Blanko Inspeksi Sanitasi Ttu.docx

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INSPEKSI SANITASI TEMPAT-TEMPAT UMUM DI SD/MI, SMP DAN SMA

Ruang Tanam SAB No

Jamban

Spal

Sampah

Kantin

Pencahayaan

CTPS Hijau

Nama Sekolah MS

TMS

MS

TMS

MS

TMS

MS

TMS

MS

TMS

MS

TMS

MS

TMS

KETERANGAN : 1. 2. 3. 4. 5. 6 7. 8.

Mengetahui, Pelaksana Sanitasi

(…….…….……………………………………….)

ADA

TIDAK

INSPEKSI SANITASI TEMPAT-TEMPAT UMUM DI PUSKESMAS WILAYAH KOTABUMI I

SAB No

Jamban

Spal

Wadah

Pencahayaan

Sampah

Nama Sekolah MS

TMS

MS

TMS

MS

TMS

MS

TMS

Cleaning Service

MS

TMS

ADA

TDK

MS

TMS

KETERANGAN : 1. 2. 3. 4. 5. 6 7. 8.

Mengetahui, Pelaksana Sanitasi

(…….…….……………………………………….)

ADA

TIDAK

BLANKO

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