PEMERINTAH KABUPATEN BANDUNG

DINAS KESEHATAN
PUSKESMAS CIPEDES
JL. Jatisari No. 5 Desa Cipedes Kec. Paseh Telp (022) 859662445
Pkmcipedes_bandungkab@yahoo.com

LAPORAN PELAKSANAAN TUGAS

1. Dasar Penugasan : ..............................................

2. Nama Petugas / Tim : ..............................................
3. Tujuan Perjalanan : .............................................
4. Tanggal Perjalanan : ..............................................
5. Maksud Perjalanan : ..............................................
6. Pejabat Yang Ditemui : .............................................
7. Hasil Kunjungan, antara lain :
a. Proses pelaksanaan :
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b. Permasalahan yang dihadapi :
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c. Kesimpulan / saran perbaikan :
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Mengetahui Pelapor

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