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LAPORAN INSIDEN KESELAMATAN
formulir laporan insiden keselamatan
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tanggal insiden
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MM
/
DD
/
YYYY
waktu insiden
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Time
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lokasi ditemukannya insiden
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Unit terkait insiden
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Kronologi jadian
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tindak lanjut penanganan insiden
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seberapa sering insiden serupa terjadi
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kategori insiden
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grade insiden
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nama pelapor
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