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PEMERINTAH KABUPATEN MALANG

DINAS KESEHATAN
UPT PUSKESMAS GEDANGAN
Jln. Raya Hasanudin no.60 🕿 085101372323 Email: pkmgedangan060@gmail.com
GEDANGAN-65178

LAPORAN HASIL KEGIATAN


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ISI LAPORAN
1. Pelaksanaan Kegiatan
Dasar : ............................................. Peserta/sasaran : .................................
Hari/tanggal : ............................................. Pelaksana : .................................
Tempat : ............................................. Materi : .................................
2. Hasil Pelaksanaan Kegiatan
a. Rencana Pelaksanaan
a.1. Nama kegiatan : ……………………………………………………………..
a.2. Jumlah Sasaran : ……………………………………………………………..
……………………………………………………………..
a.3. Waktu : ……………………………………………………………..
a.4. Pelaksanaan : ……………………………………………………………..
b. Porses Pelaksanaan
b.1. Kegiatan ini dilakukan dengan cara
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b.2. Pengumpulan Informasi kebutuhan dan harapan masyarakat
Sumber
No Isi Informasi Keterangan
Informasi

c. Permasalahan yang ditemui pada waktu melaksanaan kegiatan


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d. Kesimpulan, saran dan perbaikan
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e. Lampiran (Foto/Absensi/Askep)
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Pelaksana

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NIP.

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