Form Inspeksi K3.docx

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KEMENTERIAN PENDIDIKAN NASIONAL POLITEKNIK PERKAPALAN NEGERI SURABAYA Jl. Teknik Kimia, Kampus ITS, Sukolilo – Surabaya 60111 Telp. (031) 5947186, 5942887 Fax (031) 5942887 Laman : www.ppns.ac.id Form : 005/TANGGA_PERANCAH/K3_PPNS/2019 Lokasi : Nama Pekerja :

Kelompok

Dosen

Pekerjaan

:

: 1.

Lokasi

:

2.

Waktu

:

3.

Nama Pengamat :

: Dewi Kurniasih, dr., S.KM., M.Kes

Tangga Perancah (Scaffolding) Permenakertrans Nomor 1 Tahun 1980 tentang K3 Konstruksi Bangunan No.

Tangga Perancah

Ya

Tidak

Keterangan

1

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