Formulir I Laporan Penyimpangan Dan Tindakan Yang Telah Diambil

 

H`rcubdr D

BGU@[GF UIFTDCUGFNGF MGF ]DFMGLGF TGFN ]IBGA MDGCKDB

Uifydcpgfngf F` :  Fgcg Ur`mul/Ur`sis/Uicirdlsggf/_dstic/Gbgt Ur`mul/Ur`sis/Uicirdlsggf/_dstic/Gbgt :  F`. Kits : ]gfnngb tirjgmd pifydcpgfngf : [dfodgf pifydcpgfngf ygfn tirjgmd :

[dfodgf tdfmglgf siciftgrg ygfn tibga mdgckdb :

[dsdl` tiragmgp cutu, ligcgfgf, mgf ihiltdhdtgs `kgt trgmdsd`fgb ]dfnnd/lrdtds : Cififnga :

[ifmga :

Ogtgtgf: Ur`sis agrus mdaiftdlgf sgcpgd tdfmglgf bikda bgfjut mdtitgplgf mgf mdsitujud Gpglga gmg kits gtgu pr`mul bgdf ygfn tirlifg dckgsfyg 0 Jibgslgf kdbg yg :

Tg

]dmgl  

Uibgp`r 

 Fgcg :

…………………………

]gfmgtgfngf :

…………………

]gfnngb : ………………………

]gfmgtgfngf :

…………………

]gfnngb : ………………………

L``rmdfgt`r Mdvdsd (Yfdt Kirsgfnlutgf)

 Fgcg :

…………………………

H`rcubdr D

 

BGU@[GF UIFTDCUGFNGF MGF ]DFMGLGF TGFN ]IBGA MDGCKDB

Ivgbugsd ]iragmgp Bgp`rgf, ]dfmglgf mgf [isdl` :

L``rmdfgt`r Mdvdsd Uicgstdgf Cutu :

 Fgcg :

…………………………

Jifds Uifydcpgfngf :

]gfmgtgfngf :

…………………

]gfnngb : ………………………

]dfnlgt [dsdl` :

Kits

]dfnnd

 F`f-Kits

Cififnga

cds. : sgrgfg pifufjgfn

[ifmga

Ogtgtgf :