RENCANA PELAKSANAAN KEGIATAN PELAYANAN PROGRAM :.............................

TAHUN 2018

NO KEGIATAN TUJUAN SASARAN TARGET WAKTU TEMPAT PJ PELAKSANA INDIKATOR

KEBERHASILAN

Mengetahui
Kepala Puskesmas Sandai Penanggung jawab Program

..................................................... ...............................................
NIP............................................... NIP..........................................
 Target Kinerja Program …..
Tahun 2018

No Jenis Kegiatan Target

2018 / bln Jan Feb Mar Apr Mei Juni Juli Agt Sept Okt Nov Des
(%)
1
2
3
4
5
6
7
8

Ket :

Mengetahui
Kepala Puskesmas Sandai Penanggung jawab Program

..................................................... ...............................................
NIP............................................... NIP..........................................

JADWAL PELAKSANAAN KEGIATAN PROGRAM :

TAHUN 2018

NO KEGIATAN Tempat Jan Feb Maret Apr Mei Juni Juli Agt Sept Okt Nop Des
 Mengetahui
Kepala Puskesmas Sandai Penanggung jawab Program

..................................................... ...............................................
NIP............................................... NIP..........................................

RENCANA PELAKSANAAN BULANAN KEGIATAN ..................................................................... PUSKESMAS SANDAI

BULAN : 2018
NO KEGIATAN 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 JM
L

Keterangan :

Mengetahui
Kepala Puskesmas Sandai Penanggung jawab Program

..................................................... ...............................................
NIP............................................... NIP..........................................

HASIL KEGIATAN .................................................. PUSKESMAS SANDAI

BULAN : 2018
N KEGIATAN 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 JML
O

Keterangan :

Mengetahui
Kepala Puskesmas Sandai Penanggung jawab Program

..................................................... ...............................................
NIP............................................... NIP..........................................

Capaian Kinerja bulan : 2018

UPAYA / PROGRAM :
No Jenis Kegiatan Target Capaian Keterangan
bulanan Bulan ini
1

Mengetahui
Kepala Puskesmas Sandai Penanggung jawab Program

..................................................... ...............................................
NIP............................................... NIP..........................................

HASIL MONITORING DAN EVALUASI CAPAIAN KEGIATAN : .................

BULAN : 2018

No KEGIATAN Target Capaian Hasil Analisa masalah Rencana pemecahan masalah Rencana tindak lanjut
 1 - -

Mengetahui
Kepala Puskesmas Sandai Penanggung jawab Program

..................................................... ...............................................
NIP............................................... NIP..........................................

RENCANA TINDAK LANJUT (RTL) PROGRAM : ..................................................................... BULAN 2018

No KEGIATAN KEGIATAN RTL Tujuan Sasaran Bentuk kegiatan Pelaksana Waktu Biaya Indikator
keberhasilan
1
 Mengetahui
Kepala Puskesmas Sandai Penanggung jawab Program

..................................................... ...............................................
NIP............................................... NIP..........................................