100/70 - NORMAL
146213 PIC 120/80 - NORMAL
153808 FO 110/80 - NORMAL
146360 SFA 110/70 - NORMAL
200694 FA 100/80 - NORMAL
212026 FA 110/70 - NORMAL
222181 FA 100/80 - NORMAL
222647 FA 110/70 - NORMAL
162915 PIC 110/70 - NORMAL
181243 FO 120/80 - NORMAL
162834 SFA 110/80 - NORMAL
193862 FA 100/70 - NORMAL
194197 FA 110/80 - NORMAL
201688 FA 110/70 - NORMAL
222488 FA 100/70 - NORMAL
52040296 PIC 120/80 - NORMAL
184753 FO 120/80 - NORMAL
181324 SFA 110/70 - NORMAL
170759 FA 100/70 - NORMAL
183045 FA 100/70 - NORMAL
201908 FA 110/80 - NORMAL
212825 FA 110/70 - NORMAL
142232 PIC 120/80 - NORMAL
151950 FO 120/70 - NORMAL
162604 SFA 110/70 - NORMAL
184700 FA 110/80 - NORMAL
184698 FA 100/70 - NORMAL
193853 FA 110/70 - NORMAL
200044 FA 110/70 - NORMAL
172873 PIC 120/80 - NORMAL
200947 FO 120/80 - NORMAL
52105427 SFA 120/80 - NORMAL
170512 FA 100/70 - NORMAL
181007 FA 110/70 - NORMAL
182015 FA 110/70 - NORMAL
222478 FA 100/80 - NORMAL
52040294 PIC 120/80 - NORMAL
200277 FO 120/80 - NORMAL
52083642 SFA 100/70 - NORMAL
180636 FA 110/70 - NORMAL
183054 FA 100/70 - NORMAL
213273 FA 120/70 - NORMAL
222651 FA 100/80 - NORMAL
62092821 PIC 120/80 - NORMAL
171897 FO 110/70 - NORMAL
144173 SFA 110/70 - NORMAL
183769 FA 100/80 - NORMAL
191674 FA 100/70 - NORMAL
201682 FA 110/70 - NORMAL
220163 FA 110/70 - NORMAL
146213 PIC 110/70 - NORMAL
184709 FO 120/80 - NORMAL
161692 SFA 110/80 - NORMAL
182515 FA 110/80 - NORMAL
182010 FA 100/70 - NORMAL
191002 FA 110/70 - NORMAL
201915 FA 100/70 - NORMAL
131783 PIC 100/80 - NORMAL
200947 FO 110/80 - NORMAL
163068 SFA 100/70 - NORMAL
193336 FA 110/70 - NORMAL
193857 FA 100/80 - NORMAL
201913 FA 110/70 - NORMAL
222188 FA 110/70 - NORMAL
150696 PIC 120/70 - NORMAL
180364 FO 120/80 - NORMAL
161695 SFA 100/70 - NORMAL
171819 FA 100/70 - NORMAL
201914 FA 110/70 - NORMAL
212036 FA 110/70 - NORMAL
212535 FA 100/70 - NORMAL
143063 PIC 120/80 - NORMAL
201606 FO 120/70 - NORMAL
154965 SFA 110/80 - NORMAL
181656 FA 100/70 - NORMAL
194195 FA 110/70 - NORMAL
221526 FA 110/80 - NORMAL
222179 FA 100/80 - NORMAL
52127459 PIC 110/80 - NORMAL
200278 FO 120/80 - NORMAL
160377 SFA 110/80 - NORMAL
201689 FA 110/80 - NORMAL
222338 FA 100/70 - NORMAL
192121 FA 110/70 - NORMAL
201784 FA 100/70 - NORMAL
131779 PIC 120/80 - NORMAL
201541 FO 120/80 - NORMAL
170230 SFA 110/70 - NORMAL
181001 FA 100/70 - NORMAL
193330 FA 110/80 - NORMAL
201680 FA 110/70 - NORMAL
211847 FA 100/70 - NORMAL
142231 PIC 120/80 - NORMAL
201106 FO 110/70 - NORMAL
152082 SFA 110/80 - NORMAL
181316 FA 110/70 - NORMAL
194189 FA 120/80 - NORMAL
200707 FA 110/70 - NORMAL
200443 FA 100/80 - NORMAL
160893 PIC 120/80 - NORMAL
180310 FO 120/80 - NORMAL
170501 SFA 110/70 - NORMAL
212589 FA 110/80 - NORMAL
193334 FA 110/70 - NORMAL
212327 FA 110/80 - NORMAL
222336 FA 110/80 - NORMAL
151661 PIC 120/80 - NORMAL
190602 FO 120/80 - NORMAL
153030 SFA 110/70 - NORMAL
182513 FA 100/70 - NORMAL
191678 FA 110/70 - NORMAL
222182 FA 110/70 - NORMAL
222647 FA 100/70 - NORMAL
150696 PIC 120/80 - NORMAL
200959 FO 120/80 NORMAL
170349 SFA 100/70 - NORMAL
162836 FA 100/70 - NORMAL
201255 FA 100/80 - NORMAL
200702 FA 100/70 - NORMAL
201687 FA 110/70 - NORMAL
143750 PIC 120/80 - NORMAL
201610 FO 120/80 - NORMAL
161695 SFA 110/70 - NORMAL
180999 FA 110/70 - NORMAL
201797 FA 100/80 - NORMAL
212025 FA 100/70 - NORMAL
222180 FA 110/70 - NORMAL
133020 PIC 120/70 - NORMAL
200277 FO 120/80 - NORMAL
147224 SFA 100/70 - NORMAL
182731 FA 100/70 - NORMAL
193329 FA 100/80 - NORMAL
193852 FA 110/70 - NORMAL
201792 FA 100/70 - NORMAL
144382 PIC 110/70 - NORMAL
172219 FO 120/80 - NORMAL
162414 SFA 110/80 - NORMAL
200697 FA 110/80 - NORMAL
201905 FA 100/70 - NORMAL
221518 FA 120/70 - NORMAL
222488 FA 100/80 - NORMAL
151210 PIC 120/70 - NORMAL
184348 FO 120/80 - NORMAL
154962 SFA 110/80 - NORMAL
193857 FA 110/70 - NORMAL
201909 FA 110/70 - NORMAL
201694 FA 100/70 - NORMAL
183073 FA 100/70 - NORMAL
143479 PIC 110/70 - NORMAL
192768 FO 120/80 - NORMAL
151038 SFA 110/70 - NORMAL
171819 FA 100/80 - NORMAL
193045 FA 100/80 - NORMAL
193860 FA 110/70 - NORMAL
222338 FA 110/70 - NORMAL
131779 PIC 110/80 - NORMAL
180960 FO 100/70 - NORMAL
151407 SFA 120/80 - NORMAL
212334 FA 120/70 - NORMAL
191981 FA 100/80 - NORMAL
213213 FA 110/80 - NORMAL
213195 FA 110/70 - NORMAL
146844 PIC 120/80 - NORMAL
160422 FO 120/80 - NORMAL
162834 SFA 110/70 - NORMAL
171489 FA 110/80 - NORMAL
183768 FA 120/80 - NORMAL
200642 FA 100/80 - NORMAL
222481 FA 110/80 - NORMAL
172963 PIC 120/70 - NORMAL
201106 FO 120/80 - NORMAL
160573 SFA 110/70 - NORMAL
201916 FA 100/70 - NORMAL
222487 FA 100/70 - NORMAL
222648 FA 110/80 - NORMAL
222488 FA 110/80 - NORMAL
146844 PIC 120/80 - NORMAL
160422 FO 110/70 - NORMAL
162834 SFA 110/80 - NORMAL
171489 FA 100/80 - NORMAL
183768 FA 110/70 - NORMAL
200642 FA 120/80 - NORMAL
222481 FA 110/70 - NORMAL
142231 PIC 120/80 - NORMAL
180897 FO 110/70 - NORMAL
163480 SFA 110/80 - NORMAL
211845 FA 120/70 - NORMAL
211846 FA 110/80 - NORMAL
222185 FA 100/70 - NORMAL
222650 FA 110/80 - NORMAL
153349 PIC 120/80 - NORMAL
201612 FO 110/80 - NORMAL
153020 SFA 100/70 - NORMAL
183762 FA 100/70 - NORMAL
200047 FA 100/80 - NORMAL
201562 FA 100/70 - NORMAL
220160 FA 110/70 - NORMAL
141499 PIC 120/80 - NORMAL
193023 FO 120/80 - NORMAL
162175 SFA 100/70 - NORMAL
193852 FA 110/70 - NORMAL
200443 FA 100/70 - NORMAL
213424 FA 110/70 - NORMAL
FA 100/70 - NORMAL
133020 PIC 120/80 - NORMAL
190484 FO 120/80 - NORMAL
172614 SFA 110/70 - NORMAL
181005 FA 100/70 - NORMAL
183768 FA 110/80 - NORMAL
213418 FA 110/70 - NORMAL
222483 FA 120/80 - NORMAL
162915 PIC 110/80 - NORMAL
182541 FO 120/70 - NORMAL
151628 SFA 100/70 - NORMAL
200456 FA 110/70 - NORMAL
213419 FA 110/70 - NORMAL
222650 FA 110/80 - NORMAL
222336 FA 100/80 - NORMAL
141511 PIC 110/80 - NORMAL
180960 FO 120/80 - NORMAL
201254 SFA 110/70 - NORMAL
193857 FA 110/80 - NORMAL
193862 FA 110/70 - NORMAL
200754 FA 100/70 - NORMAL
201919 FA 100/70 - NORMAL

TOTAL PILOT FA EOB

GRAND TOTAL
TOTAL PILOT FA EOB

GRAND TOTAL
TOTAL PILOT FA EOB

NORMAL 58 150
HIPOTENSI 0 0
PRE HIPERTENSI 4 0
GRAND TOTAL

Remaks
Remaks
Remaks
MEDICAL EXAMINATION
AIRLINE : ID
DATE / MONTH : NOVEMBER 2022
LOCATION : STA.
Total
No Date Maintenance
check
1 1-Nov-22 5 2 0 2 0 10 0 14
2 2-Nov-22 6 2 0 2 0 10 0 14
3 3-Nov-22 6 1 0 1 0 5 0 7
4 4-Nov-22 6 1 0 1 0 5 0 7
5 5-Nov-22 6 1 0 1 0 5 0 7
6 6-Nov-22 6 1 0 1 0 5 0 7
7 7-Nov-22 6 1 0 1 0 5 0 7
8 8-Nov-22 5 1 0 1 0 5 0 7
9 9-Nov-22 6 1 0 1 0 5 0 7
10 10-Nov-22 6 1 0 1 0 5 0 7
G
R
A
P
11 11-Nov-22 6 1 0 1 0 5 0 7
H
12 12-Nov-22 6 1 0 1 0 5 0 7
I
C
13 13-Nov-22 7 1 0 1 0 5 0 7
R
E
F
L
I
14 14-Nov-22 6 1 0 1 0 5 0 7
G
H
T 15 15-Nov-22 6 1 0 1 0 5 0 7
H
E
A
L
16 16-Nov-22 7 1 0 1 0 5 0 7
T
H
C
17 17-Nov-22 6 2 0 1 0 5 0 8
H
18 18-Nov-22 6 1 0 1 0 5 0 7
E
C
K
A
T
S
19 19-Nov-22 6 1 0 1 0 5 0 7
T
A
. 20 20-Nov-22 6 1 0 1 0 5 0 7
C
G
K 21 21-Nov-22 6 1 0 1 0 5 0 7
D
U
R
I
22 22-Nov-22 6 1 0 1 0 5 0 7
N
23 23-Nov-22 6 1 0 2 0 5 0 8
G
A
P
R
I
L 24 24-Nov-22 6 1 0 1 0 5 0 7
2
0
2
2
25 25-Nov-22 6 1 0 1 0 5 0 7
26 26-Nov-22 6 1 0 1 0 5 0 7
27 27-Nov-22 6 1 0 1 0 5 0 7
28 28-Nov-22 6 1 0 1 0 5 0 7
29 29-Nov-22 6 1 0 1 0 5 0 7
30 30-Nov-22 6 1 0 1 0 5 0 7
31
TOTAL 180 33 0 33 0 160 0 226
y & Quality
MINATION
LTH CHECK LIST
NURSE
PAGI
B 1 Total Crew on Flight Duty 187

D 4 Total Crew Not Checked (PIC, SIC, and FA) 0
D
D
B FLIGHT PIC SIC
B 180 33 33
B
D
D 12000
B
B 10000
B
D 8000
D
6000
D
B
4000
B
B 2000
D
D 0
FLIGHT PIC SIC
D
B
B
B
D
D
D
FA MAINTENANCE
160 226
Safe
Flight
No Date Name
Number
1 11/1/2022 ID 6711 DIMAS AGUNG SUGIATMA
2 11/1/2022 ID 6711 KRESNA WIDYA KENCANA
3 11/1/2022 ID 6711 NI PUTU RAHMA ALVIONITA
4 11/1/2022 ID 6711 REPUBLIKA TUNGGA DEWI
5 11/1/2022 ID 6711 DELVIA RESTU KHORINA
6 11/1/2022 ID 6711 SITI MULYANI
7 11/1/2022 ID 6711 PUTU TANIA SARASWATI OKA P
8 11/1/2022 ID 6713 HENGKY STENLY EVERLY LOLOWANG
9 11/1/2022 ID 6713 ALDOFINNO IMANUEL K M S
10 11/1/2022 ID 6713 MAISSY RARA PERMATASARI
11 11/1/2022 ID 6713 MIFTAHUL JANNAH
12 11/1/2022 ID 6713 SEPTY VELISTA PANGESTU
13 11/1/2022 ID 6713 ARUM ANINDITA
15 11/2/2022 ID 6711 RAHADHIAN ARGA KUSUMA
16 11/2/2022 ID 6711 ALEX TOHATTA
17 11/2/2022 ID 6711 DITA FEBRIANTI
19 11/2/2022 ID 6711 NIKMATUL AIDHA PUTRI EDI
20 11/2/2022 ID 6711 ZAFIQA AMALIA KUSUMA
21 11/2/2022 ID 6711 NOVIKA ARIYANTI
22 11/2/2022 ID 6113 I KADEK DWI ATMAJA
24 11/2/2022 ID 6113 RANA ALIFAH KHOIRUNNISA
25 11/2/2022 ID 6113 LUTFIAH NURJIHAN
26 11/2/2022 ID 6113 LIA SULISTYANING PAMUNGKAS
27 11/2/2022 ID 6113 SHINTA PUTRI AGUSTIEN
28 11/2/2022 ID 6113 MARSHANDA SIAGIAN
29 11/3/2022 ID 6711 ARRIE ADHITYA
30 11/3/2022 ID 6711 BACILIO BAGAS AUSTIN WIRADIKRAMA YUNANTO
31 11/3/2022 ID 6711 NI KADEK DWI PUSPAKA ANGGA PADMI
32 11/3/2022 ID 6711 ROMI FAIZAL
33 11/3/2022 ID 6711 APRILIA WULANSARI
34 11/3/2022 ID 6711 DINDA KAYLA ANANDA ZULMA
38 11/4/2022 ID 6711 ANGGI DWI SAPUTRO
39 11/4/2022 ID 6711 APRIL LIDYA YANTI NST
41 11/4/2022 ID 6711 ASFIAH FANANI
42 11/4/2022 ID 6711 I NYOMAN ALEXANDER
43 11/5/2022 ID 6711 ABDUL RAHMAN
44 11/5/2022 ID 6711 MARCHA BINTANG PERWIRA
45 11/5/2022 ID 6711 ANGGI ANGGRAENI
46 11/5/2022 ID 6711 LAURENTIA JUANITA SARASWATI
47 11/5/2022 ID 6711 KIFTIA
48 11/5/2022 ID 6711 MENAKSI PRISYLIA HAYATUN NUFUS
49 11/5/2022 ID 6711 VINNEZHA RORENZHA
50 11/6/2022 ID 6711 AD EGHI KRISTANTYO P
51 11/6/2022 ID 6711 GALANG GAGUNG PRAMONO A
53 11/6/2022 ID 6711 NOVIA ERMA SHANTY
54 11/6/2022 ID 6711 SISKA PRASETYA
55 11/6/2022 ID 6711 GEUBRINA TARI
56 11/6/2022 ID 6711 CLAUDIA ELISABETH DAMEYTA
57 11/7/2022 ID 6711 RAFAEL STEFAN LAWALATA
58 11/7/2022 ID 6711 ADITYA NUSA BASKORO
59 11/7/2022 ID 6711 NI MADE YULI PERMATA SARI
61 11/7/2022 ID 6711 THASYA AYU FEBRIANTY
63 11/7/2022 ID 6711 RARIN ANGGI ISMAYA
64 11/8/2022 ID 6711 MUHAMMAD FEBRIANSYAH
65 11/8/2022 ID 6711 FACHRY FERDINANSYAH
67 11/8/2022 ID 6711 LISA RINDI ANTIKA
68 11/8/2022 ID 6711 DINA MULYANI
70 11/8/2022 ID 6711 MUHAMMAD HERNAN RUSYDI
71 11/9/2022 ID 6711 RANDY WAHYUDI PUTRA
72 11/9/2022 ID 6711 RIAN FAHMI PANJAITAN
74 11/9/2022 ID 6711 SEKAR AYU CANDRANINGTYAS
75 11/9/2022 ID 6711 KUSMIATI
76 11/9/2022 ID 6711 AGATHA WAHYU PUTRI GUNAWAN
77 11/9/2022 ID 6711 SAVIRA QURROTA A YUNINA PITONO
79 11/10/2022 ID 6711 FAJAR PRAYOGA
81 11/10/2022 ID 6711 SELLYNA DAFAA PUTRI
84 11/10/2022 ID 6711 FARHAN ARRAZI
86 11/11/2022 ID 6711 MUHAMMAD IVAN OCTAVIAN ADAMY
87 11/11/2022 ID 6711 ABDUL AZIS
88 11/11/2022 ID 6711 HERVINA NUR AINI HANITA PUTRI
89 11/11/2022 ID 6711 YEHEZKIEL SONDAKH
90 11/11/2022 ID 6711 PUTRA BAGUS MAULANA
91 11/11/2022 ID 6711 MUHAMAD RIZAL ZULKARNAIN
92 11/12/2022 ID 6711 JASON
93 11/12/2022 ID 6711 GELDARAFI PERKASA
94 11/12/2022 ID 6711 ELYSIA MARIA
95 11/12/2022 ID 6711 TRI REJEKI WIDADA NINGSIH
96 11/12/2022 ID 6711 KOMANG ELDAYANI
97 11/12/2022 ID 6711 ANDHINI NINDYA PUTRI
99 11/13/2022 ID 6711 AJWAD SAID MAHMUD
100 11/13/2022 ID 6711 P RAKA PERING ADITYA KUMARA
102 11/13/2022 ID 6711 TENGKU RAHMAH LOPI
103 11/13/2022 ID 6711 PRABU AIRLANGGA BHARATA SURYA
104 11/13/2022 ID 6711 RIMA DEVIANI
105 11/13/2022 ID 6711 YAKUB TABIR MARPAUNG
106 11/14/2022 ID 6711 ANDIKA DWITYA
108 11/14/2022 ID 6711 R LINGGA ANDINI RAHAYU
110 11/14/2022 ID 6711 ELIN ERFANDA SARI
112 11/14/2022 ID 6711 GABRIEL MARIYA
115 11/15/2022 ID 6711 ADHEILLA INDRIANA ARDINA
116 11/15/2022 ID 6711 FATMA KHARISMA WULANDARI
118 11/15/2022 ID 6711 MD RICKY FERNANDO
120 11/16/2022 ID 6711 SYUKUR HANDAYA BARKA
121 11/16/2022 ID 6711 ERLANGGA ALISYAHBANA
123 11/16/2022 ID 6711 ALIFFIA NINDA ANGGRAINI
125 11/16/2022 ID 6711 DEWA AYU CINDY PRATIWI
126 11/16/2022 ID 6711 KEVIN SUSANTO
128 11/17/2022 ID 6711 WILDAN NAZRI ADLANI
129 11/17/2022 ID 6711 AGUNG MAHAGIRI SUGIRI
130 11/17/2022 ID 6711 FRIZELLA PUTRI ANGGELA
131 11/17/2022 ID 6711 YUAN MUSTIKA DEWI
132 11/17/2022 ID 6711 ERIENA OLIVIANTI
133 11/17/2022 ID 6711 KENINDU ANGRAINI
134 11/17/2022 ID 6711 EVA SOVIANA
135 11/18/2022 ID 6711 HENGKY STENLY EVERLY LOLOWANG
137 11/18/2022 ID 6711 AYU WULANSARI
138 11/18/2022 ID 6711 NURUL JANAH
141 11/18/2022 ID 6711 IRFAN FIRMANSYAH
142 11/19/2022 ID 6711 DWI ISWAHYUDI
143 11/19/2022 ID 6711 BRAMANTYO EKO PUTRO
144 11/19/2022 ID 6711 SRI WAHYUNI
146 11/19/2022 ID 6711 REGITA NUR INDAH PAULANI
147 11/19/2022 ID 6711 WETTI OKTAVIA
148 11/19/2022 ID 6711 GLADY LIYANA DEWI
149 11/20/2022 ID 6711 FARIS PURNAMA
150 11/20/2022 ID 6711 ABDULLAH BASKORO
151 11/20/2022 ID 6711 DEWI PARADIPA BR PERANGIN ANGIN
152 11/20/2022 ID 6711 SHEYLLA MELLANI
153 11/20/2022 ID 6711 GITA RAHMALIA
155 11/20/2022 ID 6711 EVA SOVIANA
157 11/21/2022 ID 6711 YOHANES PANDU JATMIKO
161 11/21/2022 ID 6711 NIMAS AYU KUMALA DEWI
162 11/21/2022 ID 6711 KUSMIATI
163 11/22/2022 ID 6711 ERWIN WAHYUONO
165 11/22/2022 ID 6711 YULIA SRI UTAMI
166 11/22/2022 ID 6711 HERFIANA DHEA ZAMAR
167 11/22/2022 ID 6711 HESTIKA YANET STEVANI NR
171 11/23/2022 ID 6711 SAMUDRA FADHIL ISKANDAR
172 11/23/2022 ID 6711 DHEGA NOOR AJI IBNU HARSONO
173 11/23/2022 ID 6711 FELICIA R R V NIKIJULUW
174 11/23/2022 ID 6711 NOVIANI
175 11/23/2022 ID 6711 NADYA MAHARANI
177 11/23/2022 ID 6711 FEBIOLA ADINDA RACHMAWATI LAMONGI
178 11/24/2022 ID 6711 DIMAS AGUNG SUGIATMA
179 11/24/2022 ID 6711 ERLANGGA ALISYAHBANA
180 11/24/2022 ID 6711 SITI NIRMALA SARI
181 11/24/2022 ID 6711 LINA DESIANTI
182 11/24/2022 ID 6711 DINDA FENY ASFIYATI
184 11/24/2022 ID 6711 NADA SAZKIA
185 11/25/2022 ID 6711 WIDODO
187 11/25/2022 ID 6711 NOVIA SARASWATI
188 11/25/2022 ID 6711 MARIA LISTYANINGTYAS
189 11/25/2022 ID 6711 I DEWA AYU RATIH VERADITA
190 11/25/2022 ID 6711 SITI NURSYAHBANI
191 11/25/2022 ID 6711 CHINTHIA DEVITA
193 11/26/2022 ID 6711 AYU SETIANA
194 11/26/2022 ID 6711 YUDISTIRA PRATAMA
195 11/26/2022 ID 6711 ADE NOVIANTI
196 11/26/2022 ID 6711 PREBINISSA TURKIYA DIRHAMSYAH
200 11/27/2022 ID 6711 PAUNDRA HERMAWAN
201 11/27/2022 ID 6711 FITRIANI
204 11/27/2022 ID 6711 SHEIBYNA KINKHA
205 11/27/2022 ID 6711 KEZIA NOPELIA TARIGAN
206 11/28/2022 ID 6711 ARIF HIDAYAT
208 11/28/2022 ID 6711 INDIRA CAHYANY
209 11/28/2022 ID 6711 MONICA AYU SARASWATI
210 11/28/2022 ID 6711 ANNISA NUR FAUZIA
211 11/28/2022 ID 6711 GUSTI AYU SUCI SHINTA DEWI
213 11/29/2022 ID 6711 ABDUL RAHMAN
214 11/29/2022 ID 6711 RYAN MANGGALA
216 11/29/2022 ID 6711 AYU WULANDARI
217 11/29/2022 ID 6711 RESI SEKAR WANGI
219 11/29/2022 ID 6711 RANITA ADINATA
220 30-Nov-2022 ID 6711 ARYANDRA SYAH ARWAN
221 30-Nov-2022 ID 6711 KEVIN HADYAN R KRESHNAPATY
222 30-Nov-2022 ID 6711 FHAUZAN
223 30-Nov-2022 ID 6711 NOVIANI
224 30-Nov-2022 ID 6711 RESTIANA PEBRIANTI
225 30-Nov-2022 ID 6711 YUNIKA SRI ENDAH LESTARI
226 30-Nov-2022 ID 6711 MONICA SANIA TANONE
MEDICAL EXAMINATION
Blood
Pressure
131994 PIC 110/70 - NORMAL

190485 FO 110/70 - NORMAL
151273 SFA 120/80 - NORMAL
170618 FA 100/70 - NORMAL
171391 FA 100/80 - NORMAL
193044 FA 110/80 - NORMAL
220696 FA 100/70 - NORMAL
143084 PIC 120/80 - NORMAL
201601 FO 120/80 - NORMAL
145194 SFA 110/80 - NORMAL
181333 FA 100/80 - NORMAL
181654 FA 100/70 - NORMAL
201912 FA 100/80 - NORMAL
222338 FA 100/70 - NORMAL
153349 PIC 120/80 - NORMAL
201637 FO 110/80 - NORMAL
172614 SFA 110/70 - NORMAL
193857 FA 100/70 - NORMAL
193860 FA 100/70 - NORMAL
201786 FA 100/70 - NORMAL
170779 FA 100/80 - NORMAL
141499 PIC 110/70 - NORMAL
201610 FO 120/80 - NORMAL
163362 SFA 110/70 - NORMAL
193321 FA 100/80 - NORMAL
212606 FA 100/80 - NORMAL
222649 FA 100/70 - NORMAL
201692 FA 100/80 - NORMAL
133275 PIC 110/70 - NORMAL
201603 FO 110/80 - NORMAL
161697 SFA 120/70 - NORMAL
200920 FA 120/80 - NORMAL
201911 FA 110/70 - NORMAL
222845 FA 110/80 - NORMAL
222651 FA 100/70 - NORMAL
146214 PIC 120/80 - NORMAL
180364 FO 110/70 - NORMAL
194186 SFA 120/80 - NORMAL
170610 FA 120/80 - NORMAL
192119 FA 120/70 - NORMAL
211846 FA 110/80 - NORMAL
220400 FA 120/80 - NORMAL
151951 PIC 120/80 - NORMAL
190489 FO 120/70 - NORMAL
160951 SFA 110/70 - NORMAL
171753 FA 120/80 - NORMAL
172228 FA 120/80 - NORMAL
193050 FA 110/70 - NORMAL
193626 FA 120/80 - NORMAL
152886 PIC 120/70 - NORMAL
150691 FO 110/70 - NORMAL
162823 SFA 110/70 - NORMAL
193621 FA 110/70 - NORMAL
193624 FA 100/70 - NORMAL
200753 FA 110/70 - NORMAL
222838 FA 110/80 - NORMAL
147220 PIC 120/80 - NORMAL
183922 FO 120/80 - NORMAL
161171 SFA 110/80 - NORMAL
183752 FA 100/70 - NORMAL
212340 FA 110/70 - NORMAL
201910 FA 100/80 - NORMAL
212536 FA 100/80 - NORMAL
141511 PIC 120/80 - NORMAL
200953 FO 120/70 - NORMAL
170235 SFA 110/80 - NORMAL
193049 FA 110/70 - NORMAL
193932 FA 110/70 - NORMAL
212537 FA 100/70 - NORMAL
212824 FA 120/80 - NORMAL
52102917 PIC 120/80 - NORMAL
193023 FO 110/70 - NORMAL
151303 SFA 110/80 - NORMAL
181348 FA 100/80 - NORMAL
184698 FA 110/70 - NORMAL
193046 FA 100/80 - NORMAL
211852 FA 110/80 - NORMAL
131783 PIC 110/80 - NORMAL
173289 FO 120/80 - NORMAL
162834 SFA 110/80 - NORMAL
201688 FA 110/80 - NORMAL
201692 FA 110/70 - NORMAL
211846 FA 100/80 - NORMAL
222184 FA 110/80 - NORMAL
142231 PIC 110/70 - NORMAL
192729 FO 120/80 - NORMAL
52105427 SFA 120/80 - NORMAL
201917 FA 110/70 - NORMAL
213251 FA 110/70 - NORMAL
213274 FA 120/80 - NORMAL
220404 FA 110/80 - NORMAL
151946 PIC 110/80 - NORMAL
201609 FO 120/80 - NORMAL
151038 SFA 100/70 - NORMAL
151635 FA 100/70 - NORMAL
181017 FA 100/70 - NORMAL
182731 FA 110/70 - NORMAL
201913 FA 100/70 - NORMAL
144133 PIC 120/80 - NORMAL
193020 FO 110/70 - NORMAL
170618 SFA 110/80 - NORMAL
193625 FA 120/80 - NORMAL
212825 FA 120/80 - NORMAL
220698 FA 100/70 - NORMAL
222183 FA 110/70 - NORMAL
52127459 PIC 110/70 - NORMAL
201610 FO 110/80 - NORMAL
200692 SFA 110/70 - NORMAL
170768 FA 100/70 - NORMAL
193045 FA 110/70 - NORMAL
193862 FA 120/70 - NORMAL
222946 FA 110/80 - NORMAL
62092772 PIC 120/80 - NORMAL
180310 FO 120/80 - NORMAL
146359 SFA 110/80 - NORMAL
183762 FA 100/80 - NORMAL
201913 FA 100/70 - NORMAL
220403 FA 110/70 - NORMAL
201917 FA 110/80 - NORMAL
133224 PIC 110/80 - NORMAL
201608 FO 120/70 - NORMAL
162414 SFA 110/70 - NORMAL
191999 FA 100/70 - NORMAL
182726 FA 110/70 - NORMAL
191992 FA 100/80 - NORMAL
220402 FA 120/80 - NORMAL
151193 PIC 120/80 - NORMAL
153418 FO 120/80 - NORMAL
163373 SFA 110/70 - NORMAL
181003 FA 100/80 - NORMAL
183061 FA 100/70 - NORMAL
212028 FA 110/70 - NORMAL
212533 FA 110/70 - NORMAL
143084 PIC 120/80 - NORMAL
200953 FO 120/80 - NORMAL
143188 SFA 100/70 - NORMAL
184700 FA 110/80 - NORMAL
193624 FA 100/70 - NORMAL
201792 FA 100/70 - NORMAL
22849 FA 120/80 - NORMAL
143312 PIC 120/80 - NORMAL
141030 FO 120/80 - NORMAL
200922 SFA 110/70 - NORMAL
191990 FA 100/80 - NORMAL
200748 FA 120/80 - NORMAL
201691 FA 100/80 - NORMAL
201916 FA 120/80 - NORMAL
133025 PIC 120/70 - NORMAL
192728 FO 120/80 - NORMAL
148120 SFA 110/80 - NORMAL
193034 FA 110/80 - NORMAL
201898 FA 100/70 - NORMAL
201910 FA 100/70 - NORMAL
212533 FA 110/70 - NORMAL
52040296 PIC 120/80 - NORMAL
171897 FO 110/80 - NORMAL
170768 SFA 110/80 - NORMAL
163379 FA 100/70 - NORMAL
201786 FA 110/70 - NORMAL
200749 FA 110/70 - NORMAL
184698 FA 110/80 - NORMAL
180553 PIC 120/80 NORMAL
192729 FO 120/80 - NORMAL
163370 SFA 110/70 - NORMAL
181637 FA 100/70 - NORMAL
200046 FA 100/80 - NORMAL
201694 FA 110/70 - NORMAL
191998 FA 110/80 - NORMAL
52062733 PIC 100/80 - NORMAL
184753 FO 110/80 - NORMAL
192678 FO 120/80 - NORMAL
151028 SFA 110/70 - NORMAL
221526 FA 110/70 - NORMAL
200451 FA 110/70 - NORMAL
191990 FA 110/70 - NORMAL
222091 FA 120/80 - NORMAL
131994 PIC 100/70 - NORMAL
201608 FO 120/80 - NORMAL
170242 SFA 110/70 - NORMAL
172061 FA 100/80 - NORMAL
171402 FA 110/70 - NORMAL
193050 FA 100/70 - NORMAL
222949 FA 110/70 - NORMAL
160628 PIC 120/80 - NORMAL
192729 FO 120/80 - NORMAL
161865 SFA 110/70 - NORMAL
173034 FA 110/80 - NORMAL
222337 FA 110/70 - NORMAL
194210 FA 120/70 - NORMAL
184695 FA 120/80 - NORMAL
150696 PIC 110/80 - NORMAL
133559 FO 110/70 - NORMAL
183364 SFA 120/80 - NORMAL
170775 FA 100/70 - NORMAL
201570 FA 100/80 - NORMAL
201680 FA 100/70 - NORMAL
193624 FA 100/70 - NORMAL
146214 PIC 110/70 - NORMAL
183205 FO 110/80 - NORMAL
170766 SFA 110/70 - NORMAL
193336 FA 120/70 - NORMAL
182010 FA 100/80 - NORMAL
212037 FA 100/70 - NORMAL
220163 FA 100/70 - NORMAL
146213 PIC 120/80 - NORMAL
184709 FO 100/70 - NORMAL
162838 SFA 110/70 - NORMAL
191671 FA 110/70 - NORMAL
193320 FA 110/70 - NORMAL
212331 FA 110/80 - NORMAL
22651 FA 100/70 - NORMAL
151951 PIC 120/70 - NORMAL
171730 FO 110/80 - NORMAL
163370 SFA 110/80 - NORMAL
181015 FA 100/80 - NORMAL
181643 FA 110/70 - NORMAL
201693 FA 100/70 - NORMAL
222647 FA 110/80 - NORMAL
150693 PIC 120/80 - NORMAL
192714 FO 120/70 - NORMAL
200643 SFA 120/80 - NORMAL
221526 FA 110/70 - NORMAL
173035 FA 100/70 - NORMAL
181316 FA 100/70 - NORMAL
194205 FA 100/80 - NORMAL

TOTAL PILOT FA EOB

GRAND TOTAL
TOTAL PILOT FA EOB

GRAND TOTAL
TOTAL PILOT FA EOB

NORMAL 61 164
HIPOTENSI 0 0
PRE HIPERTENSI 1 0
GRAND TOTAL

Remaks
Remaks
Remaks
MEDICAL EXAMINATION
AIRLINE : ID
DATE / MONTH : DESEMBER 2022
LOCATION : STA.
Total
No Date Maintenance
check
1 1-Dec-22 6 1 0 1 0 5 0 7
2 2-Dec-22 6 1 0 1 0 5 0 7
3 3-Dec-22 6 1 0 1 0 5 0 7
4 4-Dec-22 7 1 0 1 0 5 0 7
5 5-Dec-22 6 1 0 1 0 5 0 7
6 6-Dec-22 6 1 0 1 0 5 0 7
7 7-Dec-22 7 1 0 1 0 5 0 7
8 8-Dec-22 6 1 0 1 0 5 0 7
9 9-Dec-22 6 1 0 1 0 5 0 7
10 10-Dec-22 7 1 0 1 0 5 0 7
G
R
A
P
11 11-Dec-22 6 1 0 1 0 5 0 7
H
12 12-Dec-22 6 1 0 1 0 5 0 7
I
C
13 13-Dec-22 6 1 0 1 0 5 0 7
R
E
F
L
I
14 14-Dec-22 6 1 0 1 0 5 0 7
G
H
T 15 15-Dec-22 6 1 0 1 0 5 0 7
H
E
A
L
16 16-Dec-22 6 1 0 1 0 5 0 7
T
H
C
17 17-Dec-22 6 1 0 1 0 5 0 7
H
18 18-Dec-22 6 1 0 1 0 5 0 7
E
C
K
A
T
S
19 19-Dec-22 6 1 0 1 0 5 0 7
T
A
. 20 20-Dec-22 6 1 0 1 0 5 0 7
C
G
K 21 21-Dec-22 6 1 0 1 0 5 0 7
D
U
R
I
22 22-Dec-22 7 1 0 1 0 5 0 7
N
23 23-Dec-22 6 1 0 1 0 5 0 7
G
A
P
R
I
L 24 24-Dec-22 6 1 0 1 0 5 0 7
2
0
2
2
25 25-Dec-22 5 1 0 1 0 5 0 7
26 26-Dec-22 6 1 0 1 0 5 0 7
27 27-Dec-22 5 1 0 1 0 5 0 7
28 28-Dec-22 5 1 0 1 0 5 0 7
29 29-Dec-22 5 1 0 1 0 5 0 7
30 30-Dec-22 6 1 0 1 0 5 0 7
31 31-Dec-22 4 1 0 1 0 5 0 7
TOTAL 184 31 0 31 0 155 0 217
y & Quality
MINATION
LTH CHECK LIST
NURSE
PAGI

D 4 Total Crew Not Checked (PIC, SIC, and FA) 0
D
B
B FLIGHT PIC SIC
B 184 31 31
B
D
D 12000
D
B 10000
B
B 8000
B
6000
D
D
4000
D
B 2000
B
B 0
FLIGHT PIC SIC
B
D
D
D
B
B
B
B
FA MAINTENANCE
155 217
Safe
Flight
No Date Name
Number
1 12/1/2022 ID 6711 BAYNAFRAH
2 12/1/2022 ID 6711 JANPRATAMA
3 12/1/2022 ID 6711 LULU SELASTIAWATI
4 12/1/2022 ID 6711 ELVIA BELLA KANIA DOTULONG
5 12/1/2022 ID 6711 YULIN PRATIWI
7 12/1/2022 ID 6711 RANI TRISMAYANTI
10 12/2/2022 ID 6711 SYARIFAH RADIAH
11 12/2/2022 ID 6711 GEADARA PERMATA SYAQINAH
12 12/2/2022 ID 6711 AYA CHANDRA
15 12/3/2022 ID 6711 ONI ARIANSYAH
17 12/3/2022 ID 6711 ANA MUKHIDATUN MUNAWAROH
18 12/3/2022 ID 6711 ADRIANA ALAMANDA
19 12/3/2022 ID 6711 CINDY FEBRIANA DEVI
20 12/3/2022 ID 6711 NOVIANI
21 12/3/2022 ID 6711 VINA PRATIWI
23 12/4/2022 ID 6711 RISYAD SENATAMA PUTRA
24 12/4/2022 ID 6711 DINA DAMAYANTI
25 12/4/2022 ID 6711 SUSRINAH TREE APRITA
26 12/4/2022 ID 6711 WETTI OKTAVIA
27 12/4/2022 ID 6711 EVA SOVIANA
30 12/5/2022 ID 6711 ANDIKA DWI SETYAWAN
31 12/5/2022 ID 6711 DIAH AYU WULANDARI
33 12/5/2022 ID 6711 SYAVUNG INRI MAMAHIT
34 12/5/2022 ID 6711 INDRINNA CHAIRUNNISSA
35 12/5/2022 ID 6711 MUHAMMAD JORDAN
38 12/6/2022 ID 6711 SUCI FITRIYANI
40 12/6/2022 ID 6711 HANA MASITA
41 12/6/2022 ID 6711 ENDAH KURNIATI
42 12/6/2022 ID 6711 FEBY ROSITA
43 12/7/2022 ID 6711 ABDUL RAHMAN
44 12/7/2022 ID 6711 WANDA KRISNA RAHMANDA
45 12/7/2022 ID 6711 HANDINI SETIA PRASTICA
47 12/7/2022 ID 6711 ELSA LUVITA
49 12/7/2022 ID 6711 AYU SUKMA DEWI
50 12/8/2022 ID 6711 FARIS PURNAMA
52 12/8/2022 ID 6711 ANGGITA LARASATI
53 12/8/2022 ID 6711 ADE NOVIANTI
55 12/8/2022 ID 6711 MARSHANDA GITA CAROLINA
57 12/9/2022 ID 6711 GABRIEL DHANISWARA
58 12/9/2022 ID 6711 JALU AVI TRENGGONO
59 12/9/2022 ID 6711 SYARIFAH SARI DEWI YURI A
60 12/9/2022 ID 6711 LULU
61 12/9/2022 ID 6711 RUSTIYAWATI SRI RIZKI
63 12/9/2022 ID 6711 SILVANIA
65 12/10/2022 ID 6711 FAJAR PRAYOGA
66 12/10/2022 ID 6711 DHEA NOFIANI
68 12/10/2022 ID 6711 MARTA ANGGRAINI MARIA
69 12/10/2022 ID 6711 TESSA LONIKA RIKIN
70 12/10/2022 ID 6711 VINA PRATIWI
71 12/11/2022 ID 6711 WANDA KRISNA RAHMANDA
72 12/11/2022 ID 6711 DERRY YURHADI
73 12/11/2022 ID 6711 NOVITA SARI
75 12/11/2022 ID 6711 ZHASQIA PUTRI FARIZHA
77 12/11/2022 ID 6711 GLEDYS ANGGRAINI PURBA
78 12/12/2022 ID 6711 HARHAR WITHARGA SARAGIH
79 12/12/2022 ID 6711 MAGI PARLINDUNGAN PAHLEVI P
80 12/12/2022 ID 6711 FHAUZAN
81 12/12/2022 ID 6711 LAURENTIA JUANITA SARASWATI
83 12/12/2022 ID 6711 ELSA LUVITA
84 12/12/2022 ID 6711 YUDHA ASHARI
85 12/13/2022 ID 6711 RANGGA TRIADI MUKRIM
88 12/13/2022 ID 6711 GHEABY DHEANITHA HALIM
89 12/13/2022 ID 6711 DINNA SHOFFIRRA
90 12/13/2022 ID 6711 AYA CHANDRA
94 12/14/2022 ID 6711 CAHYANI FITRI AZIZAH
95 12/14/2022 ID 6711 KARINA NAZWA UTAMI
97 12/14/2022 ID 6711 SAVIRA QURROTA A YUNINA PITONO
98 12/14/2022 ID 6711 NI MADE ARINA DWI PUTRI
99 12/15/2022 ID 6711 JASON
101 12/15/2022 ID 6711 SASHI INDAHSARI SUJATNO
102 12/15/2022 ID 6711 GITA ZAHARAH
103 12/15/2022 ID 6711 BETANIA KRISNA DEWI
104 12/15/2022 ID 6711 REGITA NUR INDAH PAULANI
105 12/15/2022 ID 6711 ANISYA KARIMAH
106 12/16/2022 ID 6711 M DHIKI FIRMANSYAH
109 12/16/2022 ID 6711 ADE NOVIANTI
113 12/17/2022 ID 6711 ANGGRIAN DEVITA KAHAR
114 12/17/2022 ID 6711 NATALINO JOSHUA EKARISTO
117 12/17/2022 ID 6711 NITA MULYASARI
118 12/17/2022 ID 6711 MAELANI SAPUTRI
120 12/18/2022 ID 6711 MUKHAMMAD FATKUL YASIR
124 12/18/2022 ID 6711 WETTI OKTAVIA
126 12/18/2022 ID 6711 RIZA MAULIA
128 12/19/2022 ID 6711 DANIEL F J WONGSOADMODJO
130 12/19/2022 ID 6711 SITI UMI LATIFAH
131 12/19/2022 ID 6711 LINDA TRISNA AYU
133 12/19/2022 ID 6711 NABILAH PUTRI MUBARAMAH
135 12/20/2022 ID 6711 PUTRA AULIA RACHMAN
136 12/20/2022 ID 6711 LULU SELASTIAWATI
137 12/20/2022 ID 6711 ANNISA PRATIWI MAHMUD
140 12/20/2022 ID 6711 RIFDA FARA NABILA
141 12/21/2022 ID 6711 HANSTIO STEYR
143 12/21/2022 ID 6711 SEPTI VERA MARTHI NOVA
146 12/21/2022 ID 6711 LAUDI AL KHAFI
147 12/21/2022 ID 6711 FADILA SINTA ROSALIA
148 12/22/2022 ID 6711 KEVIN TRI MAULANA
149 12/22/2022 ID 6711 BAMPHY ADYA PERMANA
151 12/22/2022 ID 6711 BUNGA FITRIANA RAMADHAN
152 12/22/2022 ID 6711 PUTRI DEWI AYUNI
153 12/22/2022 ID 6711 GITA RAHMALIA
157 12/23/2022 ID 6711 LADY KURNIA CINTYA PUTRI
158 12/23/2022 ID 6711 SHEYLLA MELLANI
159 12/23/2022 ID 6711 DAYU FAUZIAH PRATIWI
160 12/23/2022 ID 6711 AVELYA CAHYANDARI
163 12/24/2022 ID 6711 GALUH SATRIO LAKSONO
164 12/24/2022 ID 6711 ELDA MAULINA
166 12/24/2022 ID 6711 SHEREN XENA LEVINA MAMBO
168 12/24/2022 ID 6711 TIRZA INKANIA CAROLINE KOJO
170 12/25/2022 ID 6711 ARFIANTO ANUGRAH WIBOWO
171 12/25/2022 ID 6711 BIRU LINTANG PAMBAYUN
172 12/25/2022 ID 6711 ADRIANI MARISKA WONDAL
173 12/25/2022 ID 6711 WETTI OKTAVIA
175 12/25/2022 ID 6711 NURAHMAT HIDAYAT
176 12/26/2022 ID 6711 KRISTIANTO WIBISONO
178 12/26/2022 ID 6711 DESTI ASRESTY
179 12/26/2022 ID 6711 DIKA DWI ASTUTI
183 12/27/2022 ID 6711 M YURIKO HANAKA
185 12/27/2022 ID 6711 IRIANI DWI NOVITA
186 12/27/2022 ID 6711 TIARA FITRI WIYONO
187 12/27/2022 ID 6711 DINA MULYANI
188 12/27/2022 ID 6711 SINTA TRI MAHESTI
189 12/27/2022 ID 6711 ANNISA PRATIWI MAHMUD
191 12/28/2022 ID 6711 RIDHO AFIARO
192 12/28/2022 ID 6711 GITA ZAHARAH
197 12/29/2022 ID 6711 ADI WIDJAJANTO
198 12/29/2022 ID 6711 AHMAD ADIYAN
199 12/29/2022 ID 6711 FEBRINA DIANITA
201 12/29/2022 ID 6711 YULIN PRATIWI
204 12/30/2022 ID 6711 DAMAR RISELPA
206 12/30/2022 ID 6711 PITIN PEBRI LESTARI
208 12/30/2022 ID 6711 NI KADEK SINTYA PRADNYA UTAMI
210 12/30/2022 ID 6711 UMI KALSUM
211 12/31/2022 ID 6711 MUHAMMAD FADIL INDRAYANTO
213 12/31/2022 ID 6711 SERVINDA APRILIA
215 12/31/2022 ID 6711 ADRIANA ALAMANDA
217 12/31/2022 ID 6711 MIKE RIZKI MEILINI
218
219
220
221
222
223
224
225
226
MEDICAL EXAMINATION
Blood
Pressure
142530 PIC 120/80 - NORMAL

184726 FO 110/70 - NORMAL
151297 SFA 110/80 - NORMAL
182725 FA 100/70 - NORMAL
193038 FA 110/80 - NORMAL
193050 FA 110/70 - NORMAL
193331 FA 100/80 - NORMAL
146214 PIC 110/70 - NORMAL
180364 FO 100/80 - NORMAL
170357 SFA 110/80 - NORMAL
184692 FA 100/70 - NORMAL
201689 FA 110/70 - NORMAL
201786 FA 100/80 - NORMAL
220161 FA 110/70 - NORMAL
145374 PIC 120/80 - NORMAL
200953 FO 120/70 - NORMAL
170496 SFA 110/70 - NORMAL
193036 FA 100/70 - NORMAL
180637 FA 110/70 - NORMAL
221526 FA 110/70 - NORMAL
201783 FA 100/70 - NORMAL
172963 PIC 120/80 - NORMAL
192959 FO 120/80 - NORMAL
153535 SFA 110/80 - NORMAL
194211 FA 100/70 - NORMAL
201691 FA 100/70 - NORMAL
212533 FA 110/70 - NORMAL
191002 FA 100/70 - NORMAL
143482 PIC 120/80 - NORMAL
192739 FO 130/80 - NORMAL
170232 SFA 100/70 - NORMAL
201680 FA 110/70 - NORMAL
201687 FA 110/70 - NORMAL
211839 FA 110/70 - NORMAL
220406 FA 100/70 - NORMAL
52115981 PIC 110/70 - NORMAL
200947 FO 120/80 - NORMAL
162395 SFA 100/70 - NORMAL
201917 FA 110/80 - NORMAL
193616 FA 110/80 - NORMAL
201901 FA 110/70 - NORMAL
170350 FA 100/70 - NORMAL
151951 PIC 110/80 - NORMAL
52127407 FO 120/70 - NORMAL
160385 SFA 110/80 - NORMAL
192119 FA 110/70 - NORMAL
194200 FA 110/80 - NORMAL
211846 FA 110/70 - NORMAL
193851 FA 100/70 - NORMAL
133025 PIC 120/80 - NORMAL
184348 FO 120/80 - NORMAL
170607 SFA 110/70 - NORMAL
170775 FA 110/70 - NORMAL
193038 FA 100/80 - NORMAL
212334 FA 100/70 - NORMAL
193321 FA 110/80 - NORMAL
52082721 PIC 120/80 - NORMAL
144246 FO 120/70 - NORMAL
147224 SFA 100/80 - NORMAL
191005 FA 100/70 - NORMAL
191680 FA 110/80 - NORMAL
200695 FA 100/70 - NORMAL
222872 FA 110/70 - NORMAL
52115981 PIC 120/80 - NORMAL
173289 FO 120/80 - NORMAL
163477 SFA 120/80 - NORMAL
191998 FA 110/70 - NORMAL
200754 FA 110/80 - NORMAL
200710 FA 100/70 - NORMAL
201783 FA 100/70 - NORMAL
52127407 PIC 120/70 - NORMAL
135746 FO 120/80 - NORMAL
146384 SFA 110/80 - NORMAL
163379 FA 100/70 - NORMAL
170776 FA 100/80 - NORMAL
200692 FA 110/70 - NORMAL
200743 FA 110/70 - NORMAL
133218 PIC 120/80 - NORMAL
180901 FO 110/80 - NORMAL
200643 SFA 120/80 - NORMAL
171753 FA 110/70 - NORMAL
201786 FA 120/80 - NORMAL
194200 FA 100/80 - NORMAL
220411 FA 110/70 - NORMAL
150697 PIC 120/80 - NORMAL
182541 FO 120/70 - NORMAL
144173 SFA 100/80 - NORMAL
193615 FA 100/70 - NORMAL
193934 FA 110/70 - NORMAL
201689 FA 100/70 - NORMAL
201784 FA 110/70 - NORMAL
142231 PIC 110/80 - NORMAL
180364 FO 120/80 - NORMAL
170236 SFA 110/80 - NORMAL
183826 FA 100/80 - NORMAL
193625 FA 100/70 - NORMAL
211852 FA 110/70 - NORMAL
212535 FA 100/70 - NORMAL
151946 PIC 120/80 - NORMAL
200953 FO 110/80 - NORMAL
160564 SFA 110/70 - NORMAL
172058 FA 100/80 - NORMAL
182021 FA 100/70 - NORMAL
200748 FA 100/80 - NORMAL
212328 FA 110/70 - NORMAL
172873 PIC 120/80 - NORMAL
192729 FO 110/70 - NORMAL
170232 SFA 110/70 - NORMAL
170775 FA 110/80 - NORMAL
201570 FA 110/70 - NORMAL
170611 FA 110/70 - NORMAL
201784 FA 100/70 - NORMAL
180539 PIC 120/80 - NORMAL
171895 FO 120/80 - NORMAL
181003 SFA 110/70 - NORMAL
193626 FA 100/80 - NORMAL
212609 FA 100/70 - NORMAL
200450 FA 110/80 - NORMAL
144173 FA 110/70 - NORMAL
62102868 PIC 110/80 - NORMAL
200953 FO 110/80 - NORMAL
170607 SFA 110/70 - NORMAL
193862 FA 100/70 - NORMAL
201691 FA 100/80 - NORMAL
212537 FA 100/70 - NORMAL
222648 FA 100/70 - NORMAL
142232 PIC 120/80 - NORMAL
201606 FO 120/80 - NORMAL
141470 SFA 110/70 - NORMAL
171764 FA 120/80 - NORMAL
193946 FA 110/80 - NORMAL
180637 FA 110/70 - NORMAL
181330 FA 100/70 - NORMAL
131783 PIC 120/80 - NORMAL
180902 FO 110/70 - NORMAL
151297 SFA 110/70 - NORMAL
180642 FA 110/70 - NORMAL
191678 FA 110/70 - NORMAL
194210 FA 110/70 - NORMAL
220826 FA 100/70 - NORMAL
151945 PIC 120/80 - NORMAL
201107 FO 110/70 - NORMAL
151757 SFA 110/70 - NORMAL
193050 FA 100/80 - NORMAL
193626 FA 110/80 - NORMAL
212332 FA 100/70 - NORMAL
212817 FA 110/80 - NORMAL
52128305 PIC 120/80 - NORMAL
190490 FO 110/70 - NORMAL
170232 SFA 110/80 - NORMAL
171796 FA 100/70 - NORMAL
192114 FA 100/70 - NORMAL
201898 FA 100/80 - NORMAL
201908 FA 110/70 - NORMAL
62092772 PIC 110/80 - NORMAL
180310 FO 110/70 - NORMAL
161078 SFA 100/70 - NORMAL
193034 FA 100/70 - NORMAL
200442 FA 100/80 - NORMAL
201795 FA 110/80 - NORMAL
201909 FA 110/80 - NORMAL
152886 PIC 120/80 - NORMAL
201526 FO 110/70 NORMAL
163484 SFA 110/70 - NORMAL
182010 FA 110/80 - NORMAL
200456 FA 110/80 - NORMAL
194205 FA 100/70 - NORMAL
211841 FA 100/70 - NORMAL
180553 PIC 120/80 - NORMAL
153809 FO 110/80 - NORMAL
172052 SFA 120/80 - NORMAL
191285 FA 120/80 - NORMAL
201691 FA 120/80 - NORMAL
201786 FA 120/80 - NORMAL
213212 FA 110/80 - NORMAL
52128277 PIC 110/70 - NORMAL
193023 FO 120/80 - NORMAL
170348 SFA 110/80 - NORMAL
160377 FA 110/80 - NORMAL
180636 FA 110/70 - NORMAL
193862 FA 100/70 - NORMAL
183752 FA 100/80 - NORMAL
140013 PIC 120/80 - NORMAL
182539 FO 110/70 - NORMAL
170612 SFA 110/70 - NORMAL
171797 FA 110/70 - NORMAL
193932 FA 110/80 - NORMAL
200751 FA 100/70 - NORMAL
180642 FA 110/80 - NORMAL
180553 PIC 110/80 - NORMAL
171917 FO 120/70 - NORMAL
172058 SFA 110/70 - NORMAL
193625 FA 100/80 - NORMAL
170233 FA 100/70 - NORMAL
194210 FA 110/80 - NORMAL
212589 FA 100/70 - NORMAL
52020031 PIC 120/80 - NORMAL
201640 FO 110/70 - NORMAL
162405 SFA 110/80 - NORMAL
180637 FA 110/70 - NORMAL
193038 FA 100/70 - NORMAL
212037 FA 100/80 - NORMAL
191999 FA 100/80 - NORMAL
141637 PIC 120/80 - NORMAL
200959 FO 120/80 - NORMAL
163068 SFA 100/70 - NORMAL
170611 FA 110/70 - NORMAL
201796 FA 110/80 - NORMAL
193050 FA 100/70 - NORMAL
220784 FA 110/80 - NORMAL
146212 PIC 110/70 - NORMAL
192729 FO 110/80 - NORMAL
153020 SFA 100/70 - NORMAL
180636 FA 100/80 - NORMAL
193036 FA 110/70 - NORMAL
201680 FA 100/80 - NORMAL
212608 FA 110/70 - NORMAL

TOTAL PILOT FA EOB

GRAND TOTAL
TOTAL PILOT FA EOB

GRAND TOTAL
TOTAL PILOT FA EOB

NORMAL 61 155
HIPOTENSI 0 0
PRE HIPERTENSI 1 0
GRAND TOTAL

Remaks
Remaks
Remaks
MEDICAL EXAMINATION
AIRLINE : ID
DATE / MONTH : JANUARI 2023
LOCATION : STA.
Total
No Date Maintenance
check
1 1-Jan-23 4 0 0 0 0 0 0 0
2 2-Jan-23 6 1 0 1 0 5 0 7
3 3-Jan-23 6 1 0 1 0 5 0 7
4 4-Jan-23 6 1 0 1 0 5 0 7
5 5-Jan-23 5 1 0 1 0 5 0 7
6 6-Jan-23 6 1 0 1 0 5 0 7
7 7-Jan-23 6 1 0 1 0 5 0 7
8 8-Jan-23 6 1 0 1 0 5 0 7
9 9-Jan-23 5 1 0 1 0 5 0 7
10 10-Jan-23 4 1 0 1 0 5 0 7
G
R
A
P
11 11-Jan-23 5 1 0 1 0 5 0 7
H
12 12-Jan-23 6 1 0 1 0 5 0 7
I
C
13 13-Jan-23 6 1 0 1 0 5 0 7
R
E
F
L
I
14 14-Jan-23 6 1 0 1 0 5 0 7
G
H
T 15 15-Jan-23 6 1 0 1 0 5 0 7
H
E
A
L
16 16-Jan-23 5 1 0 1 0 5 0 7
T
H
C
17 17-Jan-23 5 1 0 1 0 5 0 7
H
18 18-Jan-23 6 1 0 1 0 5 0 7
E
C
K
A
T
S
19 19-Jan-23 6 1 0 1 0 5 0 7
T
A
. 20 20-Jan-23 6 1 0 1 0 5 0 7
C
G
K 21 21-Jan-23 6 1 0 1 0 5 0 7
D
U
R
I
22 22-Jan-23 5 1 0 1 0 5 0 7
N
23 23-Jan-23 6 1 0 1 0 5 0 7
G
A
P
R
I
L 24 24-Jan-23 6 1 0 1 0 5 0 7
2
0
2
2
25 25-Jan-23 6 1 0 1 0 5 0 7
26 26-Jan-23 5 1 0 1 0 5 0 7
27 27-Jan-23 5 1 0 1 0 5 0 7
28 28-Jan-23 5 1 0 1 0 5 0 7
29 29-Jan-23 5 1 0 1 0 5 0 7
30 30-Jan-23 4 1 0 1 0 5 0 7
31 31-Jan-23 4 1 0 1 0 5 0 7
TOTAL 168 30 0 30 0 150 0 210
y & Quality
MINATION
LTH CHECK LIST
NURSE
PAGI
0 1 Total Crew on Flight Duty 187

B
B
B FLIGHT PIC SIC
D 168 30 30
D
D
B GRAPHIC PRE - FLIGHT HEALTH CHECK AT S
B 12000
B
B 10000
D
D 8000
D
6000
B
B
4000
B
B 2000
D
D 0
FLIGHT PIC SIC
D
B
B
B
B
B
D
D
FA MAINTENANCE
150 210
Safe
Flight
No Date Name
Number
3 1/2/2023 ID 6711 SASHI INDAHSARI SUJATNO
5 1/2/2023 ID 6711 GESSY RAMADHIANI
10 1/3/2023 ID 6711 NANCY FITMAYA
11 1/3/2023 ID 6711 SEPTY VELISTA PANGESTU
12 1/3/2023 ID 6711 JESSICA VANNESSA
14 1/3/2023 ID 6711 GITA RAHMALIA
17 1/4/2023 ID 6711 ALDO ABIYOGA
20 1/4/2023 ID 6711 KOMANG ELDAYANI
25 1/5/2023 ID 6711 GABRILLE NATALIA
26 1/5/2023 ID 6711 ADITYA RESTU YOGA ARDHIKA
27 1/5/2023 ID 6711 DARIUS
28 1/5/2023 ID 6711 BUDI PAMUNGKAS
29 1/6/2023 ID 6711 ANDIKA DWITYA
30 1/6/2023 ID 6711 ATALASAFA ZIDANNAHDAH SUROPATI
32 1/6/2023 ID 6711 CINDY ERITA PUTRI
33 1/6/2023 ID 6711 RAKHA SIWI CAHYA PEROSITA SARI
34 1/6/2023 ID 6711 EVA SOVIANA
36 1/7/2023 ID 6711 BAYNAFRAH
38 1/7/2023 ID 6711 DHEA NOFIANI
40 1/7/2023 ID 6711 AFRITA SRI SULISTIOWATI
41 1/7/2023 ID 6711 AYA CHANDRA
42 1/7/2023 ID 6711 LAUDI AL KHAFI
45 1/8/2023 ID 6711 MELISA PUTRIANI
50 1/9/2023 ID 6711 MOHAMAD LUTHFAN GAZIAN
51 1/9/2023 ID 6711 MUHAMMAD REZA TAMSIL
52 1/9/2023 ID 6711 KIKI KUMALA SARI
53 1/9/2023 ID 6711 IIS IMELDA JUNAID
57 1/10/2023 ID 6711 MIRGA BUDI DARMAWAN
58 1/10/2023 ID 6711 WIBI FRINO ARBI
61 1/10/2023 ID 6711 ADE NOVIANTI
62 1/10/2023 ID 6711 KUSMIATI
65 1/11/2023 ID 6711 BATEEN BUDI PRASANTO
66 1/11/2023 ID 6711 HARLINA RYSKY DIAN FEBRIANI
68 1/11/2023 ID 6711 FEBIYOLA YESIKA BR HUTAURUK
70 1/11/2023 ID 6711 PUTRI ANNISA
71 1/12/2023 ID 6711 SENDY IZAZI DIVIA
72 1/12/2023 ID 6711 LEONARDO YUDISTIRA SATRIA
73 1/12/2023 ID 6711 DONA FITRIA IMANDA PUTRI
74 1/12/2023 ID 6711 KUS SARI HAYATI
79 1/13/2023 ID 6711 MAHENDRA PRABOWO
81 1/13/2023 ID 6711 REGA AYU PANESSA
82 1/13/2023 ID 6711 SHEREN XENA LEVINA MAMBO
84 1/13/2023 ID 6711 ADE NOVIANTI
86 1/14/2023 ID 6711 HENDRO HADHI RUSMONO
87 1/14/2023 ID 6711 TEHARA SAFIRA STELLA MAJID
88 1/14/2023 ID 6711 AJENG AYU HARTINAH
89 1/14/2023 ID 6711 TIARA FITRI WIYONO
90 1/14/2023 ID 6711 YUNIKA SRI ENDAH LESTARI
93 1/15/2023 ID 6711 YEHEZKIEL ASTONORWANDI
94 1/15/2023 ID 6711 RAHMADANI MUHTAR
95 1/15/2023 ID 6711 ZHASQIA PUTRI FARIZHA
97 1/15/2023 ID 6711 AYA CHANDRA
99 1/16/2023 ID 6711 RENATO CARERA JUNIOR
100 1/16/2023 ID 6711 JANPRATAMA
101 1/16/2023 ID 6711 RANA ALIFAH KHOIRUNNISA
104 1/16/2023 ID 6711 NADILLA TRI SHALSYABILLA
107 1/17/2023 ID 6711 DHEAVISA PUTRA MANDALA
108 1/17/2023 ID 6711 DENNISA SUKMA
112 1/17/2023 ID 6711 NOVIANI
113 1/18/2023 ID 6711 TAUFAN WIDYA KUSUMA D A
117 1/18/2023 ID 6711 GREACE MAY ANGEL SIANTURI
119 1/18/2023 ID 6711 DESI ALFITRI NATALIA ASRI
122 1/19/2023 ID 6711 DONA FITRIA IMANDA PUTRI
123 1/19/2023 ID 6711 NUR SALSABIL ADRIYANDRA
125 1/19/2023 ID 6711 INDRINNA CHAIRUNNISSA
126 1/19/2023 ID 6711 EVA SOVIANA
128 1/20/2023 ID 6711 AZHAR PAMUNGKAS
130 1/20/2023 ID 6711 NABILLA SALSABILLA
132 1/20/2023 ID 6711 LAUDI AL KHAFI
136 1/21/2023 ID 6711 ADHEILLA INDRIANA ARDINA
137 1/21/2023 ID 6711 SITI UMI LATIFAH
138 1/21/2023 ID 6711 MAYA ANGELA ROMADHONA
142 1/22/2023 ID 6711 GUSTIFAR PURNAMA ALLADIJA
148 1/23/2023 ID 6711 DANA AVIANTARA
149 1/23/2023 ID 6711 IKRAM ALFIN PUTRA
150 1/23/2023 ID 6711 FITRI AYU ARUM PUSPITA
151 1/23/2023 ID 6711 MARETA RIMA SUCIANA
152 1/23/2023 ID 6711 HANNY CHANTIKA NOVIA
155 1/24/2023 ID 6711 MARTWIN WESSY DHARTA RIYADI
156 1/24/2023 ID 6711 DENDY BAGUS PRATAMA
157 1/24/2023 ID 6711 LALITA ISWARI PANGAYOMAN
159 1/24/2023 ID 6711 OLGA ANDRIANI
161 1/24/2023 ID 6711 VERLITA MEIANI NATALIA
163 1/25/2023 ID 6711 JANPRATAMA
164 1/25/2023 ID 6711 DHEA NOFIANI
165 1/25/2023 ID 6711 SARAH SEPTIANI LATIFAH
167 1/25/2023 ID 6711 BRITIA RISKA KUSUMA WARDANI
170 1/26/2023 ID 6711 YEHEZKIEL ASTONORWANDI
171 1/26/2023 ID 6711 AYU WULANDARI
173 1/26/2023 ID 6711 LENNY
175 1/26/2023 ID 6711 RESVIKA LEONITA MAHARANI
177 1/27/2023 ID 6711 ALIT GLADIANTO
178 1/27/2023 ID 6711 FITRIANI
180 1/27/2023 ID 6711 NOVIANI
182 1/27/2023 ID 6711 AFRITA SRI SULISTIOWATI
183 1/28/2023 ID 6711 HEBERT EVAN LAHUNDUITAN
184 1/28/2023 ID 6711 DESTI ASRESTY
187 1/28/2023 ID 6711 ZAHRA DWI UTAMI
190 1/29/2023 ID 6711 DAMAR RISELPA
191 1/29/2023 ID 6711 IKRAM ALFIN PUTRA
193 1/29/2023 ID 6711 VINA PRATIWI
195 1/29/2023 ID 6711 JESIKA LINDSAY WAROUW
197 1/30/2023 ID 6711 ADISTYAWAN YOGA WICAKSONO
198 1/30/2023 ID 6711 ANDHIKA AKBARI PERDANA
199 1/30/2023 ID 6711 AQLIA ISSABELLA ZIOTTY
200 1/30/2023 ID 6711 SEKAR AYU CANDRANINGTYAS
202 1/30/2023 ID 6711 ANDHINI MEITRI HAPSARI
203 1/30/2023 ID 6711 TASYA ANDARINI MARSAULINA
206 1/31/2023 ID 6711 AGNES MIRA KUSUMA WARDANI
207 1/31/2023 ID 6711 FIRDHA ARIESTA IMELDA JUNIOR
208 1/31/2023 ID 6711 ICHA FRAMUHTY EFENDY
210 1/31/2023 ID 6711 AVELYA CAHYANDARI
211
212
213
214
215
216
217
218
219
220
221
222
223
224
225
226
MEDICAL EXAMINATION
Blood
Pressure
52128305 PIC 110/70 0 NORMAL

200953 FO 120/70 0 NORMAL
160564 SFA 100/70 0 NORMAL
163379 FA 100/70 0 NORMAL
172619 FA 110/80 0 NORMAL
191998 FA 100/70 0 NORMAL
201691 FA 100/70 0 NORMAL
172963 PIC 120/80 0 NORMAL
190481 FO 120/70 0 NORMAL
163108 SFA 110/70 0 NORMAL
181654 FA 110/80 0 NORMAL
182011 FA 110/80 0 NORMAL
193624 FA 110/70 0 NORMAL
201898 FA 100/70 0 NORMAL
162823 PIC 110/70 0 NORMAL
147158 FO 120/80 0 NORMAL
201532 SFA 110/70 0 NORMAL
212537 FA 100/70 0 NORMAL
193934 FA 110/70 0 NORMAL
181017 FA 110/80 0 NORMAL
212817 FA 100/70 0 NORMAL
150697 PIC 110/80 0 NORMAL
201107 FO 120/80 0 NORMAL
170768 SFA 100/80 0 NORMAL
201897 FA 110/80 0 NORMAL
213026 FA 120/80 0 NORMAL
213198 FA 110/70 0 NORMAL
221518 FA 110/70 0 NORMAL
52127459 PIC 120/80 0 NORMAL
201602 FO 110/70 0 NORMAL
170232 SFA 110/80 0 NORMAL
201683 FA 100/80 0 NORMAL
192121 FA 110/70 0 NORMAL
212533 FA 110/70 0 NORMAL
193615 FA 100/70 0 NORMAL
142530 PIC 120/80 0 NORMAL
201541 FO 120/80 0 NORMAL
163477 SFA 120/80 0 NORMAL
162836 FA 110/80 0 NORMAL
170764 FA 100/70 0 NORMAL
201689 FA 100/70 0 NORMAL
212332 FA 110/70 0 NORMAL
143482 PIC 120/80 0 NORMAL
182307 FO 120/70 0 NORMAL
170506 SFA 110/70 0 NORMAL
170611 FA 110/70 0 NORMAL
193862 FA 100/70 0 NORMAL
201898 FA 110/80 0 NORMAL
201797 FA 110/70 0 NORMAL
146286 PIC 120/70 0 NORMAL
201530 FO 120/80 0 NORMAL
153030 SFA 110/70 0 NORMAL
181638 FA 110/70 0 NORMAL
200442 FA 110/70 0 NORMAL
201786 FA 110/80 0 NORMAL
201693 FA 110/80 0 NORMAL
144244 PIC 130/80 0 NORMAL
180391 FO 120/80 0 NORMAL
170233 SFA 110/70 0 NORMAL
163379 FA 100/70 0 NORMAL
170775 FA 100/70 0 NORMAL
184698 FA 110/70 0 NORMAL
201784 FA 110/70 0 NORMAL
143482 PIC 110/80 0 NORMAL
172080 FO 120/80 0 NORMAL
151748 SFA 110/70 0 NORMAL
171796 FA 110/80 0 NORMAL
171481 FA 100/70 0 NORMAL
200749 FA 110/70 0 NORMAL
212034 FA 100/70 0 NORMAL
146844 PIC 120/80 0 NORMAL
171825 FO 120/80 0 NORMAL
170513 SFA 110/70 0 NORMAL
201259 FA 100/70 0 NORMAL
191673 FA 110/80 0 NORMAL
193336 FA 100/70 0 NORMAL
201909 FA 100/80 0 NORMAL
152886 PIC 120/80 0 NORMAL
171687 FO 120/80 0 NORMAL
170232 SFA 110/70 0 NORMAL
181018 FA 110/80 0 NORMAL
200456 FA 100/70 0 NORMAL
212537 FA 110/70 0 NORMAL
170775 FA 110/70 0 NORMAL
133020 PIC 120/80 0 NORMAL
193013 FO 120/80 0 NORMAL
162191 SFA 100/70 0 NORMAL
154970 FA 110/70 0 NORMAL
171797 FA 100/80 0 NORMAL
181316 FA 110/80 0 NORMAL
211846 FA 110/80 0 NORMAL
62092772 PIC 120/80 0 NORMAL
190484 FO 120/80 0 NORMAL
145002 SFA 110/70 0 NORMAL
170776 FA 100/70 0 NORMAL
180637 FA 110/80 0 NORMAL
201689 FA 110/70 0 NORMAL
201910 FA 100/70 0 NORMAL
180538 PIC 120/80 0 NORMAL
184726 FO 120/70 0 NORMAL
163362 SFA 110/70 0 NORMAL
201691 FA 100/80 0 NORMAL
201901 FA 100/70 0 NORMAL
213422 FA 120/80 0 NORMAL
201786 FA 110/80 0 NORMAL
152886 PIC 120/70 0 NORMAL
151950 FO 120/70 0 NORMAL
170759 SFA 110/80 0 NORMAL
183752 FA 100/80 0 NORMAL
193862 FA 110/80 0 NORMAL
201897 FA 100/70 0 NORMAL
221526 FA 110/70 0 NORMAL
131993 PIC 110/70 0 NORMAL
200953 FO 120/80 0 NORMAL
170768 SFA 110/70 0 NORMAL
191678 FA 100/70 0 NORMAL
201562 FA 110/70 0 NORMAL
201910 FA 100/80 0 NORMAL
201914 FA 110/80 0 NORMAL
52115981 PIC 120/80 0 NORMAL
180364 FO 120/80 0 NORMAL
170513 SFA 110/70 0 NORMAL
200704 FA 100/70 0 NORMAL
201913 FA 100/80 0 NORMAL
211839 FA 100/70 0 NORMAL
212533 FA 110/70 0 NORMAL
52128305 PIC 120/80 0 NORMAL
171626 FO 110/80 0 NORMAL
163370 SFA 110/70 0 NORMAL
191306 FA 100/80 0 NORMAL
193615 FA 100/70 0 NORMAL
212332 FA 110/70 0 NORMAL
201897 FA 110/70 0 NORMAL
133020 PIC 110/80 0 NORMAL
192959 FO 110/80 0 NORMAL
146359 SFA 100/70 0 NORMAL
171764 FA 100/70 0 NORMAL
193948 FA 100/70 0 NORMAL
194210 FA 110/80 0 NORMAL
193624 FA 110/80 0 NORMAL
52094826 PIC 130/80 0 PREHIPERTENSI
190486 FO 120/80 0 NORMAL
163108 SFA 100/70 0 NORMAL
193321 FA 110/70 0 NORMAL
200692 FA 110/70 0 NORMAL
201797 FA 110/80 0 NORMAL
212037 FA 100/70 0 NORMAL
131778 PIC 110/80 0 NORMAL
190487 FO 110/70 0 NORMAL
161878 SFA 110/80 0 NORMAL
200745 FA 100/70 0 NORMAL
201894 FA 110/70 0 NORMAL
201905 FA 100/70 0 NORMAL
201916 FA 100/70 0 NORMAL
52073448 PIC 120/80 0 NORMAL
201607 FO 120/70 0 NORMAL
161680 SFA 100/70 0 NORMAL
193625 FA 100/70 0 NORMAL
201685 FA 110/80 0 NORMAL
201694 FA 110/70 0 NORMAL
212830 FA 110/80 0 NORMAL
52115981 PIC 120/80 0 NORMAL
184726 FO 100/70 0 NORMAL
163477 SFA 120/80 0 NORMAL
180648 FA 100/80 0 NORMAL
191306 FA 110/70 0 NORMAL
181014 FA 110/70 0 NORMAL
193038 FA 100/70 0 NORMAL
150697 PIC 120/80 0 NORMAL
190484 FO 120/80 0 NORMAL
181015 SFA 100/70 0 NORMAL
201786 FA 120/80 0 NORMAL
221523 FA 110/70 0 NORMAL
201915 FA 110/70 0 NORMAL
147232 FA 100/70 0 NORMAL
180553 PIC 120/80 0 NORMAL
200273 FO 120/80 0 NORMAL
170766 SFA 110/70 0 NORMAL
193615 FA 100/80 0 NORMAL
221526 FA 100/70 0 NORMAL
212537 FA 110/70 0 NORMAL
170764 FA 110/70 0 NORMAL
146263 PIC 110/70 0 NORMAL
170348 FO 120/80 0 NORMAL
193862 SFA 110/80 0 NORMAL
200749 FA 110/70 0 NORMAL
212042 FA 100/70 0 NORMAL
192729 FA 100/80 0 NORMAL
171796 FA 110/70 0 NORMAL
141637 PIC 120/80 0 NORMAL
190487 FO 120/80 0 NORMAL
162414 SFA 110/80 0 NORMAL
201783 FA 100/70 0 NORMAL
200442 FA 100/70 0 NORMAL
181636 FA 100/70 0 NORMAL
194205 FA 100/70 0 NORMAL
144287 PIC 120/80 0 NORMAL
171824 FO 120/80 0 NORMAL
161447 SFA 110/80 0 NORMAL
181348 FA 110/70 0 NORMAL
163379 FA 110/70 0 NORMAL
173670 FA 100/80 0 NORMAL
193854 FA 100/70 0 NORMAL
133020 PIC 120/70 0 NORMAL
193023 FO 120/70 0 NORMAL
152082 SFA 110/70 0 NORMAL
184690 FA 110/70 0 NORMAL
222180 FA 110/70 0 NORMAL
201901 FA 100/70 0 NORMAL
201795 FA 100/70 0 NORMAL

TOTAL PILOT FA EOB

GRAND TOTAL
TOTAL PILOT FA EOB

MEKALUKAN ALCOHOL TEST 60 150
TIDAK MELAKUKAN ALCOHOL TEST 0 0
GRAND TOTAL
TOTAL PILOT FA EOB

NORMAL 58 150
HIPOTENSI 0 0
PRE HIPERTENSI 2 0
GRAND TOTAL

Remaks
Remaks
Remaks
MEDICAL EXAMINATION
AIRLINE : ID
DATE / MONTH : JANUARI 2023
LOCATION : STA.
Total
No Date Maintenance
check
1 1-Feb-23 4 1 0 1 0 5 0 7
2 2-Feb-23 5 1 0 1 0 5 0 7
3 3-Feb-23 5 1 0 1 0 5 0 7
4 4-Feb-23 6 1 0 1 0 5 0 7
5 5-Feb-23 5 1 0 1 0 5 0 7
6 6-Feb-23 4 1 0 1 0 5 0 7
7 7-Feb-23 6 1 0 1 0 5 0 7
8 8-Feb-23 5 1 0 1 0 5 0 7
9 9-Feb-23 5 1 0 1 0 5 0 7
10 10-Feb-23 5 1 0 1 0 5 0 7
G
R
A
P
11 11-Feb-23 6 1 0 1 0 5 0 7
H
12 12-Feb-23 5 1 0 1 0 5 0 7
I
C
13 13-Feb-23 4 1 0 1 0 5 0 7
R
E
F
L
I
14 14-Feb-23 5 1 0 1 0 5 0 7
G
H
T 15 15-Feb-23 5 1 0 1 0 5 0 7
H
E
A
L
16 16-Feb-23 5 1 0 1 0 5 0 7
T
H
C
17 17-Feb-23 5 1 0 1 0 5 0 7
H
18 18-Feb-23 5 1 0 1 0 5 0 7
E
C
K
A
T
S
19 19-Feb-23 5 1 0 1 0 5 0 7
T
A
. 20 20-Feb-23 4 1 0 1 0 5 0 7
C
G
K 21 21-Feb-23 4 1 0 1 0 5 0 7
D
U
R
I
22 22-Feb-23 5 1 0 1 0 5 0 7
N
23 23-Feb-23 6 1 0 1 0 5 0 7
G
A
P
R
I
L 24 24-Feb-23 5 1 0 1 0 5 0 7
2
0
2
2
25 25-Feb-23 6 1 0 1 0 5 0 7
26 26-Feb-23 6 1 0 1 0 5 0 7
27 27-Feb-23 5 1 0 1 0 5 0 7
28 28-Feb-23
29
30
31
TOTAL 136 27 0 27 0 135 0 189
y & Quality
MINATION
LTH CHECK LIST
NURSE
PAGI

B
D
D FLIGHT PIC SIC
D 136 27 27
D
D
D 12000
B
B 10000
B
D 8000
D
6000
B
B
4000
D
D 2000
D
B 0
FLIGHT PIC SIC
B
B
D
D
FA MAINTENANCE
135 189
Safe
Flight
No Date Name
Number
1 2/1/2023 ID 6711 YULIAN HOSPI LUCKI YANUAR
2 2/1/2023 ID 6711 ALDO ABIYOGA
3 2/1/2023 ID 6711 NURLIDAYNI FITRI
7 2/1/2023 ID 6711 NIDA ULCHUSNA
8 2/2/2023 ID 6711 M SATRIA AFANTI
11 2/2/2023 ID 6711 VINA RAHMA DIANTI
13 2/2/2023 ID 6711 MUHAMMAD JORDAN
14 2/2/2023 ID 6711 RESTIFANI WULAN RAHIMA
17 2/3/2023 ID 6711 FITRIANI
18 2/3/2023 ID 6711 NUR LAILY IFFAH SEPTIANI
20 2/3/2023 ID 6711 ANNISA SEPTIANI
21 2/3/2023 ID 6711 RESTIANA PEBRIANTI
22 2/4/2023 ID 6711 DANA AVIANTARA
26 2/4/2023 ID 6711 CYNTHIA KUSUMA DEWI
28 2/4/2023 ID 6711 AJENG RAHMAWATI
29 2/5/2023 ID 6711 MEMED ALIBASYAH
31 2/5/2023 ID 6711 MARIA DEWI CAHYANINGTYAS
33 2/5/2023 ID 6711 LENNY
34 2/5/2023 ID 6711 BRITIA RISKA KUSUMA WARDANI
35 2/5/2023 ID 6711 ELZHA ADELLYANI SETYANINGRUM
36 2/6/2023 ID 6711 HANSTIO STEYR
37 2/6/2023 ID 6711 GELDARAFI PERKASA
39 2/6/2023 ID 6711 CITRA NURFITRI IMANI
40 2/6/2023 ID 6711 RANI SARI INTAN
41 2/6/2023 ID 6711 LIA LIANA
42 2/6/2023 ID 6711 HELBI PARERUNGAN
46 2/7/2023 ID 6711 SUCI FITRIYANI
47 2/7/2023 ID 6711 SOFIA FITRIANA
48 2/7/2023 ID 6711 JIHAN AMALIAH
49 2/7/2023 ID 6711 OLGA ANDRIANI
50 2/8/2023 ID 6711 THEODORES EKO RACHMATDIONO
52 2/8/2023 ID 6711 SELLY BR SEMBIRING
54 2/8/2023 ID 6711 IKA DEWI KAHANI
55 2/8/2023 ID 6711 NOVIANI
56 2/8/2023 ID 6711 DIAZKA MAULIDA SUDARSONO
58 2/9/2023 ID 6711 HENDRO HADHI RUSMONO
64 2/10/2023 ID 6711 M AMRULLAH R
65 2/10/2023 ID 6711 IDA BAGUS DWIJA PUTRA
66 2/10/2023 ID 6711 SAFITA SHINTA DEWI
68 2/10/2023 ID 6711 HANNY CHANTIKA NOVIA
69 2/10/2023 ID 6711 ARISTOBAWA P M
71 2/10/2023 ID 6711 ARYANDRA SYAH ARWAN
72 2/10/2023 ID 6711 KEVIN FERLYANTO
73 2/10/2023 ID 6711 TANTRI NIRMALASARI PUTRI
76 2/10/2023 ID 6711 HANA MASITA
81 2/11/2023 ID 6711 NOVIANI
82 2/11/2023 ID 6711 SUKMADEWI
88 2/12/2023 ID 6711 NOVIANI
89 2/12/2023 ID 6711 SUKMADEWI
93 2/13/2023 ID 6711 REZA SIDIQ PRASETYA
94 2/13/2023 ID 6711 INDIRA CAHYANY
95 2/13/2023 ID 6711 NURUL JANAH
96 2/13/2023 ID 6711 INTANIA PERMATA SARI
98 2/13/2023 ID 6711 AYA CHANDRA
100 2/14/2023 ID 6711 MUHAMMAD DIANTAMA SUDIAR
102 2/14/2023 ID 6711 MAULIANA SUHADA
105 2/14/2023 ID 6711 KHALDA CHANTIKA
110 2/15/2023 ID 6711 LIYA SURYANI
112 2/15/2023 ID 6711 NOVIANI
114 2/16/2023 ID 6711 PUTRA AULIA RACHMAN
115 2/16/2023 ID 6711 SYARIFAH RADIAH
116 2/16/2023 ID 6711 YUFTARA ROSYANA MARETTA
120 2/17/2023 ID 6711 ALVA TAMPAN WULANO
121 2/17/2023 ID 6711 MARTHEN MATHEIS DONALD MUGUJAI
123 2/17/2023 ID 6711 BELLA SEPTIANA
124 2/17/2023 ID 6711 VIOLA MONALISA
125 2/17/2023 ID 6711 TRIHARTIKA DEWI
126 2/17/2023 ID 6711 MELISA ERVINA PONDAAG
127 2/18/2023 ID 6711 AJWAD SAID MAHMUD
129 2/18/2023 ID 6711 SARTIKA B
133 2/18/2023 ID 6711 SANIA PUTRI ALNINDITA
135 2/19/2023 ID 6711 MUHAMMAD FIKRI ARDRIAWAN
137 2/19/2023 ID 6711 LOUISA ESTER REHING SOLO
138 2/19/2023 ID 6711 AYA CHANDRA
139 2/19/2023 ID 6711 ANISA MUTIARAKITA
140 2/19/2023 ID 6711 CINDY SYAKINATUS SIVA
142 2/20/2023 ID 6711 PAUNDRA HERMAWAN
143 2/20/2023 ID 6711 MADE SHUSMA LARAS SHINTA
144 2/20/2023 ID 6711 NEVI NURPIAH
145 2/20/2023 ID 6711 SRI WAHYUNI ASRI
146 2/20/2023 ID 6711 TESSA LONIKA RIKIN
147 2/20/2023 ID 6711 KEIKO KEISHA
148 2/21/2023 ID 6711 MUHAMMAD FADIL INDRAYANTO
149 2/21/2023 ID 6711 NATALINO JOSHUA EKARISTO
150 2/21/2023 ID 6711 NURUL AWALIA RAMADHANI
152 2/21/2023 ID 6711 AMELIA MAHARANI
155 2/22/2023 ID 6711 DAMAR RISELPA
156 2/22/2023 ID 6711 MARCELL ABISHA GIOVANNI SITORUS
158 2/22/2023 ID 6711 NURUL JANAH
163 2/23/2023 ID 6711 YUDISTIRA PRATAMA
164 2/23/2023 ID 6711 SERVINDA APRILIA
165 2/23/2023 ID 6711 YOSI PUSPA DEWI
166 2/23/2023 ID 6711 ASTRI MAYLINDA
169 2/24/2023 ID 6711 ARI PRIYATMOKO
171 2/24/2023 ID 6711 NOVITA SARI
175 2/24/2023 ID 6711 M S ENDAH SARI PRIWATINI
177 2/25/2023 ID 6711 ADAM BRAMANTIO
178 2/25/2023 ID 6711 NABILA REGINA SYAHLA D
180 2/25/2023 ID 6711 ELSA LUVITA
182 2/25/2023 ID 6711 ZAHRA DWI UTAMI
184 2/26/2023 ID 6711 DENDY BAGUS PRATAMA
185 2/26/2023 ID 6711 INTAN PERTIWI
187 2/26/2023 ID 6711 AYA CHANDRA
192 2/27/2023 ID 6711 FELICIA R R V NIKIJULUW
193 2/27/2023 ID 6711 RESTIANA PEBRIANTI
195 2/27/2023 ID 6711 RARIN ANGGI ISMAYA
196 2/27/2023 ID 6711 DELSYA NUVHIKA RIZQIANY
197
198
199
200
201
202
203
204
205
206
207
208
209
210
211
212
213
214
215
216
217
218
219
220
221
222
223
224
225
226
MEDICAL EXAMINATION
Blood
Pressure
143471 PIC 110/80 0 NORMAL

201532 FO 120/80 0 NORMAL
143458 SFA 110/70 0 NORMAL
162836 FA 110/80 0 NORMAL
191002 FA 110/70 0 NORMAL
193615 FA 100/70 0 NORMAL
TMP222951 FA 100/70 0 NORMAL
147219 PIC 110/70 0 NORMAL
200953 FO 120/80 0 NORMAL
162823 SFA 110/70 0 NORMAL
193052 FA 100/80 0 NORMAL
201786 FA 110/80 0 NORMAL
220406 FA 120/70 0 NORMAL
201919 FA 120/70 0 NORMAL
172963 PIC 120/80 0 NORMAL
192959 FO 120/80 0 NORMAL
170766 SFA 110/70 0 NORMAL
173668 FA 110/70 0 NORMAL
201901 FA 100/70 0 NORMAL
TMP222864 FA 110/70 0 NORMAL
173035 FA 110/80 0 NORMAL
131778 PIC 110/80 0 NORMAL
200959 FO 120/80 0 NORMAL
163108 SFA 110/70 0 NORMAL
170611 FA 100/70 0 NORMAL
172066 FA 110/70 0 NORMAL
182725 FA 100/80 0 NORMAL
183747 FA 100/70 0 NORMAL
144680 PIC 120/80 0 NORMAL
192729 FO 110/70 0 NORMAL
171754 SFA 110/80 0 NORMAL
193615 FA 110/80 0 NORMAL
221523 FA 100/70 0 NORMAL
181014 FA 100/80 0 NORMAL
220162 FA 110/70 0 NORMAL
151945 PIC 120/80 0 NORMAL
201609 FO 120/70 0 NORMAL
170232 SFA 100/80 0 NORMAL
213245 FA 100/70 0 NORMAL
201902 FA 100/70 0 NORMAL
172234 FA 110/70 0 NORMAL
212027 FA 120/80 0 NORMAL
142232 PIC 120/80 0 NORMAL
182307 FO 110/80 0 NORMAL
172052 SFA 110/70 0 NORMAL
162395 FA 110/70 0 NORMAL
212038 FA 110/70 0 NORMAL
201895 FA 110/70 0 NORMAL
201685 FA 120/80 0 NORMAL
52040294 PIC 110/80 0 NORMAL
200277 FO 110/70 0 NORMAL
151636 SFA 110/80 0 NORMAL
193862 FA 110/70 0 NORMAL
220773 FA 110/70 0 NORMAL
221526 FA 120/80 0 NORMAL
221550 FA 120/80 0 NORMAL
52115981 PIC 110/80 0 NORMAL
193013 FO 120/80 0 NORMAL
141470 SFA 110/70 0 NORMAL
191673 FA 100/70 0 NORMAL
201691 FA 100/80 0 NORMAL
201786 FA 120/80 0 NORMAL
201916 FA 120/80 0 NORMAL
142230 PIC 110/80 0 NORMAL
171629 FO 120/70 0 NORMAL
170511 SFA 110/70 0 NORMAL
201692 FA 110/80 0 NORMAL
201894 FA 110/70 0 NORMAL
201253 FA 120/70 0 NORMAL
212537 FA 110/70 0 NORMAL
150693 PIC 120/80 0 NORMAL
180523 FO 120/70 0 NORMAL
163480 SFA 100/80 0 NORMAL
181003 FA 100/70 0 NORMAL
191306 FA 100/70 0 NORMAL
193616 FA 100/70 0 NORMAL
201905 FA 100/80 0 NORMAL
133025 PIC 120/80 0 NORMAL
182539 FO 120/80 0 NORMAL
170607 SFA 110/70 0 NORMAL
221526 FA 110/80 0 NORMAL
192116 FA 100/80 0 NORMAL
201917 FA 110/80 0 NORMAL
201681 FA 110/70 0 NORMAL
133025 PIC 120/80 0 NORMAL
182539 FO 120/80 0 NORMAL
170607 SFA 110/70 0 NORMAL
221526 FA 110/80 0 NORMAL
192116 FA 100/80 0 NORMAL
201917 FA 110/80 0 NORMAL
201681 FA 110/70 0 NORMAL
143482 PIC 120/80 0 NORMAL
201106 FO 110/80 0 NORMAL
162838 SFA 110/80 0 NORMAL
184700 FA 100/80 0 NORMAL
200047 FA 120/70 0 NORMAL
201786 FA 110/80 0 NORMAL
201689 FA 100/80 0 NORMAL
52128305 PIC 120/80 0 NORMAL
182544 FO 110/70 0 NORMAL
172052 SFA 100/70 0 NORMAL
181331 FA 100/70 0 NORMAL
191999 FA 110/80 0 NORMAL
201908 FA 110/70 0 NORMAL
212820 FA 110/70 0 NORMAL
133020 PIC 110/70 0 NORMAL
200959 FO 120/80 0 NORMAL
163108 SFA 110/70 0 NORMAL
200749 FA 100/70 0 NORMAL
184702 FA 100/70 0 NORMAL
193615 FA 110/80 0 NORMAL
221526 FA 100/80 0 NORMAL
150697 PIC 120/80 0 NORMAL
180902 FO 110/80 0 NORMAL
170357 SFA 110/70 0 NORMAL
182720 FA 100/70 0 NORMAL
193862 FA 100/80 0 NORMAL
212817 FA 110/70 0 NORMAL
201681 FA 110/70 0 NORMAL
143483 PIC 120/80 0 NORMAL
201612 FO 120/70 0 NORMAL
170235 SFA 100/70 0 NORMAL
181343 FA 110/70 0 NORMAL
182724 FA 100/80 0 NORMAL
193051 FA 110/70 0 NORMAL
212030 FA 100/70 0 NORMAL
144133 PIC 120/80 0 NORMAL
184709 FO 110/80 0 NORMAL
161679 SFA 110/70 0 NORMAL
182725 FA 100/70 0 NORMAL
193625 FA 110/70 0 NORMAL
201898 FA 100/80 0 NORMAL
220781 FA 100/70 0 NORMAL
150697 PIC 120/80 0 NORMAL
171627 FO 110/80 0 NORMAL
170618 SFA 110/70 0 NORMAL
194204 FA 120/80 0 NORMAL
201689 FA 100/70 0 NORMAL
213191 FA 100/70 0 NORMAL
TMP223014 FA 110/70 0 NORMAL
180553 PIC 130/80 0 NORMAL
183205 FO 130/80 0 NORMAL
182735 SFA 110/80 0 NORMAL
170773 FA 100/80 0 NORMAL
193953 FA 110/70 0 NORMAL
200710 FA 110/70 0 NORMAL
191669 FA 110/70 0 NORMAL
146212 PIC 120/80 0 NORMAL
171895 FO 110/80 0 NORMAL
170230 SFA 110/70 0 NORMAL
201691 FA 100/70 0 NORMAL
201907 FA 110/70 0 NORMAL
201909 FA 110/80 0 NORMAL
211846 FA 110/70 0 NORMAL
141637 PIC 120/80 0 NORMAL
193019 FO 120/70 0 NORMAL
162823 SFA 100/80 0 NORMAL
184700 FA 110/80 0 NORMAL
191999 FA 110/70 0 NORMAL
201897 FA 110/70 0 NORMAL
201915 FA 100/70 0 NORMAL
131779 PIC 110/70 0 NORMAL
183364 FO 120/80 0 NORMAL
153020 SFA 100/70 0 NORMAL
172617 FA 110/80 0 NORMAL
172631 FA 100/70 0 NORMAL
201570 FA 100/80 0 NORMAL
201785 FA 110/80 0 NORMAL
160893 PIC 130/80 0 NORMAL
200950 FO 120/80 0 NORMAL
146384 SFA 110/70 0 NORMAL
194197 FA 100/70 0 NORMAL
163379 FA 100/80 0 NORMAL
193934 FA 110/70 0 NORMAL
221551 FA 110/80 0 NORMAL
143482 PIC 120/80 0 NORMAL
184723 FO 120/80 0 NORMAL
161432 SFA 110/70 0 NORMAL
194205 FA 100/70 0 NORMAL
194200 FA 110/80 0 NORMAL
201680 FA 120/80 0 NORMAL
212042 FA 100/70 0 NORMAL
142231 PIC 120/80 0 NORMAL
201607 FO 120/80 0 NORMAL
141478 SFA 110/70 0 NORMAL
193862 FA 100/80 0 NORMAL
201689 FA 100/70 0 NORMAL
201786 FA 100/80 0 NORMAL
201898 FA 110/80 0 NORMAL
133025 PIC 110/70 0 NORMAL
200953 FO 120/80 0 NORMAL
151028 SFA 110/70 0 NORMAL
173035 FA 110/70 0 NORMAL
201901 FA 110/80 0 NORMAL
212536 FA 110/80 0 NORMAL
212591 FA 110/70 0 NORMAL

TOTAL PILOT FA EOB

GRAND TOTAL
TOTAL PILOT FA EOB

GRAND TOTAL
TOTAL PILOT FA EOB

NORMAL 61 155
HIPOTENSI 3 0
PRE HIPERTENSI 1 0
GRAND TOTAL

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Safety, Security & Quality

D 2 Total Crew Checked (PIC, SIC, and FA) 245

D 3 Total Maintenance Check (Morning & Night Shift) 245

PIC 120/80 - NORMAL FIT

06.50 WIB DINI AYU PERMATA SARI S.Tr.Keb

MELAKUKAN BLOOD PRESSURE 62 155

TOTAL PILOT FA EOB

TOTAL PILOT FA EOB

Kategori TDS (mmHg) TDD (mmHg)

D 2 Total Crew Checked (PIC, SIC, and FA) 218

B 3 Total Maintenance Check (Morning & Night Shift) 218

HT HEALTH CHECK AT STA. CGK DURING MAY 2022

PIC 120/80 - NORMAL FIT

06.50 WIB DINI AYU PERMATA SARI S.Tr.Keb

MELAKUKAN BLOOD PRESSURE 60 133

TOTAL PILOT FA EOB

TOTAL PILOT FA EOB

Kategori TDS (mmHg) TDD (mmHg)

B 2 Total Crew Checked (PIC, SIC, and FA) 211

B 3 Total Maintenance Check (Morning & Night Shift) 211

HT HEALTH CHECK AT STA. CGK DURING MAY 2022

52040296 PIC 120/80 - NORMAL

FIT 06.50 WIB DINI AYU PERMATA SARI S.Tr.Keb

MELAKUKAN BLOOD PRESSURE 61 150

TOTAL PILOT FA EOB

TOTAL PILOT FA EOB

Kategori TDS (mmHg) TDD (mmHg)

B 2 Total Crew Checked (PIC, SIC, and FA) 273

B 3 Total Maintenance Check (Morning & Night Shift) 273

HT HEALTH CHECK AT STA. CGK DURING MAY 2022

133022 PIC 120/80 - NORMAL

FIT 06.50 WIB DINI AYU PERMATA SARI S.Tr.Keb

MELAKUKAN BLOOD PRESSURE 61 150

TOTAL PILOT FA EOB

TOTAL PILOT FA EOB

Kategori TDS (mmHg) TDD (mmHg)

B 2 Total Crew Checked (PIC, SIC, and FA) 226

B 3 Total Maintenance Check (Morning & Night Shift) 226

HT HEALTH CHECK AT STA. CGK DURING MAY 2022

131994 PIC 110/70 - NORMAL

FIT 06.50 WIB BELLA YOLANDIA SARI S.Tr.Keb

MELAKUKAN BLOOD PRESSURE 62 164

TOTAL PILOT FA EOB

TOTAL PILOT FA EOB

Kategori TDS (mmHg) TDD (mmHg)

D 2 Total Crew Checked (PIC, SIC, and FA) 217

D 3 Total Maintenance Check (Morning & Night Shift) 217

HT HEALTH CHECK AT STA. CGK DURING MAY 2022

142530 PIC 120/80 - NORMAL

FIT 06.50 WIB DINI AYU PERMATA SARI S.Tr.Keb

MELAKUKAN BLOOD PRESSURE 62 155

TOTAL PILOT FA EOB

TOTAL PILOT FA EOB

Kategori TDS (mmHg) TDD (mmHg)

D 2 Total Crew Checked (PIC, SIC, and FA) 210

D 3 Total Maintenance Check (Morning & Night Shift) 210

HT HEALTH CHECK AT STA. CGK DURING MAY 2022

52128305 PIC 110/70 0 NORMAL

FIT 05.50 WIB DINI AYU PERMATA SARI S.Tr.Keb

MELAKUKAN BLOOD PRESSURE 60 150

TOTAL PILOT FA EOB

TOTAL PILOT FA EOB