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Formulir A berisi surat pengantar dengan nomor, klasifikasi, lampiran, perihal, tujuan pengiriman, serta ringkasan kejadian dan identitas korban. Formulir B menyajikan identitas pelapor, rincian peristiwa (waktu, tempat, apa yang terjadi), identitas korban, waktu saat dilaporkan, serta bagian persetujuan dan pemeriksaan oleh komandan serta pemeriksa.",{"@graph":51,"@context":106},[52,68,89],{"@type":53,"itemListElement":54},"BreadcrumbList",[55,59,62,65],{"item":56,"name":57,"@type":58,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":60,"name":10,"@type":58,"position":61},"https://docshare.wps.com/id/template/",2,{"item":63,"name":15,"@type":58,"position":64},"https://docshare.wps.com/id/template/formulir/",3,{"item":66,"name":47,"@type":58,"position":67},"https://docshare.wps.com/id/template/work-accident-incident-report-appendix-a-b/175460/",4,{"url":66,"name":47,"@type":69,"image":70,"author":75,"headline":47,"publisher":78,"fileFormat":81,"inLanguage":45,"description":49,"dateModified":82,"datePublished":83,"encodingFormat":81,"isAccessibleForFree":84,"interactionStatistic":85},"DigitalDocument",{"url":71,"@type":72,"width":73,"height":74},"https://docshare.wps.com/thumbnails/work-accident-incident-report-appendix-a-b/175460.png","ImageObject",442,249,{"name":76,"@type":77},"Margaret","Person",{"url":56,"name":79,"@type":80},"DocShare","Organization","application/vnd.openxmlformats-officedocument.wordprocessingml.document","2026-09-19","2026-09-02",true,{"@type":86,"interactionType":87,"userInteractionCount":67},"InteractionCounter",{"@type":88},"ViewAction",{"@type":90,"mainEntity":91},"FAQPage",[92,98,102],{"name":93,"@type":94,"acceptedAnswer":95},"Apa perbedaan fungsi Formulir A dan Formulir B dalam laporan kecelakaan kerja?","Question",{"text":96,"@type":97},"Formulir A berfungsi sebagai surat pengantar/laporan ringkas yang ditujukan kepada pihak tertentu, sedangkan Formulir B memuat rincian terstruktur kejadian, identitas pelapor, dan identitas korban beserta waktu pelaporan.","Answer",{"name":99,"@type":94,"acceptedAnswer":100},"Informasi apa saja yang harus diisi untuk identitas korban pada Formulir A?",{"text":101,"@type":97},"Formulir A meminta data seperti nama, pangkat/golongan, NRP/NIP, nomor KTP, kesatuan, dan alamat.",{"name":103,"@type":94,"acceptedAnswer":104},"Bagian apa saja yang terdapat pada Formulir B setelah uraian peristiwa dilaporkan?",{"text":105,"@type":97},"Formulir B mencantumkan identitas korban dan waktu saat dilaporkan, kemudian bagian tanda mengetahui oleh Komandan Satuan (nama, pangkat, NRP) serta Pemeriksa (nama, pangkat, NRP) beserta kota dan tanggal.","https://schema.org",{"og:url":66,"og:type":108,"og:title":47,"og:site_name":79,"og:description":49},"article",{"robots":110,"canonical":66},"index,follow",{"doc_id":112,"site_id":44},175460,1788320289,{"code":4,"msg":5,"data":115},{"doc_id":112,"user_id":116,"nickname":76,"user_avatar":117,"doc_module":9,"category_id":14,"category_name":15,"doc_title":47,"doc_description":49,"doc_content":118,"file_id":119,"file_url":120,"file_type":121,"file_size":122,"view_count":67,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":64,"language":123,"language_code":45,"site_id":44,"html_lang":45,"table_of_contents":124,"faqs":125,"seo_title":126,"seo_description":49,"update_tm":113,"read_time":9},137451207643,"https://ap-avatar.wpscdn.com/davatar_3d24733baf745e90a7e4bdd5f77d97b2","FORMULIR A\nKOP SATUAN\nKota ,      bulan tahun\nNomor \t: B /         /    / 20…\nKlasifikasi \t: Biasa\nLampiran \t: ..... lembar\nPerihal \t: Laporan Kejadian Kecelakaan Kerja\n.........................................\n.........................................\n........................................           \t\tKepada\nYth.    Dirut PT ASABRI (Persero)\nJl. Mayjen Sutoyo No.11\nJakarta Timur, 13630\nNo. Telp (021) 8094140\nNo. Fax (021) 8012313\nUp. Kepala Divisi Pelayanan\nDengan ini dilaporkan bahwa telah terjadi kecelakaan Kerja karena Dinas pada tanggal .................................... pukul ....................... atas :\nNama \t\t\t:\nPangkat/Gol\t\t:\nNRP/NIP\t\t:\nNo. KTPA\t\t:\nKesatuan\t\t:\nAlamat\t\t:\nBerita Acara Kejadian Kecelakaan Kerja tersebut disampaikan sebagaimana terlampir.\nDemikian mohon menjadi periksa dan penyelesaian lebih lanjut.\nFORMULIR B\nKOP SATUAN\nLAPORAN KEJADIAN KECELAKAAN KERJA\nNomor LKKK/............/.../20…\nYANG MELAPORKAN\nNama Lengkap\t:\t....................................................................................\nTempat/Tanggal Lahir\t:\t....................................................................................\nPekerjaan\t:\t....................................................................................\nKesatuan/Instansi\t:\t....................................................................................\nAlamat tempat tinggal sesuai KTP\t:\t....................................................................................\nNomorTelp/HP/ E-mail\t:\t....................................................................................\nPERISTIWA YANG DILAPORKAN\nWaktu Kejadian\t:\t....................................................................................\nTempat Kejadian\t:\t.....................................................................................\nApa Yang Terjadi\t:\t.....................................................................................\nIdentitas Korban\t:\t....................................................................................\nNama Lengkap\t:\t....................................................................................\nTempat/Tanggal Lahir\t:\t....................................................................................\nPekerjaan\t:\t....................................................................................\nKesatuan/Instansi\t:\t....................................................................................\nAlamat tempat tinggal sesuai KTP\t:\t....................................................................................\nNomorTelp/HP/ E-mail\t:\t....................................................................................\nWaktu saat dilaporkan\t:\t....................................................................................\nMengetahui,\nKomandan Satuan\nNama\nPangkat NRP\nKota, Tanggal – Bulan – Tahun\nPemeriksa\nNama\nPangkat NRP","cbCaivVmTrwIdW0f","https://ap.wps.com/l/cbCaivVmTrwIdW0f","docx",24379,"Indonesian","# Formulir A\n## Surat pengantar laporan kejadian kecelakaan kerja\n# Formulir B\n## Laporan kejadian kecelakaan kerja\n## Identitas pelapor dan peristiwa\n## Identitas korban dan waktu pelaporan\n## Tanda mengetahui, komandan satuan, dan pemeriksa","[{\"question\":\"Apa perbedaan fungsi Formulir A dan Formulir B dalam laporan kecelakaan kerja?\",\"answer\":\"Formulir A berfungsi sebagai surat pengantar/laporan ringkas yang ditujukan kepada pihak tertentu, sedangkan Formulir B memuat rincian terstruktur kejadian, identitas pelapor, dan identitas korban beserta waktu pelaporan.\"},{\"question\":\"Informasi apa saja yang harus diisi untuk identitas korban pada Formulir A?\",\"answer\":\"Formulir A meminta data seperti nama, pangkat/golongan, NRP/NIP, nomor KTP, kesatuan, dan alamat.\"},{\"question\":\"Bagian apa saja yang terdapat pada Formulir B setelah uraian peristiwa dilaporkan?\",\"answer\":\"Formulir B mencantumkan identitas korban dan waktu saat dilaporkan, kemudian bagian tanda mengetahui oleh Komandan Satuan (nama, pangkat, NRP) serta Pemeriksa (nama, pangkat, NRP) beserta kota dan tanggal.\"}]","Laporan Kejadian Kecelakaan Kerja - Lampiran A & B | DOCX"]