| A | B | C | D | E | F | G | H | |
|---|---|---|---|---|---|---|---|---|
1 | RUMAH SAKIT UMUM DAERAH AJI MUHAMMAD PARIKESIT | |||||||
2 | INSTALASI CSSD | |||||||
3 | ||||||||
4 | website: rsamp.kukarkab.go.id email : rsudamparikesit@yahoo.com | |||||||
5 | ||||||||
6 | INSTRUMENT CHECKLIST | |||||||
7 | Jalan Ratu Agung No . 1 ( (0541) 661013 - 661015 Tenggarong Seberang | |||||||
8 | ||||||||
9 | Tanggal Sterilisasi | 8/3/2026 | ||||||
10 | Jam | |||||||
11 | ||||||||
12 | No | Nama Item Instrument | Jumlah | Petugas Pemeriksa | Keterangan | |||
13 | Sorting Washing | Packing | Perawat Instrument | |||||
14 | 1 | Gunting Perban | 1 | |||||
15 | 2 | Gunting Aff Hecting | 1 | |||||
16 | 3 | Pinset Anatomis | 1 | |||||
17 | 4 | Pinset Sirugis | 1 | |||||
18 | Total | 4 | ||||||
19 | ||||||||
20 | Petugas Pemeriksa | Nama Terang | TTD | |||||
21 | Sorting Washing | |||||||
22 | Packing | |||||||
23 | Perawat Instrument | |||||||
24 | ||||||||
25 | Catatan : | |||||||
26 | ||||||||
27 | ||||||||
28 | ||||||||
29 | Apabila alat tidak sesuai dengan checklist, segera kembalikan kepada petugas CSSD. | |||||||
30 | ||||||||