KUESIONER ANALISIS SITUASI KESEHATAN MASYARAKAT PENGALAMAN BELAJAR LAPANGAN (PBL) TAHUN AJARAN 2016/2017 2016 /2017
I. ANALISIS KEPENDUDUKAN KEPENDUDUKAN (Analisis Situasi Umum) a. Pengenalan Tempat 1.
Des / Ke!"#$% .
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b. Keterangan Rumah Tangga 1
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c. Keterangan Anggta Rumah Tangga N Urut 1 2 , 6 7 : < 10
Nama Anggta Rumah Tangga (ART)
Khusus ART ! *enis Umur Kelamin (thn+bln) # tahun Pen$i$i%an Ternggi
Khusus ART , &' tahun Status Pe%eraan
"ubungan $engan Kepala RT
2. Pe8es%
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Khusus ART perempuan &'-# tahun
II. ANALISIS MASALAH KESEHATAN KELUARGA 1. A-$ 8 %33&+ e!"#3 %3 'e%8e#+ s+ se!' 1 +$"% . A8 . T8
II. ANALISIS MASALAH KESEHATAN KELUARGA 1. A-$ 8 %33&+ e!"#3 %3 'e%8e#+ s+ se!' 1 +$"% . A8 . T8 2. A-! 8= +" 'e%8e#+ s+ >
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Nama
Nama Pen/a%it
Umur
Status
Umur
Status
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Pen/ebab 0eninggal
1 2 , 6
III. ANALISIS KESE"ATAN LIN1KUN1AN A. 2ectr Pen/a%it 1. A-$ 8se+# +e'-+ @%33! 8 8#%se/-#+ ? . A8 . T8 A8 2. J 8= -$ # 8 8#%se +e#se"+ 'e%3!# ? . A8 . T8 A8
III. ANALISIS KESE"ATAN LIN1KUN1AN A. 2ectr Pen/a%it 1. A-$ 8se+# +e'-+ @%33! 8 8#%se/-#+ ? . A8 . T8 A8 2. J 8= -$ # 8 8#%se +e#se"+ 'e%3!# ? . A8 . T8 A8 ,. A-$ 8 se+# +e'-+ @%33! %8 % !!+ ? . A8 . T8 A8 . J 8= 8'%$ +e'-+ s"'e# !!+ +e#se"+ ? . Te'-+ s'-$ . D#%se/-#+ *............................. . A-$ 8 se+# #"'$ %8 % %'" ? . A8 . T8 A8 6. J 8= 8'%$ +e'-+ s"'e# %'" +e#se"+ ? . P#+ . S"%3 *.............................
3. Air 3ersih 1. A-$ 8 #"'$ %8 8 +e#se8 # e#s$ ? . A8 . T8 A8 Ose#s > . Je#%$ 8% e%%3 (@8 e#4#%) . T8 e#" *. Ke#"$ 8. Be#" e. Be#s 2. A-$ e%s s"'e# # e#s$ +e#se"+ ? . S"'"# . S"%3 *. A# $"% 8. A# PDAM e. S"'e# '+ # (# -%*"#%) . K&!' -e%'-"%3% 3.............................................. ,. B! 'e%33"%% s"'"# 3!= s"'"# @-e - %3 %8 3"%% ? . S"'"# 'e%33"%% *%*% . S"'"# &# . A-$ # s"'"# s"8$ 'e'e%"$ s+%8#+ ese$+% (@8 e#"= @8 e#"= @8 e#4#%) . S"8$ . T8 . J @8= - "s$ %3 %8 !"% ? . Me'#% s
. Me'"+ s#%3% *. Me%3e%8-% 8. Me%'$% $% ' 6. D'%$ !e+ @' "%+" 'e%3'! # s"'"# ? . D 3%+"%3 . D!%+ 7. A-$ %8 "3 'e%33"%% # s"%3 ? . Y . T8 :. J = "%+" - 'e%33"%% # s"%3 ? . M%"' 8% 's . N"* *.................................... <. A-$ 8 se+# # e#s$ 8!' #8"s C 10 'e+e# +e#8-+ s"'e# -e%*e'#% (# !'$= se-@*+%= s'-$= %8%3 +e#% )? . A8 . T8 8 10. Be#- "'!$ -e'% # "%+" e-e#!"% se!"#"$ e3+% #"'$ +%33 ( +e#'s" '%"' 8% 's ) 8!' se$# se'!' ?............................................................!+e#/$# 11. Be#- # s"'e# # '%"' e +e'-+ -e%'-"%3% &+&#%/ @% +e#8e+ ? . C 10 'e+e# . 10 'e+e# *. T8 +$" 12. See!"' # 8&%s"'s "%+" 8'%"'= *# -e%3&!$% - %3 83"%% ? . D's . Ds-e%se# 8e%3% !+ -e'%s +" -e%8%3% *. Ds#%3 / +#s 1,. A-$ e%s s#%/ +e'-+ -e%'-%% # '%"' ? . Ds-e%se# . Te&/*e#e+/+e#'&s/e#3e% *. Ke%8 8. E'e#/ -%* +e#+"+"e. E'e#/ -%* +e#" . L%%
4. *amban 1. A-$ 8#"'$ %8 8 '% e!"#3 ? . A8 . T8 8 2. A-! 8= e%s - %3 83"%% ? . Le$e# %3s 8e%3% se-@*+% . Le$e# %3s +%- se-@*+% *. 5e'-!"%3 8. .................................................... ,. Be#- # se-@+% 8# s"'e# # e#s$ ? . C 10 'e+e# . 10 'e+e# . Ke8% !%+ '% ? . L%+ se'e% e8- #
. T8 e8- # . A-$ 8 +e'-+ -e%'-"%3% # 8 '% ? ( B A# ) . A8 . T8 8 6. Be#- ! '% 8e#s$% ? . , $# se! . Se'%33" se! *. 2 '%33" se! 8. ...................................... 7. A-! @8 'e'-"% '%= e'% %33&+ e!"#3 %8 BAB ( B"%3 A# Bes# ) ? . P#+ . S"%3 *. * "'"' 8. T%$ !-%3 :. A-$ !s% %8 @8 'e'! '% ? . T8 'e'! . T8 'e'! -e#%3% *. R"'$ se4 8. R"'$ 8e+ 8e%3% s"%3
D. Perumahan 1. B3'%$ e%+" #"'$/ &%s+#"s %8 (Ose#s) ? . Pe#'%e% . Se' -e#'%e% *. T8 -e#'%e% 2. Te#"+ 8# -$ 8%8%3 #"'$ s"8# (Ose#s) ? . Te'& . P-% *. D"% 8. Se+e%3$ e+&% 8% --% e. G-s"'= ses ,. Te#"+ 8# -$ +- #"'$ s"8# (Ose#s) ? . D"% . Se%3 *. Ge%+e%3 . A-$ #"'$ %8 'e'! !%3+;!%3+ (Ose#s) ? . A8 . T8 8 . J 8= +e#"+ 8# - (Ose#s) ? . P!s@ . G-s"' *. Ases 8. T#-!es 6. Te#"+ 8# -$ !%+ #"'$ %8 (Ose#s) ? . T%$ . Se'e% s# *. Ke#'/"%/+e3e! 7. Be#- '#$ 8 #"'$ %8 (Ose#s) ? . 1 '# . 2 '#
*. Le$ 8# 2 :. A-$ %8 'e'! 8-"# 's ? . A8 . T8 8 <. A-$ #"'$ %8 'e'! '# '%8 ? . A8 . T8 8 10. D'%$ !e+ '# '%8 s"8# (Ose#s) ? . D8!' #"'$ . D!"# #"'$ 11. B3'% ee#s$% !%3"%3% #"'$ (Ose#s) ? . Be#s$ . K"#%3 e#s$ *. K&+&#
E. Sampah + Plusi 1. A-$ 8#"'$ 8 +e'-+ -e%'-"%3% s'-$ se'e%+# ? . A8 . T8 8 2. J 8= e%s% - ? . T&%3/ s'-$ . L"%3 s'-$ *. P!s@ ,. Be#- ! s'-$ +e#se"+ 8"%3 ? . Se@- $# . D" $# se! . Ke'% s'-$ +e#se"+ 8"%3 ? . Ke TPA . D # *. D ""# 8. Ke s"%3
5. Sarana Pembuangan Air Limbah (SPAL) 1. A-$ #"'$ +%33 'e'! +'-+ -e%'-"%3% # !'$ 8# '# '%8/+e'-+/8-"# . A8 . T8 8 2. A-$ !#% SPAL 'e%3!# 8e%3% ? . Y . T8 ,. Be#- # !#% SPAL 8e%3% s"'e# # e#s$ ? . C 10 'e+e# . 10 'e+e# . A-$ # !'$ @8 'e%'"!% 3e%%3% # ? . Y . T8 . A-$ !#% !'$ 'e%'"!% " %3 @8 se8- ? . Y . T8
6. B3'% -e%33"%% +e'-+ -e%'-"%3% # !'$ ? . Se%8# / #"'$ +%33 . Be#s';s'
I2. ANALISIS PELA6ANAN KESE"ATAN 1.
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. T8 8 10. A-$ 8 -e+"3s PPLKB %3 e#+"3s se*# #"@% ? . A8 . T8 8
. T8 8 10. A-$ 8 -e+"3s PPLKB %3 e#+"3s se*# #"@% ? . A8 . T8 8 11. J 8= #"@% 'e!"% -e!%% KB ? . R"@% . T8 #"@%
2. ANALISIS PRILAKU KESE"ATAN a. Pengetahuan 1.
Pe%e +e#8% -e%+ 8!$ ? . Te#e% "'% -e%+
2. ANALISIS PRILAKU KESE"ATAN a. Pengetahuan 1.
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b. Tin$a%an 1. A-$ %8 se!!" 'e%3&%s"'s '%% e#3F ? . Y . T8 2.
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10. A-$ %8 'e' !+ &%+#se-s ? J Y se"+% >........................................... . Y . T8 11. A-$ % %8 s"8$ 'e'-e#&!e$ '"%ss 8s# !e%3- ? . Y . T8 B5G DPT POLIO 5AMPAK HEPATITIS 12. A-$ %8 'e!"% -e'e#s% e$'!% se*# #"@% ? . Y . T8
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0ATRIKS REN4ANA KE1IATAN P3L 0A"ASIS>A S-& KESE"ATAN 0AS6ARAKAT STIKes SU 0EDAN DI DESA 0ATAN1 RA6EUK PP KE4A0ATAN IDI TI0UR KA3UPATEN A4E" TI0 TA"UN 7'&8
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0ATRIKS REN4ANA KE1IATAN P3L 0A"ASIS>A S-& KESE"ATAN 0AS6ARAKAT STIKes SU 0EDAN DI DESA 0ATAN1 RA6EUK PP KE4A0ATAN IDI TI0UR KA3UPATEN A4E" TI0 TA"UN 7'&8
0inggu N
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