PEMERINTAH KABUPATEN NAGEKEO

DINAS KESEHATAN
UPTD PUSKESMAS NANGARORO
Jln. Ende – Aegela No.- Telp.- Kode Pos 86464

KUISIONER RESPONDEN

A. IDENTITAS RESPONDEN

Nama :

Umur :

Jenis Kelamin :

Pekerjaan :

Alamat :

B. PERTANYAAN

1. Apa yang saudara ketahui tentang Tujuan/Visi UPTD Puskesmas Nangaroro?

Jawab :.........................................................................................................

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2. Ada berapa Misi UPTD Puskesmas Nangaroro?

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3. Sebutkan yang saudara ketahui tentang Misi UPTD Puskesmas Nangaroro?

Jawab:..........................................................................................................

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4.Sebutkan yang saudara ketahui tentang Tata Nilai UPTD Puskesmas
Nangaroro?

Jawab:..........................................................................................................

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5. Apa yang saudara ketahui sasaran kerja UPTD Puskesmas Nangaroro?

Jawab:.........................................................................................................

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6.Apa yang saudara ketahui tentang SLOGAN Pelayanan UKM?

a. KIA/KB

Jawab:.....................................................................................

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b.Promkes

Jawab:......................................................................................

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c. Gizi

Jawab :.....................................................................................

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d.P2P

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Nangaroro,............/................/2018

Responden

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Nip.....................................................