HASIL REKAP SURVEI KESEHATAN LINGKUNGAN PERUMAHAN DI RT 01 RK 01 DESA KAWUNGCARANG KECAMATAN SUMBANG HASIL REKAP SURVEI PHBS DI RT …….

HASIL REKAP SURVEI PHBS DI RT …….DESA ……. KECAMATAN ………

Diare Ispa Typus DHF Malaria TBC Kulit Apakah di

rumah ada bayi
Memb atau balita
Jamba
Sarana Sarana uang Membu
PEND n Sarana Membu Member
JML Jendel Air Pembua Membu tinja ang
IDIKA Jendel (Saran Pembu ka sihkan
PEKE ANGG a Lubang Bersih ngan ka bayi sampa
N ALAM Langit- Dindin a Ventila Pencah a angan jendela rumah
NO NAMA RESPONDEN RJAA OTA Lantai ruang asap (SGL / sarana jendela dan h pada Scor NO NAMA
TERA AT Sakit JK Umur Yankes Sakit JK Umur Yankes Sakit JK Umur Yankes Sakit JK Umur Yankes Sakit JK Umur Yankes Sakit JK Umur Yankes Sakit JK Umur Yankes langit g kamar si ayaan. pembu Air ruang dan
N KK KELU keluar dapur SPT / (Tempat kamar balita tempat
KHIR tidur angan Limbah keluarg halama
ARGA ga PP / KU Sampah tidur. ke sampa
KK kotoran (SPAL) a. n.
/ PAH) ). jamban h.
)
.

6 7 8 9 10 11 12
1 2 3 4 5 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
a b c d a b c d a b c d a b c d a b c d a b c d a b c d
Karsito Karsito
1 2 4 11 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 2 1 1 1 2 1 2 4 2 0 0 2 2 0 2 743 1 1

Endah Hadi Ningsih Endah Hadi Ningsih

2 4 2 11 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 3 2 1 0 1 0 1 2 4 0 0 1 2 2 1 1 718 2 0

Subiyantoro Subiyantoro
3 4 4 11 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 3 2 1 1 1 0 1 2 1 1 1 1 1 1 2 0 667 3 0

Agus Waluyo Agus Waluyo

4 2 2 11 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 2 1 1 1 0 1 2 1 0 2 1 2 2 2 1 737 4 0

Sunarso Sunarso
5 3 2 11 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 3 2 1 1 1 0 0 2 2 0 1 1 0 1 1 0 517 5 1

Kasmiarto Kasmiarto
6 2 2 11 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 1 1 2 0 1 0 0 0 0 1 1 1 0 0 392 6 1

Darsem Darsem
7 2 2 11 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 2 2 0 0 1 2 1 2 0 0 0 1 1 1 0 0 442 7 0

Rahim Rahim
8 2 2 11 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 1 1 1 0 1 0 0 0 0 1 1 1 1 1 449 8 0

Samo Samo
9 2 4 11 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 3 2 1 1 1 1 1 2 1 1 0 2 2 2 2 1 799 9 0

Sabar Santoso Sabar Santoso

10 2 2 11 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 1 1 0 0 0 3 0 1 0 0 0 1 0 0 268 10 0

Winarto Winarto
11 3 2 11 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 1 1 1 2 0 2 0 1 0 1 1 1 1 1 1 561 11 0

Samsi Samsi
12 2 2 11 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 1 1 1 0 1 3 0 0 1 2 1 1 1 1 574 12 0

13 Riswan 4 3 11 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 1 0 0 0 1 2 4 2 1 1 0 1 0 1 524 13
Riswan 0

14 Muhdar 2 4 11 8 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 3 2 1 1 1 0 1 4 1 0 1 2 0 1 0 2 673 14
Muhdar 0

15 Ramilah 2 4 11 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 2 1 1 2 2 2 4 3 1 1 1 1 1 2 1 904 15
Ramilah 1

16 Nilah 1 1 11 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 2 1 1 1 1 2 3 1 1 1 0 1 1 0 1 623 16
Nilah 0

17 Dwi Kurniawan 4 4 11 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 2 1 1 2 1 2 2 4 1 0 2 2 2 2 1 936 17

Dwi Kurniawan 1

18 Darto 4 2 11 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 3 2 1 1 2 0 2 3 4 0 1 1 1 1 0 0 716 18
Darto 0

19 Darsito 1 4 11 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 2 1 1 1 1 1 4 0 2 1 0 0 1 0 1 573 19
Darsito 0

20 Panji Suwarno 4 3 11 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 3 2 1 1 2 1 2 2 1 2 0 2 2 2 0 0 754 20

Panji Suwarno 0

21 nasih 1 1 11 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 1 4 0 2 0 0 0 1 0 0 318 21
nasih 0

22 sebelah bu.lurah 0 22
sebelah bu.lurah

23 Cipto Hartono 4 4 11 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 3 2 1 1 2 2 2 4 1 1 0 2 2 2 0 2 929 23

Cipto Hartono 0

24 Bambang Riadi 2 4 11 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 2 1 1 1 1 1 4 0 2 1 2 0 1 0 1 561 24

Bambang Riadi 0

25 Kusmanto 2 2 11 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 2 1 0 2 1 1 2 2 3 0 2 0 2 2 0 711 25
Kusmanto 1

26 Kedono 4 5 11 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 2 1 1 1 2 2 2 1 3 2 2 2 2 0 0 798 26
Kedono 0

27 Surasno 4 5 11 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 2 1 1 1 1 2 2 1 1 0 2 2 2 0 0 667 27
Surasno 0

28 Samsudin 2 2 11 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 3 2 0 1 1 0 1 2 0 1 1 0 0 1 0 0 454 28
Samsudin 0

29 Sahudin 3 4 11 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 3 2 1 1 2 1 1 2 1 1 0 2 2 2 1 0 773 29
Sahudin 0

30 Mukarto 2 1 11 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 3 2 1 1 2 2 2 2 1 3 0 2 2 2 2 1 973 30
Mukarto 0

31 Rasito 2 2 11 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 3 2 1 1 2 2 2 2 1 2 0 2 2 2 0 0 816 31
Rasito 0

32 Yasudi 2 3 11 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 3 2 1 1 1 2 2 2 1 3 0 2 2 2 0 1 854 32
Yasudi 0

33 Wahuno 2 2 11 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 2 2 1 1 1 1 1 2 1 0 0 2 2 2 0 0 611 33
Wahuno 1
34 Kustarto 2 4 11 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 3 2 1 1 1 2 2 2 1 1 0 2 2 2 0 0 760 34
Kustarto 1

35 Suwarjo Kiman 2 2 11 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 3 2 1 1 1 1 2 2 1 0 0 2 1 2 0 0 629 35

Suwarjo Kiman 0
HASIL REKAP SURVEI PHBS DI RT …….DESA ……. KECAMATAN ………

Persalinan oleh Pemeriksaan Bayi ASI Balita timbang Makan makanan Menggunakan air bersih Menggunakan jamban sehat Saluran air limbah
nakes bumil pada eksklusif teratur 8 x/th gizi seimbang
Nakes 4 x

Membuang Menempati luas

Lantai rumah Olah raga Mencuci tangan Menggosok gigi Tidak miras / Menjadi anggota
closet leher Disalurkan ke sampah pd rumah min 9 Tidak merokok Melakukan PSN JUMLAH
PDAM Perpipaan Sumur gali Mata air septiktank Ada Permanen kedap air teratur pakai sabun 2x sehari narkoba JPK
angasa septik tank tempatnya m2/org

37 38 39
32 33 34 35 36 40 41 42 43 44 45 46 47 48 49 50
a b c d a b a b c

0 0 0 1 1 0 0 1 0 0 1 0 0 1 1 1 0 1 1 1 1 1 0 0 12

0 0 1 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 0 12

0 0 1 0 1 0 1 0 0 1 1 1 0 1 1 1 1 0 1 11

0 0 1 0 1 0 1 0 0 1 1 1 0 1 1 1 1 1 0 11

1 1 1 1 1 0 0 1 0 1 0 1 0 0 1 1 1 1 1 1 1 1 1 0 17

1 1 0 1 1 0 0 0 1 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 7

0 0 0 1 0 1 0 1 0 0 0 1 1 0 0 1 1 1 0 0 8

0 0 0 0 1 1 0 1 0 0 0 1 1 0 1 1 1 1 1 0 10

0 0 0 1 0 1 0 1 1 0 1 1 0 0 1 1 1 1 0 0 10

0 0 0 1 0 1 0 1 0 0 1 1 1 0 0 1 1 1 1 0 10

0 0 0 1 0 1 0 1 0 0 1 1 1 0 0 1 1 1 1 0 10

0 0 0 1 0 1 0 1 0 0 1 1 1 1 1 1 1 1 1 0 12

0 0 0 1 0 0 1 1 0 0 1 1 1 0 0 1 1 1 0 0 9

0 0 0 1 0 1 0 1 0 0 1 1 1 0 1 1 1 1 0 0 10

1 1 1 1 1 1 0 0 0 0 1 0 0 1 1 1 1 0 1 1 1 1 1 0 16

0 0 0 1 0 1 0 1 0 0 1 1 1 0 0 1 0 0 1 0 8

1 1 0 1 1 0 1 0 0 1 0 1 0 0 1 1 1 1 0 1 1 1 0 0 14

0 0 0 0 1 1 0 1 0 0 1 1 1 0 0 1 1 1 0 0 9

0 0 0 1 0 0 1 0 0 1 1 1 1 0 1 1 0 1 1 0 10

0 0 0 1 0 1 0 1 0 0 1 1 0 1 0 1 1 0 1 0 9

0 0 0 1 0 1 0 1 0 0 1 1 1 0 0 0 0 0 0 0 6

0 0 0 1 0 1 0 1 0 0 1 1 1 0 0 1 1 1 0 0 9

0 0 0 1 0 1 0 1 0 0 1 1 1 0 0 1 0 1 1 0 9

1 0 0 1 1 0 0 1 0 0 1 0 1 0 1 1 0 1 0 1 1 1 1 0 14

0 0 1 0 1 0 0 1 0 1 1 0 1 1 1 1 1 1 0 11

0 0 1 0 1 0 0 1 0 1 1 0 1 1 1 1 1 1 0 11

0 0 1 0 0 0 0 1 0 1 1 0 0 1 0 1 1 1 0 8

0 0 1 0 1 0 0 1 0 1 1 0 1 1 1 1 1 1 0 11

0 0 1 0 1 0 0 1 0 1 1 1 1 1 1 1 1 0 0 11

0 0 1 0 1 0 0 1 0 0 1 0 1 0 1 1 1 0 0 8

0 0 1 0 1 0 0 1 0 1 1 0 1 1 1 1 1 0 0 10

1 1 1 1 1 0 0 0 0 1 0 0 1 0 0 1 0 0 1 1 1 1 0 0 13
1 1 1 1 1 0 0 1 0 1 0 0 1 0 1 1 0 1 1 1 1 1 1 0 17

0 0 1 0 1 0 0 1 0 0 1 0 0 1 1 1 1 1 0 9