PEMERINTAH KABUPATEN TUBAN

DINAS KESEHATAN
UPTD PUSKESMAS TAMBAKBOYO
Jalan raya Tambakboyo No. 258 Telepon (0356) 411080 kode pos 62353
Email : puskesmas.iso.tambakboyo@gmail.com
TUBAN

LAPORAN HASIL KEGIATAN

1. Tanggal Kegiatan :
2. Nama Kegiatan : Orientasi pegawai baru
3. Tempat Kegiatan : Puskesmas Tambakboyo
4. Sasaran : Pegawai baru

a. Hasil Kegiatan
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b. Indikator Keberhasilan
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c. Kesenjangan/masalah
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d. Upaya Pemecahan Masalah
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e. Lain-lain :
1. Peran Lintas Program
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2. Peran Lintas Sektor (bila ada)
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Mengetahui Lintas Sektor :

Nama : ……....……………………………………………………
Tanda Tangan : …………………………………………………………...

Mengetahui,
Penanggung Jawab ............... Pelaksana

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