Title Page
-
Nama / Name
-
No ID / ID Number
-
Departemen / Departmen
- SKM
- PP
- SIS
- QA
- FL
- FMS
- Pilot Plat
- SDC
- NSD
- Other
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Grup / Group
- A
- B
- C
- D
- Non Group
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Shift
- 1
- 2
- 3
- Non Shift
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Jenis Laporan / Type Of Report
- Sumber Bahaya / Hazard
- Nyaris Celaka / Nearmiss
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Lokasi / Location
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Isi Laporan / Detailed Report
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Foto (Jika Ada) / Photograph (If Any)