Form Pendataan Rt Dan Rekap Desa

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Magazines CONTOH: INSTRUMEN PENILAIAN PHBS

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DI TATANAN RUMAH TANGGA

FORMULIR PENILAIAN PHBS DI RUMAH TANGGA OLEH KADER DESA/PEKON/KAMPUNG/KEL.

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KECAMATAN

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RT/RW/LINGKUNGAN

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Tgl Kunjungan

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NAMA KEPALA RUMAH TANGGASign

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INDIKATOR YANG DI NILAI

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DEFINISI OPERASIONAL INDIKATOR INDIKATOR PHBS TATANAN R!AH TAN""A

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INDIKATOR Persalinan di tolong oleh Tenaga Kesehatan Bayi diberi ASI Eksklusif

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P'(,-l-ngan '(,aa a&a '(0alnan al,a ,'(u&a &ala (ua &lauan -l' ,'naga '0'a,an 5ang 'l -','n0 '&anan 6&-,'( an&ungan &an '&anan7 &-,'( uu7 a,au &an 8 *a5 ,'(u&a u0a % 9 ! ulan 'n&aa, ASI 0aja 0'ja la( 0aa u0a ! ulan

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#ontoh$ FOR! R EKAPITLASI P ENDATA ENDATAAN AN PHBS

LAPORAN PENILAIAN PHBS OLEH KADER

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JUMLAH JA!ABAN "A

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JUMLAH JA!ABAN "A

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JUMLAH RUMAH

ADA DI KUNJUNGI

INDIKATR "G

TTAL JA!AB "A

DINILAI 11

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