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Form Checksheet Absensi & Kesehatan Driver
Tensi & Suhu
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Nama Driver : *
Lokasi Area Kerja : *
Pilih Lokasi Poliklinik :
Masukan Hasil Cek Tensi di Poliklinik :
Contoh : 100/70
Masukan Hasil Cek Suhu di Poliklinik :
Contoh : 36,5
Masukan Hasil Cek Berat Badan di Poliklinik : *
Contoh : 80 Kg
Masukan Hasil Cek Tinggi Badan di Poliklinik : *
Contoh : 170 cm
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