NOTULEN

(Untuk Lokakarya Mini Puskesmas)

RAPAT/ PERTEMUAN : ......................................................................................................

Hari / Tgl/Bln/Th : ......................................................................................................
Jam Pelaksanaan : ......................................................................................................
.
PIMPINAN RAPAT/ PERTEMUAN

Notulen/ Pencatat : ......................................................................................................

1. Kata Pembukaan : ............................................................................................

2. Penyampaian Materi Rapat : ...........................................................................................
Berisi seperti contoh :
a. Hasil Rapat Kepala Puskesmas / Penanggung jawab program di Dinas Kesehatan
Kabupaten Jember
b. Evaluasi kegiatan hasil kesepakatan bulan yang lalu
c. Pemaparan hasil kegiatan berdasarkan target dan cakupan program sampai
dengan bulan sebelumnya
d. dsb
3. Pembahasan dan Pengambilan Kesepakatan (sesuaikan urut – urutan dengan check list
lokakarya mini
puskesmas ) ..........................................................................................................................
....................
..............................................................................................................................................
4. Rencana Tindak Lanjut kegiatan berdasarkan 5 W 1 H ( What, Why, Who, When, Where and
How) / program
................................................................................................................................................
...............................................................................................................................................
5. Penutup

Jember, ................................

KEPALA .................................... PENANGGUNG JAWAB RAPAT/ PERTEMUAN

............................................... ...............................................
NIP. .................................... NIP. ....................................
 NOTULEN
(Untuk Selain Lokakarya Mini Puskesmas, Misal Rapat Rutin Puskesmas, Rapat Tim
Mutu, dll )

RAPAT/ PERTEMUAN : ......................................................................................................

Hari / Tgl/Bln/Th : ......................................................................................................
Jam Pelaksanaan : ......................................................................................................
.
PIMPINAN RAPAT/ PERTEMUAN

Notulen/ Pencatat : ......................................................................................................

1. Kata Pembukaan : ............................................................................................

2. Penyampaian Materi Rapat : ...........................................................................................
3. Pembahasan
..............................................................................................................................................
..............................................................................................................................................
6. Rencana Tindak Lanjut kegiatan berdasarkan 5 W 1 H (( What, Why, Who, When, Where and
How) / program
................................................................................................................................................
...............................................................................................................................................
4. Penutup
Jember, ................................

KEPALA .................................... PENANGGUNG JAWAB RAPAT/ PERTEMUAN

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