Berita Acara

Rembuk Stunting Kalurahan

Konvergensi Pencegahan Stunting

Dalam rangka pelaksanaan Kegiatan Konvergensi Stunting Tahun Anggaran 2021 di

Kalurahan .................... Kapanewon ............................ Kabupaten Gunugkidul, Daerah Istimewa
Yogyakarta, pada :

Hari dan Tanggal : .......... Juli 2020

Jam : ......... s.d. …….. WIB

Tempat : ...................................

Telah diselenggarakan pertemuan Rembuk Stunting di Kalurahan ............................., Kapanewon

………………, yang dihadiri oleh wakil – wakil dari masyarakat kalurahan serta unsur lain yang
terkait, sebagaimana dalam Daftar Hadir terlampir.

Materi, pimpinan rapat dan narasumber dalam Rembuk Stunting Kalurahan, sebagai berikut :

A. Materi
1. Gambarran umum Penanggulangan Stunting di Kalurahan
2. Pemaparan Hasil Pemetaan Sosial Dan Diagnosis Permasalahan Stunting
3. Musyawarah Penetapan usulan kegiatan/program Konvergensi Pencegahan Dan
Penanganan Stunting.
4. Penunjukan delegasi/perwakilan dalam melakukan advokasi hasil rembuk stunting pada
forum perencanaan desa, terutama melalui forum Musyawarah Kalurahan dan
Musrenbang Kalurahan.

B. Unsur Pimpinan Rapat dan Narasumber

Pemimpin Rapat : .…………………….. dari ………………………………….
Sekretaris / Notulis : .…………………….. dari ………………………………….

Narasumber : 1. …………….…….. dari ………………………………………

2. ………….……….. dari ………………………………………
3. ……….………….. dari ………………………………………
4. ……….………….. dari ………………………………………

Setelah dilakukan pemaparan materi dan musyawarah, selanjutnya para peserta musyawarah
memutuskan dan menyepakati beberapa hal yang menjadi Keputusan Rembuk Stunting Kalurahan
yaitu sebagai berikut:
1. Tersosialisasinya Materi Optimalisasi Rumah Kalurahan Sehat dalam Mengawal Kegiatan
Konvergensi Pencegahan Stunting
2. Disepakatinya Usulan Kegiatan/Program Terkait Dengan Konvergensi Pencegahan Dan
Penanganan Stunting. Adapun usulan kegiatan/program yang disepakati terkait dengan
 konvergensi pencegahan dan penanganan stunting di Kalurahan ……………….
Kapanewon …………… sebagai berikut. (terlampir)
3. Disepakatinya Delegasi/Perwakilan Peserta Rembuk Stunting dalam Melakukan Advokasi
Hasil Rembuk Stunting ke Forum-forum Perencanaan selanjutnya di tingkat Kalurahan.
a. ………………………………………..
b. ………………………………………..
c. ………………………………………..

Demikian berita acara ini dibuat dan disahkan dengan penuh tanggung jawab agar dapat
dipergunakan sebagaimana mestinya.

………………………, Tanggal ….. Juli 2020

Ketua RDS Sekretaris RDS

( ) ( )

Mengetahui dan Menyetujui,

Wakil dari Peserta Musyawarah

Nama Alamat Tanda Tangan

1. …….……………………… ……………………………………. …………..

2. …….……………………… ……………………………………. …………..

3. …….……………………… ……………………………………. …………..

4. …….……………………… ……………………………………. …………..

5. …….……………………… ……………………………………. …………..

Catatan : format lampiran BA ambil dari excel

(catatan ini jangan ikut di print)
 DAFTAR HADIR
Rembuk Stunting Kalurahan
Konvergensi Pencegahan dan Penanganan Stunting

Hari/Tanggal : .............................
Pukul : .............................
Tempat : .............................

NO NAMA P/L ALAMAT TANDA

TANGAN
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
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50

....................., .......... 2020

(.......................................)

Notulensi
Rembuk Stunting Kalurahan
Konvergensi Pencegahan Stunting

Hari/Tanggal : ..............................
Pukul : ..............................
Tempat : ..............................
Notulen : ..............................

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.............................., ...... Juli 2020

Notulen:

(………………………..)