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    INSTRUMEN_PEROLEH_MASUKAN

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    Instrumen Peroleh Masukan

    Diunggah oleh

    Resta Silitonga

    Hak Cipta:

    © All Rights Reserved
    Unduh sebagai DOCX, PDF, TXT atau baca online dari Scribd
    Tandai sebagai konten tidak pantas
    dari 1

    PEMERINTAH KABUPATEN PELALAWAN PEMERINTAH KABUPATEN PELALAWAN PEMERINTAH KABUPATEN PELALAWAN

    DINAS KESEHATAN DINAS KESEHATAN DINAS KESEHATAN


    UPTD PUSKESMAS PANGKALAN LESUNG UPTD PUSKESMAS PANGKALAN LESUNG UPTD PUSKESMAS PANGKALAN LESUNG

    KEGITAN UKM KEGITAN UKM KEGITAN UKM

    NAMA KEGIATAN : NAMA KEGIATAN : NAMA KEGIATAN :


    WAKTU : WAKTU : WAKTU :
    TEMPAT : TEMPAT : TEMPAT :

    I. TANGGAPAN TERHADAP KEGIATAN (Baik / I. TANGGAPAN TERHADAP KEGIATAN (Baik / I. TANGGAPAN TERHADAP KEGIATAN (Baik /
    Tidak Baik, Puas / Kurang Puas / Tidak Puas, Atau Tidak Baik, Puas / Kurang Puas / Tidak Puas, Atau Tidak Baik, Puas / Kurang Puas / Tidak Puas, Atau
    Lainnya) Lainnya) Lainnya)

    1. .................................................................................. 1. ................................................................................... 1. ...................................................................................


    .................................................................................. ................................................................................... ...................................................................................
    .............................................................................. ............................................................................ ............................................................................
    2. .................................................................................. 2. .................................................................................. 2. ..................................................................................
    .................................................................................. .................................................................................. ..................................................................................
    .............................................................................. .............................................................................. ..............................................................................
    3. .................................................................................. 3. .................................................................................. 3. ..................................................................................
    ................................................ ................................................ ................................................

    II. USULAN / MASUKAN / SARAN / KRITIK II. USULAN / MASUKAN / SARAN / KRITIK II. USULAN / MASUKAN / SARAN / KRITIK

    1. .................................................................................. 1. ................................................................................... 1. ...................................................................................


    ............................................................................... .............................................................................. ..............................................................................
    2. .................................................................................. 2. ................................................................................... 2. ...................................................................................
    .................................................................................. ................................................................................... ...................................................................................
    .............................................................................. ............................................................................ ............................................................................
    3. .................................................................................. 3. ................................................................................... 3. ...................................................................................
    .................................................................................. ................................................................................... ...................................................................................
    ............................................................................. ........................................................................... ...........................................................................

    TTD TTD TTD

    ........................ ........................ ........................

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