Anda di halaman 1dari 1

LAPORAN HASIL

PELAKSANAAN KEGIATAN PERJALANAN DINAS


UPT PUSKESMAS BABATAN
TAHUN 2021

1. Dasar Penugasan : Surat tugas Nomor : ............../ST/BOK/UPT.PKMBBT/ /2021


2. Nama Petugas/TIM : 1. ...........................................
2. ...........................................
3. Tujuan Perjalanan : ............................................
4. Tanggal Perjalanan : ............................................
5. Maksud Perjalanan : ............................................
6. Pejabat Yang Ditemui : ............................................

7. Hasil Kunjungan, Antara Lain :


a. Proses Pelaksanan :
.............................................................................................................................
............................................................................................................................
.............................................................................................................................
…........................................................................................................................
............................................................................................................................
............................................................................................................................
b. Hasil :
.............................................................................................................................
.............................................................................................................................
..............................................................................................................................
..............................................................................................................................
..............................................................................................................................
c. Saran Perbaikan/Kesimpulan :
..............................................................................................................................
..............................................................................................................................
..............................................................................................................................
..............................................................................................................................
.............................................................................................................................

Mengetahui, Petugas Tanda Tangan


PLT Pimpinan UPT Puskesmas Babatan
1. ..................................

2. ..................................

dr. Wiwit Wulandari, M. KKK


NIP. 19760202 201001 2 013

Anda mungkin juga menyukai