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    Rudi Rudi
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    The document is a checklist of supplies for Outbreak Response Immunization (ORI) teams. It lists the vaccines, medical supplies, equipment, and documentation provided to each of 10 ORI teams (Teams A through J). Standard supplies include vaccines for diphtheria, tetanus and pertussis, syringes, gloves, masks, and report/attendance forms. The number of vaccinators per team ranges from 8 to 16. The final sections list standard supplies and documentation for additional teams without letters.

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    The document is a checklist of supplies for Outbreak Response Immunization (ORI) teams. It lists the vaccines, medical supplies, equipment, and documentation provided to each of 10 ORI teams (Teams A through J). Standard supplies include vaccines for diphtheria, tetanus and pertussis, syringes, gloves, masks, and report/attendance forms. The number of vaccinators per team ranges from 8 to 16. The final sections list standard supplies and documentation for additional teams without letters.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    7 views24 pages

    Chek List

    Uploaded by

    Rudi Rudi
    The document is a checklist of supplies for Outbreak Response Immunization (ORI) teams. It lists the vaccines, medical supplies, equipment, and documentation provided to each of 10 ORI teams (Teams A through J). Standard supplies include vaccines for diphtheria, tetanus and pertussis, syringes, gloves, masks, and report/attendance forms. The number of vaccinators per team ranges from 8 to 16. The final sections list standard supplies and documentation for additional teams without letters.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 24

    CHEKLIST PERBEKALAN TIM OUTBREAK RESPONSE IMMUNIZATION (ORI)

    TANGGAL
    JUMLAH
    NO TIM JENIS PERBEKALAN DIBERIKA 1 2 3 4
    N JUMLAH NAMA / JUMLAH NAMA / JUMLAH NAMA / JUMLAH NAMA / JUMLAH NAMA / JUMLAH NAMA / JUMLAH NAMA /
    TERIMA TTD KEMBALI TTD TERIMA TTD KEMBALI TTD TERIMA TTD KEMBALI TTD TERIMA TTD
    VAKSIN
    1 - PENTABIO
    2 - DT
    3 - Td
    ALKES/BHP TAMBAHAN
    4 - Spuit 3 cc
    5 - Handscoen 1 box
    6 - Masker 1 box
    7 - Safety Box
    PERLENGKAPAN KIPI
    8 - Spuit 1 cc 1 pcs
    9
    A - Abocath 20 1 pcs
    10 - Infus Set Dewasa 1 pcs
    11 - RL 1 pcs
    ATRIBUT
    12 - Lembar Laporan
    13 - Lembar Absensi
    NAME TAG
    14 - Koordinator 1
    15 - Supervisor 1
    16 - Administrator 4
    17 - Vaksinator 8

    VAKSIN
    1 - PENTABIO
    2 - DT
    3 - Td
    ALKES/BHP TAMBAHAN
    4 - Spuit 3 cc
    5 - Handscoen 1 box
    6 - Masker 1 box
    7 - Safety Box
    PERLENGKAPAN KIPI
    8 - Spuit 1 cc 1 pcs
    9 B - Abocath 20 1 pcs
    10 - Infus Set Dewasa 1 pcs
    11 - RL 1 pcs
    ATRIBUT
    12 - Lembar Laporan
    13 - Lembar Absensi
    NAME TAG
    14 - Koordinator 1
    15 - Supervisor 1
    16 - Administrator 4
    17 - Vaksinator 10

    VAKSIN
    1 - PENTABIO
    2 - DT
    3 - Td
    ALKES/BHP TAMBAHAN
    4 - Spuit 3 cc
    5 - Handscoen 1 box
    6 - Masker 1 box
    7 - Safety Box 5
    PERLENGKAPAN KIPI
    8 - Spuit 1 cc 1 pcs
    9 C - Abocath 20 1 pcs
    C
    10 - Infus Set Dewasa 1 pcs
    11 - RL 1 pcs
    ATRIBUT
    12 - Lembar Laporan
    13 - Lembar Absensi
    NAME TAG
    14 - Koordinator 1
    15 - Supervisor 1
    16 - Administrator 4
    17 - Vaksinator 10

    VAKSIN
    1 - PENTABIO
    2 - DT
    3 - Td
    ALKES/BHP TAMBAHAN
    4 - Spuit 3 cc
    5 - Handscoen 1 box
    6 - Masker 1 box
    7 - Safety Box
    PERLENGKAPAN KIPI
    8 - Spuit 1 cc 1 pcs
    D
    9 - Abocath 20 1 pcs
    10 - Infus Set Dewasa 1 pcs
    11 - RL 1 pcs
    ATRIBUT
    12 - Lembar Laporan
    13 - Lembar Absensi
    NAME TAG
    14 - Koordinator 1
    15 - Supervisor 1
    16 - Administrator 4
    17 - Vaksinator 8

    VAKSIN
    1 - PENTABIO
    2 - DT
    3 - Td
    ALKES/BHP TAMBAHAN
    4 - Spuit 3 cc
    5 - Handscoen 1 box
    6 - Masker 1 box
    7 - Safety Box
    PERLENGKAPAN KIPI
    8 - Spuit 1 cc 1 pcs
    9 E - Abocath 20 1 pcs
    10 - Infus Set Dewasa 1 pcs
    11 - RL 1 pcs
    ATRIBUT
    12 - Lembar Laporan
    13 - Lembar Absensi
    NAME TAG
    14 - Koordinator 1
    15 - Supervisor 1
    16 - Administrator 4
    17 - Vaksinator 10

    VAKSIN
    1 - PENTABIO
    2 - DT
    3 - Td
    ALKES/BHP TAMBAHAN
    4 - Spuit 3 cc
    5 - Handscoen 1 box
    6 - Masker 1 box
    7 - Safety Box
    PERLENGKAPAN KIPI
    8 - Spuit 1 cc 1 pcs
    9 F - Abocath 20 1 pcs
    10 - Infus Set Dewasa 1 pcs
    11 - RL 1 pcs
    ATRIBUT
    13 - Lembar Laporan
    13 - Lembar Absensi
    NAME TAG
    14 - Koordinator 1
    15 - Supervisor 1
    16 - Administrator 4
    17 - Vaksinator 10

    VAKSIN
    1 - PENTABIO
    2 - DT
    3 - Td
    ALKES/BHP TAMBAHAN
    4 - Spuit 3 cc
    5 - Handscoen box
    6 - Masker 1 box
    7 - Safety Box
    PERLENGKAPAN KIPI
    8 - Spuit 1 cc 1 pcs
    9 G - Abocath 20 1 pcs
    10 - Infus Set Dewasa 1 pcs
    11 - RL 1 pcs
    ATRIBUT
    12 - Lembar Laporan
    13 - Lembar Absensi
    NAME TAG
    14 - Koordinator 1
    15 - Supervisor 1
    16 - Administrator 4
    17 - Vaksinator 10

    VAKSIN
    1 - PENTABIO
    2 - DT
    3 - Td
    ALKES/BHP TAMBAHAN
    4 - Spuit 3 cc
    5 - Handscoen 1 box
    6 - Masker 1 box
    7 - Safety Box
    PERLENGKAPAN KIPI
    8 - Spuit 1 cc 1 pcs
    9 H - Abocath 20 1 pcs
    10 - Infus Set Dewasa 1 pcs
    11 - RL 1 pcs
    ATRIBUT
    12 - Lembar Laporan
    13 - Lembar Absensi
    NAME TAG
    14 - Koordinator 1
    15 - Supervisor 1
    16 - Administrator 4
    17 - Vaksinator 16

    VAKSIN
    1 - PENTABIO
    2 - DT
    3 - Td
    ALKES/BHP TAMBAHAN
    4 - Spuit 3 cc
    5 - Handscoen 1 box
    6 - Masker 1 box
    7 - Safety Box
    PERLENGKAPAN KIPI
    8 - Spuit 1 cc 1 pcs
    9 I - Abocath 20 1 pcs
    10 - Infus Set Dewasa 1 pcs
    11 - RL 1 pcs
    ATRIBUT
    12 - Lembar Laporan
    13 - Lembar Absensi
    NAME TAG
    14 - Koordinator 1
    15 - Supervisor 1
    16 - Administrator 4
    17 - Vaksinator 10

    VAKSIN
    1 - PENTABIO
    2 - DT
    3 - Td
    ALKES/BHP TAMBAHAN
    4 - Spuit 3 cc
    5 - Handscoen 1 box
    6 - Masker 1 box
    7 - Safety Box
    PERLENGKAPAN KIPI

    J
    8 - Spuit 1 cc 1 pcs
    9 J - Abocath 20 1 pcs
    10 - Infus Set Dewasa 1 pcs
    11 - RL 1 pcs
    ATRIBUT
    12 - Lembar Laporan
    13 - Lembar Absensi
    NAME TAG
    14 - Koordinator 1
    15 - Supervisor 1
    16 - Administrator 4
    17 - Vaksinator 10

    VAKSIN
    1 - PENTABIO
    2 - DT
    3 - Td
    ALKES/BHP TAMBAHAN
    4 - Spuit 3 cc
    5 - Handscoen 1 box
    6 - Masker 1 box
    7 - Safety Box
    PERLENGKAPAN KIPI
    8 - Spuit 1 cc 1 pcs
    K
    9 - Abocath 20 1 pcs
    10 - Infus Set Dewasa 1 pcs
    11 - RL 1 pcs
    ATRIBUT
    12 - Lembar Laporan
    13 - Lembar Absensi
    NAME TAG
    14 - Koordinator 1
    15 - Supervisor 1
    16 - Administrator 4
    17 - Vaksinator

    VAKSIN
    1 - PENTABIO
    2 - DT
    3 - Td
    ALKES/BHP TAMBAHAN
    4 - Spuit 3 cc
    5 - Handscoen
    6 - Masker
    7 - Safety Box
    PERLENGKAPAN KIPI
    8 - Spuit 1 cc
    9 - Abocath 20
    10 - Infus Set Dewasa
    11 - RL
    ATRIBUT
    12 - Name Tag
    13 - Lembar Laporan
    14 - Lembar Absensi

    VAKSIN
    - PENTABIO
    - DT
    - Td
    ALKES/BHP TAMBAHAN
    - Spuit 3 cc
    - Handscoen
    - Masker
    - Safety Box
    PERLENGKAPAN KIPI
    - Spuit 1 cc
    - Abocath 20
    - Infus Set Dewasa
    - RL
    ATRIBUT
    - Name Tag
    - Lembar Laporan
    - Lembar Absensi
    4
    JUMLAH NAMA /
    KEMBALI TTD
    ABSENSI PETUGAS ORI

    TANGGAL :
    TIM :
    TEMPAT ORI :

    NO NAMA TUGAS TANDA TANGAN

    1 Koordinator

    2 Supervisor

    10

    11

    12

    13

    14

    15

    16

    17

    18
    19

    20

    21

    22

    23

    24

    25

    26

    27

    28

    29

    30

    Mengetahui,
    Kepala Sekolah

    (…………………………………….)

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