06 Laporan Harian Supervisor [PDF]

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LEMBAR LAPORAN HARIAN - SUPERVISOR Tgl/bln/thn:



Kabupaten/Kota:



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Nama/ Tanda Tangan Supersior



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Nama/ Tanda Tangan Koordinator



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CATATAN BRIEFING Nama/ Tanda Tangan Enumerator 1



Nama/ Tanda Tangan Enumerator 2



Nama/ Tanda Tangan Enumerator 3



Nama/ Tanda Tangan Enumerator 4



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Wilayah/ Target Enumerator 1



Wilayah/ Hasil Enumerator 1



Wilayah/ Target Enumerator 2



Wilayah/ Hasil Enumerator 2



Wilayah/ Target Enumerator 3



Wilayah/ Hasil Enumerator 3



Wilayah/ Target Enumerator 4



Wilayah/ Hasil Enumerator 4



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Check list kegiatan No 1



Check items



(v)



Briefing kuesioner (khusus hari 1) Check kelengkapan



2



Pulpen



3



Pensil



4



Penghapus Kuesioner



5a



Kelengkapan halaman



5b



Nomor kuesioner



7



Janji waktu dan tempat debriefing



CATATAN DEBRIEFING Nama/ Tanda Tangan Enumerator 1



Nama/ Tanda Tangan Enumerator 2



Nama/ Tanda Tangan Enumerator 3



Nama/ Tanda Tangan Enumerator 4



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CATATAN (HAL YG MEMPERLANCAR & KESULITAN2 YANG DIHADAPI & RENCANA SOLUSI) 1. ....................................................................................................................................... 2. ....................................................................................................................................... 3. ...................................................................................................................................... 4. .......................................................................................................................................



LEMBAR LAPORAN REKAP HARIAN – SUPERVISIOR SURVAI PENILAIAN RISIKO KESEHATAN LINGKUNGAN



Tanggal:



Wilayah: ...........................................................................................................



Nama/ Tanda Tangan Supervisior ......................................................... ..........................................................................................................



JUMLAH KUESIONER TERKUMPUL



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JUMLAH KUESIONER TOTAL YANG TERKUMPUL (AKUMULASI)



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