KEMENTERIAN KESEHATAN R.

I
BADAN PPSDM KESEHATAN
POLITEKNIK KESEHATAN KEMENKES PALU
JURUSAN KEBIDANAN
Direktorat : Jln. Thalua Koncihi No. 19 Mamboro Telp. (0451) 492518 fax (0451) 491451 Palu Utara
Website :www.poltekkespalu.ac.id
e-mail : poltekkeskemenkespalu@yahoo.com
SULAWESI TENGAH

FORMAT BUKU PENCAPAIAN KETERAMPILAN

(LOG BOOK)
Kompetensi : ...................................................................
Tempat / Lokasi Praktik : ...................................................................
Waktu Praktik : ...................................................................
Kelompok : ...................................................................
Nama Pembimbing : ...................................................................
1. CI Institusi : ...................................................................
2. CI Lahan Praktik : ...................................................................
 Proses Pencapaian Keterampilan
Kompetensi/ Tanda-tangan
Hari/tgl Dengan Komentar
Nama / NIM Learning Keterampilan Mandiri Pembimbing
Pelaksanaan Bimbingan Pembimbing
Outcomes (M) dan Cap
(B)

Palu, ...................................................2021

Mengetahui
Pembimbing Akademik Kepala Ruangan/ CI Lahan Praktik

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NIP ....................................................... NIP .......................................................