RAPAT KOORDINASI NUSANTARA SEHAT INDIVIDU 2018

KUESIONER NUSANTARA SEHAT INDIVIDU

RAHASIA

A. PENGENALAN TEMPAT PENUGASAN

1 Provinsi .........................................................................
2 Kabupaten .........................................................................
3 Kecamatan .........................................................................
4 a. Puskesmas ...............................................................
b. Angkatan ..................... 
B. IDENTITAS NUSANTARA SEHAT INDIVIDU

Nama (lengkap dengan gelar) Profesi

PELAPORAN

Apakah selama masa kerja Saudara hingga saat ini membuat laporan kegiatan NUSANTARA SEHAT INDIVIDU? Jika ya,
laporan apa saja yang dibuat dan disampaikan kemana? Frekwensi pelaporan?
....................................................................................................................................................................................
....................................................................................................................................................................................
....................................................................................................................................................................................
....................................................................................................................................................................................
....................................................................................................................................................................................

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

MATERI SAAT PEMBEKALAN

Menurut Saudara materi apa yang kurang pada saat pembekalan? (uraikan)

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

1
....................................................................................................................................................................................
....................................................................................................................................................................................
....................................................................................................................................................................................

MASALAH / HAMBATAN
Sebutkan 5 masalah / Hambatan apa yang Saudara rasakan dalam pelaksanaan tugas Saudara sebagai NSI di
puskesmas saat ini ?

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

HARAPAN
Harapan apa yang Saudara inginkan terkait dengan Penugasan NSI di puskesmas?

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

== Terima kasih ==

Mohon dikirim ke : rakorjakarta.nsi2018@gmail.com