LAPORAN PELAKSANAAN TUGAS

Dasar Penugasan: Surat Tugas Kepala Puskesmas Nomor :440/ /PKM-KLG/ /2022
1. Nama Petugas / Tim : .......................................................................
2. Tujuan Perjalanan : .......................................................................
3. Maksud Perjalanan : Upaya gerakan masyarakat hidup sehat (germas) dalam
rangka upaya kesehatan olahraga melalui pembinaan kesehatan olahraga pada
kelompok masyarakat
4. Tanggal Perjalanan : .......................................................................
5. Hasil Kunjungan :
a. ...........................................................................................................................
b. ...........................................................................................................................
c. ...........................................................................................................................
d. ...........................................................................................................................

6. Kesimpulan/ Saran Perbaikan :

a. ...........................................................................................................................
b. ...........................................................................................................................
c. ...........................................................................................................................
d. ...........................................................................................................................

Karawang, ..........................
Maret 2019
Pelapor,

Ulfah Masfufah, Amd.Keb

NIP.-
9830810 201101 2 011
Lokasi yang dikunjungi :

(___________________)
 LAPORAN PELAKSANAAN TUGAS

1.Dasar Penugasan: Surat Tugas Kepala Puskesmas Nomor : / /PKM-KLG/ /2022

2. Nama Petugas / Tim :
3. Tujuan Perjalanan : .......................................................................
4. Maksud Perjalanan : Upaya gerakan masyarakat hidup sehat (germas) dalam
rangka upaya kesehatan olahraga melalui pengukuran kebugaran jasmani pada
kelompok masyarakat
5. Tanggal Perjalanan : .......................................................................

6. Hasil Kunjungan :
a. ...........................................................................................................................
b. ...........................................................................................................................
c. ...........................................................................................................................
d. ...........................................................................................................................

7. Kesimpulan/ Saran Perbaikan :

a. ...........................................................................................................................
b. ...........................................................................................................................
c. ...........................................................................................................................
d. ...........................................................................................................................

Karawang, ..........................
Maret 2019
Pelapor,

Nila Nurlela, Amd.Keb

NIP.-
9830810 201101 2 011
Lokasi yang dikunjungi :

(___________________)