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In-Person Attendance List

INTERNAL QUALITY AUDIT OF THE MIDWIFERY DEPARTMENT

Participant Data

Participant Category

🏛️ Poltekkes Bandung Civitas Employee / Student

👥 General Public Without NIP / NIM

🏢 Other Institutions / Campuses Hospitals, Puskesmas, Health Offices, etc.

Search by NIP / NIM (Poltekkes Bandung Employee / Student)

Enter your NIP or NIM to automatically fill in your name, email, institution, and work unit data.

Full Name *

Phone No. / WhatsApp

📋

Please complete the activity-specific data below

Originating Agency / Institution *

Position*

Current Institution / Workplace(Optional)

Attendance Status *

Attendance Date

Monday, 26 October 2026

Notes (Optional)

Digital Signature *

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General Guide to Polkesban Virtual Office