AR

PEMERINTAH KABUPATEN PARIGI MOUTONG

PUSKESMAS LAMBUNU I
JL.R.A KARTINI NO. DESA WANAMUKTI KEC.BOLANO

TANDA TERIMA TRANSPORT

PELAKSANAAN KUNJUNGAN POSYANDU
DI DESA SAMA BAHARI

NO NAMA JABATAN JUMLAH DITERIMA

1 NETI SELFIANI Kader Posyandu Rp 30,000

2 SAMSIAR Kader Posyandu Rp 30,000

3 ASNI Kader Posyandu Rp 30,000

4 MARIANI Kader Posyandu Rp 30,000

5 KASMARIANI Kader Posyandu Rp 30,000

JUMLAH Rp 150,000

Mengetahui
Kepala Puskesmas Lambunu I

Diana Abbas,SKM
Nip :19841218 200903 2 003
MOUTONG
UNU I
BOLANO

RT
SYANDU

TANDA TANGAN

Bendahara JKN

Ni Ketut Piliani
Nip :19710315 199203 2 012
NO TANGGAL JENIS KEGIATAN

Kunjungan Ke Desa Dalam Rangka

Kegiatan Posyandu
 TANDA TANGAN/CAP KETERANGAN

Kepala Desa Sama Bahari

AMRIN DAHUNG
NIP:
 LAPORAN KUNJUNGAN POSYANDU

LAPORAN

1. Dasar : ST No:......../............/.........../ 2015

2. Tujuan Kunjungan : Kunjungan Posyandu di Desa Sama Bahari
3. Hasil Kunjungan :
...............................................................................................................................................
...............................................................................................................................................
...............................................................................................................................................
...............................................................................................................................................
...............................................................................................................................................
...............................................................................................................................................
...............................................................................................................................................
...............................................................................................................................................
...............................................................................................................................................
...............................................................................................................................................

4. Kesimpulan / Saran Perbaikan

...............................................................................................................................................
...............................................................................................................................................
...............................................................................................................................................
...............................................................................................................................................

Wanamukti,.............2015

Pelapor

KASMARIANI
......................................
......................................
......................................
......................................
......................................
......................................
......................................
......................................
......................................
......................................

......................................
......................................
......................................
......................................

kti,.............2015

Pelapor

ASMARIANI
 DAFTAR HADIR KADER POSYANDU

DESA/POSYANDU : DESA SAMA BAHARI

TANGGAL :

NO NAMA JABATAN

1 NETI SELFIANI
2 SAMSIAR
3 ASNI
4 MARIANI
5 KASMARIANI

Mengetahui
Kepala Desa Sama Bahari

...........................
OSYANDU

TTD

1
2
3
4
5

Mengetahui
Desa Sama Bahari

........................
 PEMRINTAH KABUAPATEN PARIGI MOUTONG
KECAMATAN BOLANO
DESA SAMA BAHARI
Alamat Jalan.................NO......Kode Pos 94379

SURAT TUGAS
Nomor :........../.............../..........2015

Yang Bertanda Tangan di Bawah ini :

Nama :
Nip :
Jabatan :

Dengan ini memberikan tugas kepada :

NO NAMA TANGGAL TEMPAT TUJUAN

1 NETI SELFIANI

2 SAMSIAR

3 ASNI Desa Sama Bahari

4 MARIANI

5 KASMARIANI

Demikian surat tugas kami buat untuk dapat di laksanakan sebaik-baiknya.

Kepala Desa Sama

...............................
 GI MOUTONG
NO
RI
os 94379

MAKSUD PERJALANAN

Kunjungan Ke Desa Dalam rangka

Pelaksanaan Posyandu

Kepala Desa Sama Bahari

........................................