Hari/Tanggal Kegiatan : ............./.................................................................... Durasi Waktu : ........ menit atau jam. Lokasi : .................................................................................. Sasaran/Peserta : .................................................................................. Jumlah Peserta : ........ orang. Tujuan Kegiatan Penyuluhan : .................................................................................. Ringkasan Materi Penyuluhan : ................................................................................... ................................................................................... ................................................................................... Bentuk Evaluasi : 1. Pre test dan Post test 2. Tipe soal : pilihan ganda (multiple choice) Deskripsi Tahapan Kegiatan Penyuluhan : No. Tahap Kegiatan Metode Media Durasi Waktu 1. Pembukaan Ceramah/Diskusi LCD/Laptop/Poster/Leaflet 5 menit 2. Pre Test - Lembar soal 10 menit 3. Penyampaian Ceramah/Diskusi/Simulasi LCD/Laptop/Poster/Leaflet 30 menit Materi 4. Post Test - Lembar soal 10 menit 5. Kesimpulan dan Ceramah/Diskusi LCD/Laptop/Poster/Leaflet 5 menit Penutup
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