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    FORM PE KERACUNAN PANGAN (Form Kosong)

    Uploaded by

    Shinta Nasir
    Blanko Penyelidikan Epidemiologi Keracunan Pangan

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd

    FORM PE KERACUNAN PANGAN (Form Kosong)

    Uploaded by

    Shinta Nasir
    19 views1 page
    Blanko Penyelidikan Epidemiologi Keracunan Pangan

    Original Title

    FORM PE KERACUNAN PANGAN (form kosong)

    Copyright

    © © All Rights Reserved

    Available Formats

    DOCX, PDF, TXT or read online from Scribd

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    Blanko Penyelidikan Epidemiologi Keracunan Pangan

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    19 views1 page

    FORM PE KERACUNAN PANGAN (Form Kosong)

    Uploaded by

    Shinta Nasir
    Blanko Penyelidikan Epidemiologi Keracunan Pangan

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    You are on page 1of 1

    FORMULIR PENCATATAN

    LAPORAN KEWASPADAAN KERACUNAN PANGAN

    Nama pelapor :
    Nomor telp :
    Alamat :
    Melaporkan pada hari :
    Terdapat kejadian keracunan pangan :
    Lokasi / Tempat Kejadian :
    Desa/Kelurahan :
    Kecamatan :
    Kabupaten / Kota :
    Provinsi :
    Pangan diduga penyebab :
    a. Jumlah korban sakit ....... Orang
    b. Jumlah korban meninggal ...... Orang
    Gejala-gejala yang ditemui adalah antara lain :
    Pusing ( ) Diare ( )
    Sakit Perut ( ) Pingsan ( )
    Mual ( ) .............. ( )
    Muntah ( ) .............. ( )
    Demikian laporan ini dibuat.

    Curup, ...................................
    Pelapor
    Nama Jelas :
    No Telp :
    Alamat :

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