ABCDEFGHIJKLMNOPQRSTUVWXYZ
1
 PEMERINTAH KABUPATEN LAMONGAN
2





RUMAH SAKIT UMUM DAERAH KARANGKEMBANG
3
Jl. Raya - Jombang Km. 2 Babat, Lamongan, Jawa Timur 62271
4
Telepon (0322) 4651378, Faksimile (0322) 4651378,Pos-el rsudkarangkembang@gmail.com
5
Laman : www.lamongankab.go.id
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7
FORMAT AUDIT KEPATUHAN CUCI TANGAN
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Ruang : Security
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Periode : JANUARI
11
NoTanggalNama PetugasRuangan5 Momen Cuci Tangan6 Langkah Cuci TanganWaktuNumDenum%
12
12345123456Handrub (20 -30 detik)Handwash (40-60 detik)
13
101/01/2026Ghulam FauzySECURITY11100%
14
202/01/2026Ghulam FauzySECURITY11100%
15
302/01/2026Agus TribiantoSECURITY11100%
16
403/01/2026Ghulam FauzySECURITY11100%
17
504/01/2026Ghulam FauzySECURITY11100%
18
605/01/2026Ghulam FauzySECURITY11100%
19
706/01/2026Agus TribiantoSECURITY11100%
20
806/01/2026Ghulam FauzySECURITY11100%
21
907/01/2026Ghulam FauzySECURITY11100%
22
1007/01/2026Ghulam FauzySECURITY11100%
23
1108/01/2026Agus TribiantoSECURITY11100%
24
1208/01/2026Ghulam FauzySECURITY11100%
25
1309/01/2026Ghulam FauzySECURITY11100%
26
1410/01/2026Ghulam FauzySECURITY11100%
27
1511/01/2026Ghulam FauzySECURITY11100%
28
1612/01/2026Ghulam FauzySECURITY11100%
29
1713/01/2026Ghulam FauzySECURITY11100%
30
1814/01/2026Ghulam FauzySECURITY11100%
31
1915/01/2026Ghulam FauzySECURITY11100%
32
2016/01/2026Ghulam FauzySECURITY11100%
33
2117/01/2026Ghulam FauzySECURITY11100%
34
2217/01/2026Agus TribiantoSECURITY11100%
35
2318/01/2026Agus TribiantoSECURITY11100%
36
2419/01/2026Agus TribiantoSECURITY11100%
37
2520/01/2026Agus TribiantoSECURITY11100%
38
2621/01/2026Agus TribiantoSECURITY11100%
39
2721/01/2026Ghulam FauzySECURITY11100%
40
2822/01/2026Ghulam FauzySECURITY11100%
41
2923/01/2026Ghulam FauzySECURITY11100%
42
3024/01/2026Agus TribiantoSECURITY11100%
43
3125/01/2026Agus TribiantoSECURITY11100%
44
3225/01/2026Ghulam FauzySECURITY11100%
45
3226/01/2026Ghulam FauzySECURITY11100%
46
3227/01/2026Ghulam FauzySECURITY11100%
47
3228/01/2026Ghulam FauzySECURITY11100%
48
3229/01/2026Ghulam FauzySECURITY11100%
49
3230/01/2026Agus TribiantoSECURITY11100%
50
3231/01/2026Agus TribiantoSECURITY11100%
51
JUMLAH3434100%
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53
Keterangan :
Auditor
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Jika dilaksanakan beri tanda (√)
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Jika tidak dilaksanakan beri tanda (-)
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Jika tidak ada pelunag beri tanda (x)
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Patuh = 1
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Tidak Patuh = 0
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Kepatuhan Cuci tangan =
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Numerator (Jumlah kepatuhan cuci tangan yang dilaksanakan)x 100%
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Denumerator( Jumlah peluang kegiatan cuci tangan yang diobservasi)
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Target >85%
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perhari 3 orang
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65
 PEMERINTAH KABUPATEN LAMONGAN
66





RUMAH SAKIT UMUM DAERAH KARANGKEMBANG
67
Jl. Raya - Jombang Km. 2 Babat, Lamongan, Jawa Timur 62271
68
Telepon (0322) 4651378, Faksimile (0322) 4651378,Pos-el rsudkarangkembang@gmail.com
69
Laman : www.lamongankab.go.id
70
71
FORMAT AUDIT KEPATUHAN CUCI TANGAN
72
Ruang : Security
73
Periode : FEBRUARI
74
NoTanggalNama PetugasRuangan5 Momen Cuci Tangan6 Langkah Cuci TanganWaktuNumDenum%
75
12345123456Handrub (20 -30 detik)Handwash (40-60 detik)
76
101/02/2026Ghulam FauzySECURITY11100%
77
202/02/2026Ghulam FauzySECURITY11100%
78
303/02/2026Ghulam FauzySECURITY11100%
79
404/02/2026Ghulam FauzySECURITY11100%
80
505/02/2026Ghulam FauzySECURITY11100%
81
606/02/2026Ghulam FauzySECURITY11100%
82
707/02/2026Ghulam FauzySECURITY11100%
83
808/02/2026Ghulam FauzySECURITY11100%
84
909/02/2026Agus TribiantoSECURITY11100%
85
1010/02/2026Agus TribiantoSECURITY11100%
86
1111/02/2026Agus TribiantoSECURITY11100%
87
1212/02/2026Agus TribiantoSECURITY11100%
88
1313/02/2026Ghulam FauzySECURITY11100%
89
1414/02/2026Ghulam FauzySECURITY11100%
90
1515/02/2026Ghulam FauzySECURITY11100%
91
1616/02/2026Ghulam FauzySECURITY11100%
92
1717/02/2026Ghulam FauzySECURITY11100%
93
1818/02/2026Ghulam FauzySECURITY11100%
94
1919/02/2026Ghulam FauzySECURITY11100%
95
2020/02/2026Ghulam FauzySECURITY11100%
96
2121/02/2026Ghulam FauzySECURITY11100%
97
2222/02/2026Agus TribiantoSECURITY11100%
98
2323/02/2026Ghulam FauzySECURITY11100%
99
2424/02/2026Agus TribiantoSECURITY11100%
100
2525/02/2026Agus TribiantoSECURITY11100%