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PENGGUNAAN LABORATORIUM KEPERAWATAN UPN "VETERAN" JAKARTA
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(USE OF THE NURSING LABORATORY AT UPN "VETERAN" JAKARTA)
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Hari, Tanggal Peminjaman (Day, Date of Loan):
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Hari, Tanggal Penggunaan (Day, Date of Use):
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Jam Penggunaan (Time of Use):
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Tutor/Semester/Program Studi (Study Program):
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Mata Kuliah/Posedur (Course/Procedure):
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Lab Yang digunakan (Lab Used):
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Tutor/Dosen (Lecture) :HP :
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Ketua Kelompok Mahasiswa (Student)
:HP :
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Penanggung Jawab Alat (Person in Charge of Equipment)
:HP :
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NONAMA ALAT YANG DIPINJAM (NAME OF BOROWED EQUIPMENT)JUMLAH (QUANTITY)KEADAAN (CONDITION)JUMLAH KEMBALI (Quantity returned)KETERANGAN (remarks)
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BAIK (good)RUSAK (damaged)KOTOR (dirty)
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Demikian kami sampaikan rencana pengguanaan Laboratorium seperti disebut di atas
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(Thus, we convey the plan for the use of the laboratory as mentioned above)
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Jakarta,........................................
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Mahasiswa (Student)
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Catatn kegiatan tersebut dapat dilaksanakan /tidak dapat dilaksanakan *dikarenakan (The activity record can/cannot be carried out due to)
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*coret yang tidak perlu (*Cross out what is not necessary)
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Berita Acara penggunaan laboratorium keperawatan diisi dan diserahkan minimal 1 hari sebelum pelaksanaan
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(The minutes of the use of the nursing laboratory must be filled out and submitted at least 1 day before the implementation)
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*isian ttd dapat menggunakan tanda tangan elektronik
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