Anonymous

FRST#2018

FRST#18

Use this Template

Print as PDF

Use this Template

Title Page

SKPD Pengguna Anggaran
Nama Gedung Pemda
Dilaksanakan Tanggal
SKPD Pelaksana Survey
Lokasi Gedung
Petugas Survey

FORM SURVEY REHAB TOTAL SEKOLAH TAHUN 2018

Nama Sekolah
Foto Papan Nama Sekolah
Foto Sekolah dari Depan
Foto Sekolah dari Samping
Foto Sekolah dari Belakang

FOTO-FOTO KERUSAKAN

Foto Kerusakan Pondasi
Foto Kerusakan Kolom Vertikal
Foto Kerusakan Balok Horisontal
Foto Kerusakan Plat Lantai (Slab)
Foto Atap Rusak Berat
Dari Observasi Visual, kesimpulannya adalah:

Tanda Tangan

Petugas Survey
Petugas Survey
Petugas Survey
Petugas Survey
Kepala Sekolah

Anonymous

FRST#2018

FRST#18

Use this Template

Print as PDF

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.