OPP-F-SHE-28J Formulir Inspeksi Responder Bag.xlsx

	A	B	C	D	E	F	G	H
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2			FORMULIR PEMERIKSAAN & PERAWATAN RESPONDERBAG				No. Dokumen	: OPP-F-SHE-28J
3							Revisi	: 0
4							Tgl Efektif	: 01 Juli 2024
5							Halaman	: 1 DARI 1
6	Site/Lokasi		:
7	Periode Tahun		:
8	Bulan
9	NO	ITEM		JUMLAH	KONDISI		Keterangan
10	NO	ITEM		JUMLAH	Baik	Rusak	Keterangan
11	1	TOURNIQUET		1
12	2	PLASTER NON WOVEN 5X1		4
13	3	KASA HIDROFIL 5 CM		20
14	4	KASA HIDROFIL 10 CM		5
15	5	INFUSION SET		2
16	6	NASA OXYGEN CANULA		3 set
17	7	GELAS CUCI MATA		2
18	8	BPM/AMUBACK		1
19	9	RESERVOIR BPM/AMUBACK		1
20	10	REFLEX HAMMERS		1 pcs
21	11	MASKER AMUBACK		1 pcs
22	12	NECKCOLLAR		1 pcs
23	13	COTTON BALL		1 pcs
24	14	KASA STERIL		1 pcs
25	15	POCKET MASK		2 pcs
26	16	COM INSTRUMAN		1 pcs
27	17	BENGKOK		1 pcs
28	18	SURIGIKAL BLADE 11		11 pcs
29	19	SURIGIKAL BLADE 10		19 pcs
30	20	SYRIGGE 1 ML		1 pcs
31	21	SYRIGGE 50 ML		1 pcs
32	22	SYRIGGE 5 ML		1 pcs
33	23	SYRIGGE 20 ML		1 pcs
34	24	SYRIGGE 10 ML		1 pcs
35	25	JARUM IMPUS 3W		3 pcs
36	26	PINSET ANATOMI		1 pcs
37	27	PINSET SIRULGIS		1 pcs
38	28	GUNTING CLAM		1 pcs
39	29	GUNTING PERBAN		1 pcs
40	30	GUNTING		1 pcs
41	31	SCAPLE HANDLE NO 3		1 pcs
42	32	SCAPLE HANDLE NO 4		1 pcs
43	33	PLASTER ROLL		1 pcs
44	34	AKOHOL SWAB		1 pcs
45	35	GOW		1 pcs
46	36	MITELA		1 pcs
47	37	CATGUT CHROMIC		1 pcs
48	38	GUEDEL AIRWAY ISO 8		1 pcs
49	39	GUEDEL AIRWAY ISO 5,5		1 pcs
50	40	LATEX		1 pcs
51	41	ANTI SEPTIK 70%		1 pcs
52	42	BITADIN 60%		1 pcs
53	43	PLASTIK CLIP 8,7X13		1 pcs
54	44	GUEDEL AIRWAY ISO 10		1 pcs
55	45	ANSAPLAS STERIL		1 pcs
56	Catatan : Centang (V) jika kondisi baik, Strip (-) jika kondisi tidak baik, N/A jika Not Applicable
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58	Diinspeksi Oleh			Diperiksa Oleh		Disetujui Oleh
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63	Emergency Response Team			GL ERT		Sect Head SHE
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