FORM PEMANTAUAN PERILAKU PETUGAS PUSKESMAS DTP RAJAPOLAH

BULAN : ………………………………………….. TAHUN : …………………..

TGL 11 TGL 12 TGL 13 TGL 14 TGL 15 TGL 16 TGL 17 TGL 18 TGL 19 TGL 20
NO NAMA PETUGAS
S1 S2 S3 S1 S2 S3 S1 S2 S3 S1 S2 S3 S1 S2 S3 S1 S2 S3 S1 S2 S3 S1 S2 S3 S1 S2 S3 S1 S2 S3
MEDIS
1 Dr. Asep Hermana
2 Dr. Ani Nuraini
3 Drg. Rieni Andriani
PARAMEDIS/ PERAWAT GIGI
4 Nani Sumarni
5 Septi Nofarianti, Amd.KG
6 Titin Wartini
PARAMEDIS / PERAWAT
7 Neneng S.R, S.Kep
8 Reni Komala, S.Kep
9 Linda Haryani, S.Kep Ners
10 Citra Kharisma, AMK
11 Gugi Gundara, S.Kep
12 Elfira N, S.Kep Ners
13 Yusuf Sofyan, S.Kep
14 Sri Kartikawati,S.Kep Ners
15 Dede Irawan, S.Kep Ners
16 Apep Hendarsyah, S.Kep
17 Yanto Risdianto
18 Ayi Lukmanul H, S.Kep
19 Reni Y, Amd.Kep
20 Rinjani H, AMK
21 Eneng Lesti, Amd.Kep
22 Rismawati, Amd.Kep

S1 : SENYUM S2 : SAPA S3 : SANTUN

 TGL 11 TGL 12 TGL 13 TGL 14 TGL 15 TGL 16 TGL 17 TGL 18 TGL 19 TGL 20
NO NAMA PETUGAS
S1 S2 S3 S1 S2 S3 S1 S2 S3 S1 S2 S3 S1 S2 S3 S1 S2 S3 S1 S2 S3 S1 S2 S3 S1 S2 S3 S1 S2 S3
23 Deki Taufik R, S.Kep Ners
24 M Hasbi Assidiq, Amd.Kep
25 Nanang K, S.Kep Ners
26 Sri Dewi, Amd.Kep
27 Ine Wulandari, S.Kep
PARAMEDIS BIDAN
28 Hj. Mia Shofia, SKM., SST
29 Yeni Mardiani, AM.Keb
30 Anita S H, AM.Keb
31 Hj. Irma R, STR.Ke
32 N Ai Nurhayati, AM.Keb
33 Rohaenah, AM.Keb
34 Hj.Yuke Sobana, AM.Keb
35 Imas, AM.Keb
36 Suwangsih, AM.Keb
37 Lilis Liswati, AM.Keb
38 Verra Purbasari, AM.Keb
39 Detri Sri W, AM.Keb
40 Efa Diah Pitaloka, AM.Keb
41 Ani Hanifah, AM.Keb
42 Dina Nurjanah, AM.Keb
43 Fitri Fahriani D, AM.Keb
44 Trise Asri W, AM.Keb
45 Imas Maslahat, AM.Keb
46 Ilah Susilawati, AM.Keb
47 Shanty Rahayu, AM.Keb
48 Windy Astary, AM.Keb
49 Anita Rahmani, AM.Keb
50 Alisa, AM.Keb
51 Erma Chandra, AM.Keb

S1 : SENYUM S2 : SAPA S3 : SANTUN

 TGL 11 TGL 12 TGL 13 TGL 14 TGL 15 TGL 16 TGL 17 TGL 18 TGL 19 TGL 20
NO NAMA PETUGAS
S1 S2 S3 S1 S2 S3 S1 S2 S3 S1 S2 S3 S1 S2 S3 S1 S2 S3 S1 S2 S3 S1 S2 S3 S1 S2 S3 S1 S2 S3
52 Reni Rahmayani, AM.Keb
53 Ai Siti Zakiyah, AM.Keb
PETUGAS GIZI
54 Awan
PETUGAS PENDAFTARAN
55 Danti Dwi Gentra Laeli,A.Md.RMIK
56 Rini Fajriah, SKM
57 Edwin Prawira, A.Md
ANALIS LABORATORIUM
58 Leni Nursyamsiah,A.Md
59 Novyanti Candra F, Amd.AKS
ASISTEN APOTEKER
60 Eva Hesti H, AM.Far
61 Deris Kurniawan

Rajapolah, ………………………………………………………………

Mengetahui

Kepala UPT Puskesmas DTP Rajapolah Penanggung Jawab Evaluasi Perilaku

ENGKUN, S.IP dr. Ani Nuraini

NIP.196303091984101005

S1 : SENYUM S2 : SAPA S3 : SANTUN