FORMULIR 2.B.

PEMANTAUAN BULANAN ANAK 0-2 TAHUN

Desa : Jaar
Kecamatan : Dusun Timur
Kabupaten : Barito Timur
Provinsi : Kalimantan Tengah

BULAN : Januari 2020

Jenis Kelamin (L/P)

Umur dan Status
Tikar Indikator Layanan
No Tanggal Lahir Status Gizi Anak

Imunisasi Dasar

Bagi Orang Tua

Jamban Sehat
Konseling Gizi
No Register Nama Anak Anak (Normal/Buruk/K

Tinggi Badan

Kepemilikan

Kepemilikan
Berat Badan

Pengasuhan
Pengukuran

Pengukuran
Pemberian

Kunjungan

Kesehatan
Akta Lahir
Akses Air
(KIA) (Tgl/Bln/Thn) urang/Stunting)

Jaminan

(PAUD)
Rumah

Bersih
Umur Hasil
(Bulan) (M/K/H)

a b c d e f g h i j k1 (L) k2 (P) l m n o p q
1 Sean Natanael L 1/24/2018 N 24 X √ X — √ X √ √ √ √ √
2 Maleakhi D L 1/12/2018 N 24 X √ X — √ X √ √ √ √ √
3 Elisia N P 2/10/2018 N 23 X √ X — √ X √ √ √ √ √
4 Andriana S P 2/24/2018 S 23 X √ X — √ √ √ √ √ √ √
5 FX Fabia F L 2/17/2018 N 23 X √ X — √ X √ √ √ √ √
6 Adinata L 3/2/2018 N 22 X √ X — √ X √ √ √ √ √
7 Theresia A P 3/18/2018 S 22 X √ X — √ √ √ √ √ √ √
8 Ertos A L 3/29/2018 N 22 X √ X — √ X √ √ √ √ √
9 Sesilia A P 4/15/2018 N 21 H X √ √ — √ X √ √ √ √ √
10 Aghata D G L 4/4/2018 N 21 H X √ √ — √ X √ √ √ √ √
11 Alvin P P L 4/23/2018 N 21 H X √ √ — √ X √ √ √ √ √
12 Rafael J L 4/19/2018 N 21 H X √ √ — √ X √ √ √ √ √
13 Naira P P 4/26/2018 N 21 H X √ √ — √ X √ √ √ √ √
14 Vino L 2/17/2018 N 20 X √ X — √ X √ √ √ √ √
15 Neli A P 5/26/2018 N 20 X √ X — √ X √ √ √ √ √
16 Rio S L 5/19/2018 N 20 X √ X — √ X √ √ √ √ √
17 Talita P P 5/18/2018 N 20 X √ X — √ X √ √ √ √ √
18 Lana K A P 5/26/2018 N 20 X √ X — √ X √ √ √ √ √
19 Serryn E P 5/11/2018 N 20 X √ X — √ X √ √ √ √ √
20 Yehuda B J L 6/6/2018 N 19 X √ X — √ X √ √ √ √ √
21 Apika M P 6/29/2018 N 19 X √ X — √ X √ √ √ √ √
22 Brian D H L 6/11/2018 N 19 X √ X — √ X √ √ √ √ √
23 Yulius N L 6/16/2018 N 19 X √ X — √ X √ √ √ √ √
24 Prijianno D L 8/17/2018 N 17 X √ X — √ X √ √ √ √ √
25 Elora P 8/28/2018 N 17 X X X — √ X √ √ √ √ √
26 Yitro M D L 8/10/2018 N 17 X √ X — √ X √ √ √ √ √
27 Nyoman L S L 8/15/2018 N 17 X √ X — √ X √ √ √ √ √
28 Putri E P 8/11/2018 N 17 X √ X — √ X √ √ √ √ √
29 Glen G R L 8/2/2018 N 17 X √ X — √ X √ √ √ √ √
30 Yomiko C P 9/5/2018 N 16 X √ X — √ X √ √ √ √ √
31 Daren K L 9/17/2018 N 16 X √ X — √ X √ √ √ √ √
32 Satria L 10/13/2018 N 15 H X √ √ — √ X √ √ √ √ √
33 Syantika P 10/15/2018 S 15 M X √ √ √ √ √ √ √ √ √
34 Albet D L 10/28/2018 N 15 H X √ √ — √ X √ √ √ √ √
35 Hafizhah N Z P 10/18/2018 N 15 H X √ √ — √ X √ √ √ √ √
36 Angga J L 12/14/2018 N 13 X √ X — √ X √ √ √ √ √
37 Anjelo L 12/16/2018 N 13 X √ X — √ X √ √ √ √ √
38 Emanuela P 1/14/2019 N 12 H √ √ √ — √ X √ √ √ √ √
39 Septian L 1/30/2019 N 12 H √ √ √ — √ X √ √ √ √ √
40 Rahmanisa A P 1/21/2019 N 12 H √ √ √ — √ X √ √ √ √ √
41 Jeje P P L 1/4/2019 N 12 H √ √ √ — √ X √ √ √ √ √
42 Awun W L 2/3/2019 N 11 √ √ X — √ X √ √ √ √ √
43 Lorent B L 2/24/2019 N 11 √ √ X — √ X √ √ √ √ √
44 Dilan L 2/28/2019 N 11 √ √ X — √ X √ √ √ √ √
45 Ersya C P 2/6/2019 N 11 √ √ X — √ X √ √ √ √ √
46 Nita G K P 3/29/2019 N 10 √ √ X — √ X √ √ √ √ √
47 Yopiola P D P 3/23/2019 N 10 √ √ X — √ X √ √ √ √ √
48 Kenzo L 3/17/2019 N 10 √ √ X — √ X √ √ √ √ √
49 Verrel A C L 4/2/2019 N 9 H √ √ √ — √ X √ √ √ √ √
50 Yisrael S L 5/3/2019 N 8 √ √ X — √ X √ √ √ √ √
51 Geonathan L 5/21/2019 N 8 √ √ X — √ X √ √ √ √ √
52 Syaripah P 5/11/2019 N 8 √ √ X — √ X √ √ √ √ √
53 Pahiyang L P 5/27/2019 N 8 √ √ X — √ X √ √ √ √ √
54 Alocandra S L 5/4/2019 N 8 √ √ X — √ X √ √ √ √ √
55 Satria Y L 6/21/2019 N 7 √ √ X — √ X √ √ √ √ √
56 Via T P 6/19/2019 N 7 √ √ X — √ X √ √ √ √ √
57 Cristian C L 7/1/2019 N 6 H √ √ √ — √ X √ √ √ √ √
58 Dhafine M L 7/6/2019 N 6 H √ √ √ — √ X √ √ √ √ √
59 Aurelin A P 7/17/2019 N 6 H √ √ √ — √ X √ √ √ √ √
60 Cristian L L 8/2/2019 N 5 √ √ X — √ X √ √ √ √ √
61 Achmadi M L 9/24/2019 N 4 √ √ X — √ X √ √ √ √ √
62 Michael K L 9/29/2019 N 4 √ √ X — √ X √ √ √ √ √
63 Nathaniela D C P 9/21/2019 N 3 H √ √ √ — √ X √ √ √ √ √
64 Andra W L 10/29/2019 N 3 H √ √ √ — √ X √ √ √ √ √
65 Gresia O P 10/13/2019 N 2 √ √ X — √ X √ √ √ √ √
66 Okta G L 10/28/2019 N 2 √ √ X — √ X √ √ √ √ √
67 M. Abyan R L 11/25/2019 N 1 √ √ X — √ X √ √ √ √ √
68 Kenzo S L 11/9/2019 N 1 √ √ X — √ X √ √ √ √ √
69 Jhon E G L 11/23/2019 N 1 √ √ X — √ X √ √ √ √ √
70 Resti W C P 11/18/2019 N 1 √ √ X — √ X √ √ √ √ √
71 Renata N P P 11/17/2019 N 1 √ √ X — √ X √ √ √ √ √
72 Vieri A N P 12/18/2019 N 1 √ √ X — √ X √ √ √ √ √

Kepala Desa Jaar Kader Pembangunan Manusia (KPM)

ARPONI R.SONDE, SE TIANI

 FORMULIR 2.B. PEMANTAUAN BULANAN ANAK 0-2 TAHUN

Desa : Jaar
Kecamatan : Dusun Timur
Kabupaten : Barito Timur
Provinsi : Kalimantan Tengah

BULAN : Februari 2020

Jenis Kelamin (L/P)

Umur dan Status
Tikar Indikator Layanan
No Tanggal Lahir Status Gizi Anak

Imunisasi Dasar

Bagi Orang Tua

Jamban Sehat
Konseling Gizi
No Register Nama Anak Anak (Normal/Buruk/K

Tinggi Badan

Kepemilikan

Kepemilikan
Berat Badan

Pengasuhan
Pengukuran

Pengukuran
Pemberian

Kunjungan

Kesehatan
Akta Lahir
Akses Air
(KIA) (Tgl/Bln/Thn) urang/Stunting)

Jaminan

(PAUD)
Rumah

Bersih
Umur Hasil
(Bulan) (M/K/H)

a b c d e f g h i j k1 (L) k2 (P) l m n o p q
1 Elisia N P 2/10/2018 N 24 X √ X — √ X √ √ √ √ √
2 Andriana S P 2/24/2018 S 24 X √ X — √ √ √ √ √ √ √
3 FX Fabia F L 2/17/2018 N 24 X √ X — √ X √ √ √ √ √
4 Adinata L 3/2/2018 N 23 X √ X — √ X √ √ √ √ √
5 Theresia A P 3/18/2018 S 23 X √ X — √ √ √ √ √ √ √
6 Ertos A L 3/29/2018 N 23 X √ X — √ X √ √ √ √ √
7 Sesilia A P 4/15/2018 N 22 X √ X — √ X √ √ √ √ √
8 Aghata D G L 4/4/2018 N 22 X √ X — √ X √ √ √ √ √
9 Alvin P P L 4/23/2018 N 22 X √ X — √ X √ √ √ √ √
10 Rafael J L 4/19/2018 N 22 X √ X — √ X √ √ √ √ √
11 Naira P P 4/26/2018 N 22 X √ X — √ X √ √ √ √ √
12 Vino L 2/17/2018 N 21 H X √ √ — √ X √ √ √ √ √
13 Neli A P 5/26/2018 N 21 H X √ √ — √ X √ √ √ √ √
14 Rio S L 5/19/2018 N 21 H X √ √ — √ X √ √ √ √ √
15 Talita P P 5/18/2018 N 21 H X √ √ — √ X √ √ √ √ √
16 Lana K A P 5/26/2018 N 21 H X √ √ — √ X √ √ √ √ √
17 Serryn E P 5/11/2018 N 21 H X √ √ — √ X √ √ √ √ √
18 Yehuda B J L 6/6/2018 N 20 X √ X — √ X √ √ √ √ √
19 Apika M P 6/29/2018 N 20 X √ X — √ X √ √ √ √ √
20 Brian D H L 6/11/2018 N 20 X √ X — √ X √ √ √ √ √
21 Yulius N L 6/16/2018 N 20 X √ X — √ X √ √ √ √ √
22 Prijianno D L 8/17/2018 N 18 H X √ √ — √ X √ √ √ √ √
23 Elora P 8/28/2018 N 18 H X X √ — √ X √ √ √ √ √
24 Yitro M D L 8/10/2018 N 18 H X √ √ — √ X √ √ √ √ √
25 Nyoman L S L 8/15/2018 N 18 H X √ √ — √ X √ √ √ √ √
26 Putri E P 8/11/2018 N 18 H X √ √ — √ X √ √ √ √ √
27 Glen G R L 8/2/2018 N 18 H X √ √ — √ X √ √ √ √ √
28 Yomiko C P 9/5/2018 N 17 X √ X — √ X √ √ √ √ √
29 Daren K L 9/17/2018 N 17 X √ X — √ X √ √ √ √ √
30 Satria L 10/13/2018 N 16 X √ X — √ X √ √ √ √ √
31 Syantika P 10/15/2018 S 16 X √ X √ √ √ √ √ √ √
32 Albet D L 10/28/2018 N 16 X √ X — √ X √ √ √ √ √
33 Hafizhah N Z P 10/18/2018 N 16 X √ X — √ X √ √ √ √ √
34 Angga J L 12/14/2018 N 14 X √ X — √ X √ √ √ √ √
35 Anjelo L 12/16/2018 N 14 X √ X — √ X √ √ √ √ √
36 Emanuela P 1/14/2019 N 13 √ √ X — √ X √ √ √ √ √
37 Septian L 1/30/2019 N 13 √ √ X — √ X √ √ √ √ √
38 Rahmanisa A P 1/21/2019 N 13 √ √ X — √ X √ √ √ √ √
39 Jeje P P L 1/4/2019 N 13 √ √ X — √ X √ √ √ √ √
40 Awun W L 2/3/2019 N 12 H √ √ √ — √ X √ √ √ √ √
41 Lorent B L 2/24/2019 N 12 H √ √ √ — √ X √ √ √ √ √
42 Dilan L 2/28/2019 N 12 H √ √ √ — √ X √ √ √ √ √
43 Ersya C P 2/6/2019 N 12 H √ √ √ — √ X √ √ √ √ √
44 Nita G K P 3/29/2019 N 11 √ √ X — √ X √ √ √ √ √
45 Yopiola P D P 3/23/2019 N 11 √ √ X — √ X √ √ √ √ √
46 Kenzo L 3/17/2019 N 11 √ √ X — √ X √ √ √ √ √
47 Verrel A C L 4/2/2019 N 10 √ √ X — √ X √ √ √ √ √
48 Yisrael S L 5/3/2019 N 9 H √ √ √ — √ X √ √ √ √ √
49 Geonathan L 5/21/2019 N 9 H √ √ √ — √ X √ √ √ √ √
50 Syaripah P 5/11/2019 N 9 H √ √ √ — √ X √ √ √ √ √
51 Pahiyang L P 5/27/2019 N 9 H √ √ √ — √ X √ √ √ √ √
52 Alocandra S L 5/4/2019 N 9 H √ √ √ — √ X √ √ √ √ √
53 Satria Y L 6/21/2019 N 8 √ √ X — √ X √ √ √ √ √
54 Via T P 6/19/2019 N 8 √ √ X — √ X √ √ √ √ √
55 Cristian C L 7/1/2019 N 7 √ √ X — √ X √ √ √ √ √
56 Dhafine M L 7/6/2019 N 7 √ √ X — √ X √ √ √ √ √
57 Aurelin A P 7/17/2019 N 7 √ √ X — √ X √ √ √ √ √
58 Cristian L L 8/2/2019 N 6 H √ √ √ — √ X √ √ √ √ √
59 Achmadi M L 9/24/2019 N 5 √ √ X — √ X √ √ √ √ √
60 Michael K L 9/29/2019 N 5 √ √ X — √ X √ √ √ √ √
61 Nathaniela D C P 9/21/2019 N 4 √ √ X — √ X √ √ √ √ √
62 Andra W L 10/29/2019 N 4 √ √ X — √ X √ √ √ √ √
63 Gresia O P 10/13/2019 N 3 H √ √ √ — √ X √ √ √ √ √
64 Okta G L 10/28/2019 N 3 H √ √ √ — √ X √ √ √ √ √
65 M. Abyan R L 11/25/2019 N 2 √ √ X — √ X √ √ √ √ √
66 Kenzo S L 11/9/2019 N 2 √ √ X — √ X √ √ √ √ √
67 Jhon E G L 11/23/2019 N 2 √ √ X — √ X √ √ √ √ √
68 Resti W C P 11/18/2019 N 2 √ √ X — √ X √ √ √ √ √
69 Renata N P P 11/17/2019 N 2 √ √ X — √ X √ √ √ √ √
70 Vieri A N P 12/18/2019 N 2 √ √ X — √ X √ √ √ √ √

Kepala Desa Jaar Kader Pembangunan Manusia (KPM)

ARPONI R.SONDE, SE TIANI

 FORMULIR 2.B. PEMANTAUAN BULANAN ANAK 0-2 TAHUN

Desa : Jaar
Kecamatan : Dusun Timur
Kabupaten : Barito Timur
Provinsi : Kalimantan Tengah

BULAN : Maret 2020

Jenis Kelamin (L/P)

Umur dan Status
Tikar Indikator Layanan
No Tanggal Lahir Status Gizi Anak

Imunisasi Dasar

Bagi Orang Tua

Jamban Sehat
Konseling Gizi
No Register Nama Anak Anak (Normal/Buruk/K

Tinggi Badan

Kepemilikan

Kepemilikan
Berat Badan

Pengasuhan
Pengukuran

Pengukuran
Pemberian

Kunjungan

Kesehatan
Akta Lahir
Akses Air
(KIA) (Tgl/Bln/Thn) urang/Stunting)

Jaminan

(PAUD)
Rumah

Bersih
Umur Hasil
(Bulan) (M/K/H)

a b c d e f g h i j k1 (L) k2 (P) l m n o p q
1 Adinata L 3/2/2018 N 24 X √ X — √ X √ √ √ √ √
2 Theresia A P 3/18/2018 S 24 X √ X — √ √ √ √ √ √ √
3 Ertos A L 3/29/2018 N 24 X √ X — √ X √ √ √ √ √
4 Sesilia A P 4/15/2018 N 23 X √ X — √ X √ √ √ √ √
5 Aghata D G L 4/4/2018 N 23 X √ X — √ X √ √ √ √ √
6 Alvin P P L 4/23/2018 N 23 X √ X — √ X √ √ √ √ √
7 Rafael J L 4/19/2018 N 23 X √ X — √ X √ √ √ √ √
8 Naira P P 4/26/2018 N 23 X √ X — √ X √ √ √ √ √
9 Vino L 2/17/2018 N 22 X √ X — √ X √ √ √ √ √
10 Neli A P 5/26/2018 N 22 X √ X — √ X √ √ √ √ √
11 Rio S L 5/19/2018 N 22 X √ X — √ X √ √ √ √ √
12 Talita P P 5/18/2018 N 22 X √ X — √ X √ √ √ √ √
13 Lana K A P 5/26/2018 N 22 X √ X — √ X √ √ √ √ √
14 Serryn E P 5/11/2018 N 22 X √ X — √ X √ √ √ √ √
15 Yehuda B J L 6/6/2018 N 21 H X √ √ — √ X √ √ √ √ √
16 Apika M P 6/29/2018 N 21 H X √ √ — √ X √ √ √ √ √
17 Brian D H L 6/11/2018 N 21 H X √ √ — √ X √ √ √ √ √
18 Yulius N L 6/16/2018 N 21 X √ X — √ X √ √ √ √ √
19 Prijianno D L 8/17/2018 N 19 X √ X — √ X √ √ √ √ √
20 Elora P 8/28/2018 N 19 X X X — √ X √ √ √ √ √
21 Yitro M D L 8/10/2018 N 19 X √ X — √ X √ √ √ √ √
22 Nyoman L S L 8/15/2018 N 19 X √ X — √ X √ √ √ √ √
23 Putri E P 8/11/2018 N 19 X √ X — √ X √ √ √ √ √
24 Glen G R L 8/2/2018 N 19 X √ X — √ X √ √ √ √ √
25 Yomiko C P 9/5/2018 N 18 H X √ √ — √ X √ √ √ √ √
26 Daren K L 9/17/2018 N 18 H X √ √ — √ X √ √ √ √ √
27 Satria L 10/13/2018 N 17 X √ X — √ X √ √ √ √ √
28 Syantika P 10/15/2018 S 17 X √ X √ √ √ √ √ √ √
29 Albet D L 10/28/2018 N 17 X √ X — √ X √ √ √ √ √
30 Hafizhah N Z P 10/18/2018 N 17 X √ X — √ X √ √ √ √ √
31 Angga J L 12/14/2018 N 15 H X √ √ — √ X √ √ √ √ √
32 Anjelo L 12/16/2018 N 15 H X √ √ — √ X √ √ √ √ √
33 Emanuela P 1/14/2019 N 14 √ √ X — √ X √ √ √ √ √
34 Septian L 1/30/2019 N 14 √ √ X — √ X √ √ √ √ √
35 Rahmanisa A P 1/21/2019 N 14 √ √ X — √ X √ √ √ √ √
36 Jeje P P L 1/4/2019 N 14 √ √ X — √ X √ √ √ √ √
37 Awun W L 2/3/2019 N 13 √ √ X — √ X √ √ √ √ √
38 Lorent B L 2/24/2019 N 13 √ √ X — √ X √ √ √ √ √
39 Dilan L 2/28/2019 N 13 √ √ X — √ X √ √ √ √ √
40 Ersya C P 2/6/2019 N 13 √ √ X — √ X √ √ √ √ √
41 Nita G K P 3/29/2019 N 12 H √ √ √ — √ X √ √ √ √ √
42 Yopiola P D P 3/23/2019 N 12 H √ √ √ — √ X √ √ √ √ √
43 Kenzo L 3/17/2019 N 12 H √ √ √ — √ X √ √ √ √ √
44 Verrel A C L 4/2/2019 N 11 √ √ X — √ X √ √ √ √ √
45 Yisrael S L 5/3/2019 N 10 √ √ X — √ X √ √ √ √ √
46 Geonathan L 5/21/2019 N 10 √ √ X — √ X √ √ √ √ √
47 Syaripah P 5/11/2019 N 10 √ √ X — √ X √ √ √ √ √
48 Pahiyang L P 5/27/2019 N 10 √ √ X — √ X √ √ √ √ √
49 Alocandra S L 5/4/2019 N 10 √ √ X — √ X √ √ √ √ √
50 Satria Y L 6/21/2019 N 9 H √ √ √ — √ X √ √ √ √ √
51 Via T P 6/19/2019 N 9 H √ √ √ — √ X √ √ √ √ √
52 Cristian C L 7/1/2019 N 8 √ √ X — √ X √ √ √ √ √
53 Dhafine M L 7/6/2019 N 8 √ √ X — √ X √ √ √ √ √
54 Aurelin A P 7/17/2019 N 8 √ √ X — √ X √ √ √ √ √
55 Cristian L L 8/2/2019 N 7 √ √ X — √ X √ √ √ √ √
56 Achmadi M L 9/24/2019 N 6 H √ √ √ — √ X √ √ √ √ √
57 Michael K L 9/29/2019 N 6 H √ √ √ — √ X √ √ √ √ √
58 Nathaniela D C P 9/21/2019 N 5 √ √ X — √ X √ √ √ √ √
59 Andra W L 10/29/2019 N 5 √ √ X — √ X √ √ √ √ √
60 Gresia O P 10/13/2019 N 4 √ √ X — √ X √ √ √ √ √
61 Okta G L 10/28/2019 N 4 √ √ X — √ X √ √ √ √ √
62 M. Abyan R L 11/25/2019 N 3 H √ √ √ — √ X √ √ √ √ √
63 Kenzo S L 11/9/2019 N 3 H √ √ √ — √ X √ √ √ √ √
64 Jhon E G L 11/23/2019 N 3 H √ √ √ — √ X √ √ √ √ √
65 Resti W C P 11/18/2019 N 3 H √ √ √ — √ X √ √ √ √ √
66 Renata N P P 11/17/2019 N 3 H √ √ √ — √ X √ √ √ √ √
67 Vieri A N P 12/18/2019 N 3 H √ √ √ — √ X √ √ √ √ √

Kepala Desa Jaar Kader Pembangunan Manusia (KPM)

ARPONI R.SONDE, SE TIANI