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LEMBAR LAPORAN HARIAN – SUPERVISOR

Provinsi : ..................................................................
Tgl/bln/thn: .........................................................
Kabupaten/Kota: ........................................................
Nama/ Tanda Tangan Supervisor Nama/ Tanda Tangan Koordinator

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CATATAN BRIEFING
Nama/ Tanda Tangan Nama/ Tanda Tangan Nama/ Tanda Tangan Nama/ Tanda Tangan
Enumerator 1 Enumerator 2 Enumerator 3 Enumerator 4

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Wilayah/ Wilayah/ Wilayah/ Wilayah/ Wilayah/


Wilayah/ Hasil Wilayah/ Hasil Wilayah/ Hasil
Target Hasil Target Target Target
Enumerator 2 Enumerator 3 Enumerator 4
Enumerator 1 Enumerator 1 Enumerator 2 Enumerator 3 Enumerator 4
.................. .................. ..................
.................. .................. .................. .................. ..................
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Check list kegiatan


No Check items (v)
1 Briefing kuesioner (khusus hari 1)
Check kelengkapan
2 Pulpen
3 Pensil
4 Penghapus
Kuesioner
5a Kelengkapan halaman
5b Nomor kuesioner
7 Janji waktu dan tempat debriefing

CATATAN DEBRIEFING
Nama/ Tanda Tangan Nama/ Tanda Tangan Nama/ Tanda Tangan Nama/ Tanda Tangan
Enumerator 1 Enumerator 2 Enumerator 3 Enumerator 4

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CATATAN (HAL YG MEMPERLANCAR & KESULITAN2 YANG DIHADAPI & RENCANA SOLUSI)
1. .......................................................................................................................................
2. .......................................................................................................................................
3. ......................................................................................................................................
4. .......................................................................................................................................

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