Scribd Logo
Upload

Welcome to Scribd!

  • FRM-SFT-0101 Rev 3 Screening Form Guidance

    Uploaded by

    Febriana Kusumawati
    11 views1 page
    This document is a screening form used by PT. Techno Orbit Paticle Filtration to screen visitors for risk of novel coronavirus. It collects information such as the visitor's name, company, purpose of visit, date of arrival, area of origin, and number of people in their group. It also documents their temperature screening results and identifies the people responsible for the visitors during their visit. The form is prepared by the ASC responsible division and approved by the ASC plant director.

    Original Description:

    Original Title

    FRM-SFT-0101 rev 3 Screening Form Guidance

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Report this Document
    This document is a screening form used by PT. Techno Orbit Paticle Filtration to screen visitors for risk of novel coronavirus. It collects information such as the visitor's name, company, purpose of visit, date of arrival, area of origin, and number of people in their group. It also documents their temperature screening results and identifies the people responsible for the visitors during their visit. The form is prepared by the ASC responsible division and approved by the ASC plant director.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    11 views1 page

    FRM-SFT-0101 Rev 3 Screening Form Guidance

    Uploaded by

    Febriana Kusumawati
    This document is a screening form used by PT. Techno Orbit Paticle Filtration to screen visitors for risk of novel coronavirus. It collects information such as the visitor's name, company, purpose of visit, date of arrival, area of origin, and number of people in their group. It also documents their temperature screening results and identifies the people responsible for the visitors during their visit. The form is prepared by the ASC responsible division and approved by the ASC plant director.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    of 1

    Appendix - 4

    FORMULIR SKRINING No : FRM-SFT-0101


    KEWASPADAAN VIRUS NOVEL CORONA Rev. :3
    ( Screening form Date : June 15, 2020
    vigilance of novel corona viruses ) Page : 1 of 1

    Identitas Perusahaan/Pengunjung (visitor data), Filled by ASC Responsible Division


    Perusahaan (Company Name) PT. Techno Orbit Paticle Filtration
    :
    Alamat Perusahaan (company Address)
    : Jl. Jababeka IV E Blok V No 78Q

    Jababeka 1, Cikarang Utara

    Bekasi, 17534 - Indonesia


    Nomor Telp (phone number)
    : 0811 9525 156
    Pimpinan Perusahaan (Company Director)
    : Ignatius Martin Winoto
    Tujuan kedatangan (Visiting purpose) Measurment Screening, BSTR & Trays
    :
    Tanggal Kedatangan (Arrival date)
    : 23 September 2021
    Y N
    Datang dari Daerah (arrived from area) Cikarang & Cilegon
    : Red zone x

    Datang dari Negara (arrived from country)


    : Indonesia
    Lama kunjungan (Visit duration)
    :1 Hari
    Jumlah Orang (Number of Person)
    : 5 Orang
    Nama Penanggung jawab dilokasi (PIC at ASC Site )
    : Zaid Abdullah
    Jabatan (position)
    : Marketing Manager
    ID Kepegawaian (employee id)
    :-
    No. KTP/Passpor (id card/passpor number)
    : 3672 0111 0184 0004
    Penanggung Jawab PT. ASC (ASC PIC) Ammar Zulhan
    :

    Departemen (Department) : VCM 3

    Prepared by, Approved by,

    ( ____________________ ) ( _______________________ )
    ASC Resp. Division Mgr. Upward ASC Plant Director/Vice Plant Director

    You might also like