CATATAN HARIAN KEGIATAN

PENELITIAN DOSEN UNGGULAN PERGURUAN TINGGI

(PTUPT)

A. IDENTITAS PENELITIAN

Peneliti Utama : Al Murhan, SKM., M.Kes.

NIP / NIP UMM : 196601011989031006

Anggota Peneliti:
1. Dr. Aprina, S.Kp., M.Kes..................................... NIP : 196404291988032001

Penanggung jawab : ...............................................................................................

Instansi Penanggung Jawab : ...............................................................................................

(dibubuhi cap asli instansi)

Bidang Penelitian : Keperawatan

Judul Penelitian : “Kombinasi Metode Penyuluhan dan Pemicuan Terhadap

Perubahan Sikap Kepala Keluarga Tentang Stop BABS di Desa Purwosari Kecamatan Natar
Lampung Selatan”

Sub Judul Penelitian (jika ada) : ...............................................................................................

............................................................................................................................................................
............................................................................................................................................................
Nomor SK :
Tahun Pelaksanaan : 2019
B. CATATAN KEGIATAN

Hari, Tanggal : _____________________________ Paraf Peneliti : ________________

Kegiatan : ___________________________________________________________
Pelaksana : _____________________________Paraf Tim Monev : _____________
Lokasi : ____________________________________________________
Uraian Kegiatan : ___________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________

Penanggung Jawab

_______________________
(Tanda tangan, Cap)
(Gambar/Foto ditempelkan dibalik halaman ini)
Hari, Tanggal : _____________________________ Paraf Peneliti : ________________
Kegiatan : ___________________________________________________________
Pelaksana : _____________________________Paraf Tim Monev : _____________
Lokasi : ____________________________________________________
Uraian Kegiatan : ___________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________

Penanggung Jawab

_______________________
(Tanda tangan, Cap)
(Gambar/Foto ditempelkan dibalik halaman ini)
C. LEMBAR MONITORING
Hari, Tanggal :___________________________________________________________
Lokasi : ___________________________________________________________
Hasil Monitoring : (Diuraikan sesuai lampiran 6)_________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Pemonev

( ______________________ )
D. LEMBAR PENGESAHAN CATATAN HARIAN

Peneliti Utama : Al Murhan, SKM., M.Kes.

NIP / NIP UMM : 196601011989031006
Judul Penelitian : “Kombinasi Metode Penyuluhan dan Pemicuan Terhadap Perubahan
Sikap Kepala Keluarga Tentang Stop BABS di Desa Purwosari Kecamatan Natar Lampung
Selatan”.

Log book ini sudah diisi oleh peneliti dan diperiksa oleh pemonev, serta dinyatakan layak
digunakan untuk kepentingan rangkaian kegiatan penelitian.

Mengetahui,

Ka. Pusat PPM Pemonev

Lisa Suarni, M.Kep.,Sp.Mat (……………………….)

Log Book ini di upload pada akun penelitian dosen