Scribd Logo
Upload

Welcome to Scribd!

  • 6 views

    Bugih Dan Pakong Mufidz

    Uploaded by

    Ailin Paga
    The document is a form used by an enumerator for interviewing households in Pakong, Klompang Barat and Bugih, Pamekasan clusters. It contains tables to record information such as the building number, route number, date of visit, and status of completion for questionnaires of households, women, and families. The enumerator's name recorded is A. Mufidz and the dates of visits range from June 26, 2019 to July 1, 2019.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Flag for inappropriate content

    You might also like

    Bugih Dan Pakong Mufidz

    Uploaded by

    Ailin Paga
    6 views22 pages
    The document is a form used by an enumerator for interviewing households in Pakong, Klompang Barat and Bugih, Pamekasan clusters. It contains tables to record information such as the building number, route number, date of visit, and status of completion for questionnaires of households, women, and families. The enumerator's name recorded is A. Mufidz and the dates of visits range from June 26, 2019 to July 1, 2019.

    Original Description:

    abcb

    Copyright

    © © All Rights Reserved

    Available Formats

    XLSX, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Report this Document
    The document is a form used by an enumerator for interviewing households in Pakong, Klompang Barat and Bugih, Pamekasan clusters. It contains tables to record information such as the building number, route number, date of visit, and status of completion for questionnaires of households, women, and families. The enumerator's name recorded is A. Mufidz and the dates of visits range from June 26, 2019 to July 1, 2019.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as xlsx, pdf, or txt
    6 views22 pages

    Bugih Dan Pakong Mufidz

    Uploaded by

    Ailin Paga
    The document is a form used by an enumerator for interviewing households in Pakong, Klompang Barat and Bugih, Pamekasan clusters. It contains tables to record information such as the building number, route number, date of visit, and status of completion for questionnaires of households, women, and families. The enumerator's name recorded is A. Mufidz and the dates of visits range from June 26, 2019 to July 1, 2019.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as xlsx, pdf, or txt
    of 22

    RINGKASAN FORM INTERVIEW ENUMERATOR

    NAMA KLASTER : ______


    PAKONG, KLOMPANG BARAT 358080 dan BUGIH, PAMEKASAN

    NAMA ENUM : _________


    A. mufidz
    KUESIONER RUMAH TANGGA

    NO
    BANGUNAN NO RUTA K1-TGL K2-TGL K3-TGL HASIL AKHIR
    FISIK

    -1 -2 -3 -4 -5 -6

    26 juni
    203 202 selesai
    2019
    26 juni
    130 129 selesai
    2019
    26 juni
    2 2 selesai
    2019
    26 juni
    15 14 selesai
    2019
    26 juni
    141 141 selesai
    2019
    26 juni
    165 164 selesai
    2019
    26 juni
    178 176 selesai
    2019
    26 juni
    115 115 selesai
    2019
    27 juni
    47 46 selesai
    2019
    27 juni
    36 35 selesai
    2019
    27 juni
    83 82 selesai
    2019
    27 juni
    92 92 selesai
    2019
    27 juni
    70 69 selesai
    2019
    27 juni
    104 104 selesai
    2019
    27 juni
    153 153 selesai
    2019
    27 juni
    57 56 selesai
    2019
    27 juni
    191 189 selesai
    2019
    28 juni
    25 24 selesai
    2019
    29 Juni
    2 2 selesai
    2019
    29 Juni
    6 6 selesai
    2019
    29 Juni
    13 13 selesai
    2019
    29 Juni
    21 21 selesai
    2019
    29 Juni
    17 17 selesai
    2019
    29 Juni
    26 26 selesai
    2019
    29 Juni
    31 31 selesai
    2019
    29 Juni
    37 36 selesai
    2019
    29 Juni
    57 56 selesai
    2019
    30 juni
    61 60 selesai
    2019
    30 juni
    65 64 selesai
    2019
    30 juni
    9 9 selesai
    2019
    30 juni
    45 44 selesai
    2019
    30 juni
    70 68 selesai
    2019
    30 juni
    78 75 selesai
    2019
    30 juni
    51 50 selesai
    2019
    30 juni
    133 126 selesai
    2019
    01 juni
    133 126 selesai
    2019
    01 juni
    137 130 selesai
    2019
    01 juni
    147 140 selesai
    2019
    01 juni
    154 147 selesai
    2019
    01 juni
    75 72 selesai
    2019
    RINGKASAN FORM INTERVIEW EN

    dan BUGIH, PAMEKASAN 358079 NAMA KLASTER : ______


    PAKONG, KLOMPANG BARAT 358080 dan B

    NAMA ENUM : _________


    A. Mufidz
    KUESIONER WANITA

    NO
    USIA
    BANGUNAN NO RUTA NAMA WANITA
    WANITA
    FISIK

    -7 -8 -9 -10

    203 202 hayati 34

    130 129 muani 48

    2 2 kiptiyah 35

    141 141 ripah 46

    178 176 uswatun 39

    115 115 sulalah 35

    47 46 Padilah 42

    36 35 Maizah 29

    83 82 Jannatul 31

    92 92 Hamimah 44

    153 153 Mahmudah 39

    57 56 Norhayati 49
    191 189 Hamidah 47

    191 189 aas 17

    25 24 Kiromah 35

    6 6 Dewi 33

    21 21 Hanifa 37

    17 17 Dilawatik 47

    31 31 Endang 37

    57 56 Nurul 49

    70 68 Subaidah 44

    78 75 Ummiyah 47

    133 126 Rohaniyah 38

    137 130 Halimah 48

    137 130 Fani 20

    147 140 Diza 31

    75 72 Maimunah 34
    FORM INTERVIEW ENUMERATOR

    ANG BARAT 358080 dan BUGIH, PAMEKASAN 358079 NAMA KLASTER : ____

    NAMA ENUM : ________


    KUESIONER WANITA

    NO
    NO HASIL
    K1-TGL K2-TGL K3-TGL BANGUNA
    KUNJUNGAN AKHIR
    N FISIK

    -11 -12 -13 -14 -15 -16

    26 juni
    1 selesai 203
    2019
    26 juni
    1 selesai 130
    2019
    26 juni
    1 selesai 2
    2019
    26 juni
    1 selesai 15
    2019
    26 juni
    1 selesai 141
    2019
    26 juni
    1 selesai 165
    2019
    27 juni
    1 selesai 178
    2019
    27 juni
    1 selesai 115
    2019
    27 juni
    1 selesai 47
    2019
    27 juni
    1 selesai 36
    2019
    27 juni
    1 selesai 83
    2019
    27 juni
    1 selesai 92
    2019
    27 juni
    1 selesai 70
    2019
    27 juni
    1 selesai 104
    2019
    28 juni
    1 selesai 153
    2019
    29 juni
    1 selesai 153
    2019
    29 juni
    1 selesai 57
    2019
    29 juni
    1 selesai 191
    2019
    29 juni
    1 selesai 25
    2019
    30 juni
    1 selesai 2
    2019
    30 juni
    1 selesai 6
    2019
    30 juni
    1 selesai 13
    2019

    1 1 juli 2019 selesai 21

    1 1 juli 2019 selesai 17

    1 1 juli 2019 selesai 26

    1 1 juli 2019 selesai 31

    1 1 juli 2019 selesai 37

    42

    57

    61

    65

    45
    70

    78

    51

    133

    137

    147

    154

    75
    RINGKASAN FORM INTERVIEW ENUMERATOR

    MA KLASTER : ____
    PAKONG, KLOMPANG BARAT 358080 dan BUGIH, PAMEKASAN 358079

    MA ENUM : ________
    A. Mufidz
    KUESIONER KELUARGA

    ID
    NO NAMA RESPONDEN NO
    KELUARG K1-TGL K2-TGL K3-TGL
    RUTA KELUARGA KUNJUNGAN
    A

    -17 -18 -19 -20 -21 -22 -23

    26 Juni
    202 1 hayati 1
    2019
    26 Juni
    129 1 Muani 1
    2019
    26 Juni
    2 1 Kiptiyah 1
    2019
    26 Juni
    14 1 Sakduyan 1
    2019
    26 Juni
    141 1 Ripah 1
    2019
    26 Juni
    164 1 Khasiyah 1
    2019
    26 Juni
    176 1 Uswatun 1
    2019
    26 Juni
    115 1 Sulalah 1
    2019
    27 Juni
    46 1 padilah 1
    2019
    27 Juni
    35 1 Maizah 1
    2019
    27 Juni
    82 1 Jannatul 1
    2019
    27 Juni
    92 1 Hamimah 1
    2019
    27 Juni
    69 1 Suinab 1
    2019
    27 Juni
    104 1 Suhaima 1
    2019
    27 Juni
    153 1 Asmah 1
    2019
    27 Juni
    153 2 Mahmudah 1
    2019
    27 Juni
    56 1 Norhayati 1
    2019
    27 Juni
    189 1 Hamidah 1
    2019
    28 Juni
    24 1 Kiromah 1
    2019
    29 Juni
    2 1 Amir 1
    2019
    29 Juni
    6 1 Dewi 1
    2019
    29 Juni
    13 1 Rudi 1
    2019
    29 Juni
    21 1 Hanifa 1
    2019
    29 Juni
    17 1 Dilawatik 1
    2019
    29 Juni
    26 1 Kamila 1
    2019
    29 Juni
    31 1 Endang 1
    2019
    29 Juni
    36 1 Subaida 1
    2019
    29 Juni
    41 1 Rusita 1
    2019
    30 Juni
    56 1 Nurul 1
    2019
    30 Juni
    60 1 Agustin 1
    2019
    30 Juni
    64 1 Sundari 1
    2019
    30 Juni
    9 1 Bahtiyar 1
    2019
    30 Juni
    44 1 Saiful 1
    2019
    30 Juni
    68 1 Salama 1
    2019
    30 Juni
    75 1 Masturoh 1
    2019
    30 Juni
    50 1 Erin 1
    2019
    01 Juli
    126 1 Rohaniyah 1
    2019
    01 Juli
    130 1 Halimah 1
    2019
    01 Juli
    140 1 Diza 1
    2019
    01 Juli
    147 1 Eli 1
    2019
    01 Juli
    72 1 Maimunah 1
    2019
    RINGKASAN FORM INTERVIEW ENUM

    NAMA KLASTER : ____


    PAKONG, KLOMPANG BARAT 358080 dan BUGIH, PA

    NAMA ENUM : ________


    A. Mufidz
    KUESIONER REMAJA

    NO ID
    HASIL NO
    BANGUNA KELUARG NAMA REMAJA
    AKHIR RUTA
    N FISIK A

    -24 -25 -26 -27 -28

    selesai 203 202 1 Farhan

    selesai 130 129 1 Zainudin

    selesai 165 164 1 Ridol

    selesai 36 35 1 Finda

    selesai 92 92 1 Hery

    selesai 92 92 1 Khalid

    selesai 92 92 1 Fifi

    selesai 191 189 1 Aas

    selesai 25 24 1 Labib

    selesai 25 24 1 Alim

    selesai 21 21 1 Ridwan

    selesai 17 17 1 Firmansyah
    selesai 31 31 1 Diah

    selesai 57 56 1 Rahmat

    selesai 65 64 1 Rio

    selesai 9 9 1 Revan

    selesai 45 44 1 Agung

    selesai 133 126 1 Riki

    selesai 133 126 1 Harifan

    selesai 137 130 1 Fani

    selesai 137 130 1 Fauzan

    selesai

    selesai

    selesai

    selesai

    selesai

    selesai

    selesai

    selesai

    selesai

    selesai

    selesai

    selesai
    selesai

    selesai

    selesai

    selesai

    selesai

    selesai

    selesai

    selesai
    SAN FORM INTERVIEW ENUMERATOR

    BARAT 358080 dan BUGIH, PAMEKASAN 358079

    KUESIONER REMAJA

    NO KUNJUNGAN K1-TGL K2-TGL K3-TGL HASIL AKHIR

    -29 -30 -31 -32 -33

    26 Juni
    1 selesai
    2019
    26 Juni
    1 selesai
    2019
    26 Juni
    1 selesai
    2019
    27 Juni
    1 selesai
    2019
    27 Juni
    1 selesai
    2019
    27 Juni
    1 selesai
    2019
    27 Juni
    1 selesai
    2019
    27 Juni
    1 selesai
    2019
    28 Juni
    1 selesai
    2019
    28 Juni
    1 selesai
    2019
    29 Juni
    1 selesai
    2019
    29 Juni
    1 selesai
    2019
    29 Juni
    1 selesai
    2019
    30 Juni
    1 selesai
    2019
    30 Juni
    1 selesai
    2019
    30 Juni
    1 selesai
    2019
    30 Juni
    1 selesai
    2019

    1 1 Juli 2019 selesai

    1 1 Juli 2019 selesai

    1 1 Juli 2019 selesai

    1 1 Juli 2019 selesai


    RINGKASAN FORMULIR W

    NAMA KLASTER : ____


    PAKONG, KLOMPANG BARAT 358080 dan BUGIH, PAMEKASAN 358079

    NAMA ENUM : ________


    A. Mufidz
    KUESIONE

    # RUTA
    YANG DI
    LISTING # RUTA # KELUARGA
    # RUTA # KELUARGA
    TANGGAL DALAM COMPLET YANG
    TERKIRIM COMPLETE
    1 E ELIGIBLE
    KLASTE
    R

    -25 -26 -27 -28 -29 -30

    24-25 juni
    187
    2019

    26 juni 2019 8 8 8 8

    27 juni 2019 9 9 10 10

    28 juni 2019 1 1 1 1

    Total 187 18 18 19 19

    29 juni 2019 9 9 9 9

    30 juni 2019 8 8 8 8

    01 juli 2019 5 5 5 5

    Total 22 22 22 22
    RINGKASAN FORMULIR WAWANCARA SUPERVISOR

    GIH, PAMEKASAN 358079 NAMA SUPERVISOR : _________

    KUESIONER REMAJA

    # WANITA # WANITA # WANITA # REMAJA


    # KELUARGA
    YANG YANG YANG YANG
    TERKIRIM
    ELIGIBLE COMPLETE DIKIRIM ELIGIBLE

    -31 -32 -33 -34 -35

    8 6 6 6 3

    10 8 8 8 5

    1 1 1 1 2

    19 15 15 15 10

    9 4 4 4 3

    8 3 3 3 4

    5 5 5 5 4

    22 12 12 12 11
    FATHOR ROSI

    # REMAJA # REMAJA
    YANG YANG KETERANGAN
    COMPLETE DIKIRIM

    -36 -37 -38

    3 3 selesai

    5 5 selesai

    2 2 selesai

    10 10

    3 3 selesai

    4 4 selesai

    4 4 selesai

    11 11

    You might also like