PEMERINTAH KABUPATEN CIREBON

DINAS KESEHATAN
UPT PUSKESMAS GEGESIK
Jl. Raya Gegesik Arjawinangun No. 20, Gegesik,
Telp. 0231 8830182 Email: pkmgegesik@gmail.com,
kodepos 45164

SURVEY PERBAIKAN KINERJA UKM

UPT PUSKESMAS GEGESIK

1. KIA DAN KB
a. Bagaimana pendapat saudara tenteng pelayanan KIA dan KB di Puskesmas Gegesik?
.........................................................................................................................
.........................................................................................................................
b. Apakah saudara mengetahui tentang Resiko Tinggi pada kehamilan ?
.........................................................................................................................
.........................................................................................................................
c. Apa saran saudara tentang kegiatan KIA dan KB ?
.........................................................................................................................
.........................................................................................................................

2. PROMKES
a. Apakah pendapat saudara tentang PHBS ?
.........................................................................................................................
.........................................................................................................................
b. Apa menurut saudara perlu unutuk meningkatkan pelayanan di posyandu ?
.........................................................................................................................
.........................................................................................................................
c. Apa saran saudara tentang PHBS ?
.........................................................................................................................
.........................................................................................................................

3. KESLING
a. Apakah saudara memiliki jamban dan menggunakannnya?
.........................................................................................................................
.........................................................................................................................
b. Apakah saudara mengerti tentang SANITASI ?
.........................................................................................................................
.........................................................................................................................
4. GIZI
a. Apakah saudara mengerti tentang PMT pada Balita?
.........................................................................................................................
.........................................................................................................................
b. Menurut saudara kegiatan apa yang bisa menekan nilai Gizi Buruk pada Balita Selain Pemberian
Makanana Tambahan?
.........................................................................................................................
.........................................................................................................................
5. TB
a. Apakah saudara mengerti tentang cara mengobati TB
.........................................................................................................................
.........................................................................................................................

b. Apakah saudara mengetahui tentang Penyakit TB dan cara penularannya?

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

6. IMUNISASI
a. Apakah saudara mengerti tentang imunisasi ?
.........................................................................................................................
.........................................................................................................................
b. Apakah saudara mengerti tentang MMR ?
.........................................................................................................................
.........................................................................................................................

c. Apa saran saudara tentang kegiatan imunisasi ?

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

7. KOPERKOM
a. Apakah menurut saudara perlu kunjungan rumah ?
.........................................................................................................................
.........................................................................................................................
b. Apakah saudara mengerti tentang masalah kesehatan dan cara menangani masalah kesehatan
yang anda alami ?
.........................................................................................................................
.........................................................................................................................
c. Apa saran saudara tentang kegiatan KEPERKOM ?
.........................................................................................................................
.........................................................................................................................

8. DIARE DAN ISPA

a. Apakah menurut saudara perlu kunjungan rumah bagi penderita Diare dan ISPA ?
.........................................................................................................................
.........................................................................................................................
b. Apa saran saudara tentang kegiatan DIARE dan ISPA ?
.........................................................................................................................
.........................................................................................................................

9. JIWA
a. Apakah saudara mengerti tentang tanda awal penyakit jiwa?
.........................................................................................................................
.........................................................................................................................
b. Apa saran saudara tentang kegiatan Kesehatan JIWA ?
.........................................................................................................................
.........................................................................................................................
10. UKS
a. Apakah menurt saudara perlu ada pemeriksaan kesehatan di Sekolah ?
.........................................................................................................................
.........................................................................................................................
b. Apa saran saudara tentang kegiatan UKS?
.........................................................................................................................
.........................................................................................................................

11. KESORGA
a. Apakah di desa saudara perlu dibentuk kelompok Olahraga ?
.........................................................................................................................
.........................................................................................................................
b. Apa saran saudara tentang kegiatan Kesehatan Olahraga ?
.........................................................................................................................
.........................................................................................................................

12. UKGS/UKGMD
a. Apakah menurut saudara perlu ada pemeriksaan Kesehatan Gigi dan Mulut di Posyandu dan di
Sekolah ?
.........................................................................................................................
.........................................................................................................................
b. Apa saran saudara tentang kegiatan UKGS dan UKGMD ?
.........................................................................................................................
.........................................................................................................................

13. UKK
a. Apakah ada pos UKK di desa saudara?
.........................................................................................................................
.........................................................................................................................