Formulir Laporan Tumpahan Dan Paparan B3 [PDF]

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RUMAH SAKIT GRAHA HERMINE Komplek Ruko Asih Raya No. 06-15 Batu Aji, Batam Telp : (0778)363 318,363127. Fax :(0778) 363164. Email :[email protected]



Laporan Kejadian Tumpahan dan Paparan Bahan Berbahaya dan Beracun (B3) RAHASIA, TIDAK BOLEH DIFOTOCOPY, DILAPORKAN MAXIMAL 2 x 24 JAM RINCIAN KEJADIAN 1. Nama yang terkena paparan: ......................................................................................................................................... 2. Unit kerja: .................................................................................................................................... 3. Tanggal dan Waktu Insiden Tanggal : ........................................................................................ Jam ...................................... 4. Lokasi : ....................................................................................................................................... 5.



Jenis Bahan: ...............................................................................................................................



6. Kronologis Kejadian ....................................................................................................................................................... ....................................................................................................................................................... ....................................................................................................................................................... ....................................................................................................................................................... ....................................................................................................................................................... 7. Tindakan yang dilakukan setelah kejadian: ....................................................................................................................................................... ....................................................................................................................................................... ....................................................................................................................................................... ....................................................................................................................................................... .......................................................................................................................................................



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Tgl terima



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