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Borang Laporan Kes Keracunan Makanan 2010

Borang Laporan Kes Keracunan Makanan 2010

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Published by: Anita Lee on Mar 16, 2012
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LAPORAN PPD

LAPORAN KES KERACUNAN
Pejabat Pelajaran Daerah : HULU LANGAT
1. Tajuk Berita / Aduan Bertulis / Lisan :
2. Tarikh :
3. Puna !aklu"at :
4. Keratan Akbar /La#$ran :
5. Na"a Sek$lah :
6. Ala"at :
7. Tele%$n:
8. Bilan&an "urid terlibat :
9. La#$ran sisatan :

''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''
10. Da#atan siasatan :
''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''
''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''
''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''
11. Tindakan (an& dilaksanakan :
''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''
''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''
''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''
Disediakan $leh: Disahkan $leh:
)))))))))))))))**
)))))))))))))
PPD + ,E! - Pe&a.ai PPD
La#$ran ini hendaklah dihantar ke#ada /abatan Pelajaran Ne&eri bersa"a la#$ran dari#ada sek$lah den&an kadar
se&era*
LAPORAN SEKOLA,
LAPORAN KES KERACUNAN
Sek$lah :''''''''''''''''''''''''''''''''''''''''''''' Tele%$n
:'''''''''''%a0:'''''''''''
Daerah :''''''''''''''''''''''''''''''''''''''''''''' Tele%$n
:'''''''''''%a0:'''''''''''
Tarikh:'''''''''''' ,ari :''''''''''' !asa
Kejadian:'''''''''''''''''''
Bilan&an terlibat : + La"#iran A -
La#$ran te"udu&a "urid terlibat : + La"#iran B -
Puna : ''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''
''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''
Kr$n$l$&i Kejadian :
''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''
''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''
''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''
Da#atan siasatan :
''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''
''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''
''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''
Tindakan (an& dilaksanakan :
''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''
''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''
''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''
Disediakan $leh: Disahkan $leh:
)))))))))))))))**
)))))))))))))
PK + ,E! - Pen&etua/1uru Besar
La#$ran ini hendaklah dihantar ke#ada /abatan Pelajaran Ne&eri bersa"a la#$ran dari#ada sek$lah den&an kadar
se&era*
LA!P2RAN A
SENARA2 NA!A !UR2D 3AN1 TERL2BAT
B2L NA!A PENU, KELAS /ANT2NA
LA!P2RAN B
LAPORAN TE!UDU1A !UR2D TERL2BAT
NA!A !UR2D : KELAS:
NA!A !UR2D : KELAS:
NA!A !UR2D : KELAS:
NANA!A !UR2D : KELAS:
NA!A !UR2D : KELAS:
NA!A !UR2D : KELAS:
2D :
• S2LA BUAT LA!P2RAN TA!BA,AN /2KA PERLU

………………………………… PPD ( HEM ) Pegawai PPD Laporan ini hendaklah dihantar kepada Jabatan Pelajaran Negeri bersama laporan daripada sekolah dengan kadar segera.……………………………………….. LAPORAN SEKOLAH LAPORAN KES KERACUNAN Sekolah :_____________________________________________ Telefon :___________fax:___________ Daerah :_____________________________________________ Telefon :___________fax:___________ Tarikh:____________ Kejadian:___________________ Hari :___________ Masa Bilangan terlibat : ( Lampiran A ) Laporan temuduga murid terlibat : ( Lampiran B ) Punca : ______________________________________________________________________________ ____________________________________________________________________________________ Kronologi Kejadian : ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ Dapatan siasatan : ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ Tindakan yang dilaksanakan : ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ .

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