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REKAPITULASI HASIL PEMANTAUAN PHBS TATANAN KELUARG

Tahun : 2015
Semester :
RT :1
Dusun :
Desa :
Kecamatan :

INDIKATOR PHBS
No Nama Kepala Rumah Tangga
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 1 2 3 4 5 6 7 8 9 10 11 12
1 RUSMIYATI 2 2 2 1 1 1 1 1 0 0 2 2 1 1 0 1 1 1 1 1 1 1 1 0 0 1 1
2 SOGIYEM 2 2 2 1 0 1 1 1 0 1 2 2 0 1 1 1 1 1 1 0 1 1 1 0 1 1 1
3 AGUNG WAJUDIONO 2 2 2 1 0 1 1 1 0 0 2 2 0 1 1 1 1 1 1 0 1 1 1 0 0 1 1
4 DAMANI 2 2 2 1 1 1 1 1 0 1 2 2 1 0 1 1 1 1 1 1 1 1 1 0 1 1 1
5 DWI NURSANTO 1 0 1 1 1 1 1 1 0 0 2 2 0 0 1 1 0 1 1 1 1 1 1 0 0 1 1
6 SANTO BAK 2 2 2 1 0 1 1 1 2 0 2 2 1 1 0 1 1 1 1 0 1 1 1 1 0 1 1
7 LANGGENG KURNIAWAN 2 2 2 1 0 1 1 1 0 1 2 2 1 1 0 1 1 1 1 0 1 1 1 0 1 1 1
8 ROHADI 2 2 2 1 1 1 1 1 0 0 2 2 1 1 0 1 1 1 1 1 1 1 1 0 0 1 1
9 KOMAEDI 2 2 2 1 1 1 1 1 2 1 2 2 1 0 0 1 1 1 1 1 1 1 1 1 1 1 1
10 PRAPTO B.P 2 2 2 1 0 1 1 1 0 0 2 2 0 1 0 1 1 1 1 0 1 1 1 0 0 1 1
11 SUPRIHATIN 2 2 2 1 0 1 1 1 0 0 2 2 1 1 1 1 1 1 1 0 1 1 1 0 0 1 1
12 MANTO PAWIRO 2 2 2 1 1 1 1 1 2 0 2 2 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1
13 IDA PRATIWI 2 2 2 1 0 1 1 2 0 1 2 2 1 1 0 1 1 1 1 0 1 1 1 0 1 1 1
14 SIGIT YUNIANTO 2 2 2 1 1 1 1 1 0 1 2 2 1 0 1 1 1 1 1 1 1 1 1 0 1 1 1
15 YULI ISTIANTO 1 0 0 1 1 1 1 1 2 1 2 2 0 1 0 1 0 0 1 1 1 1 1 1 1 1 1
16 SEPTO NUGROHO 2 2 2 1 1 1 1 1 0 0 2 2 1 1 0 1 1 1 1 1 1 1 1 0 0 1 1
17 SLAMET WIDODO 1 0 1 1 1 1 1 1 0 1 2 2 1 1 0 1 0 1 1 1 1 1 1 0 1 1 1
18 M. SJARIF 2 2 2 1 1 1 1 1 0 1 2 2 1 1 1 1 1 1 1 1 1 1 1 0 1 1 1
19 TUKIJAN 2 2 2 1 0 1 1 2 2 1 2 2 1 1 1 1 1 1 1 0 1 1 1 1 1 1 1
20 MARWOTO 1 0 1 1 1 1 1 1 0 0 1 1 0 1 0 1 0 1 1 1 1 1 1 0 0 1 1
21 MARKANI 2 2 2 1 1 1 1 1 0 0 2 2 0 0 0 1 1 1 1 1 1 1 1 0 0 1 1
22 SUSANTO 1 1 1 1 0 1 1 1 2 1 1 2 1 0 1 1 1 1 1 0 1 1 1 1 1 1 1
23 M. SETIAWAN 1 1 1 1 1 1 1 1 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 0 1 1 1
24 KROMO ARJO 2 2 2 1 1 1 1 1 2 1 2 2 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
25 MARTO PAERAH 2 2 2 1 0 1 1 1 0 1 2 2 1 1 1 1 1 1 1 0 1 1 1 0 1 1 1
26 FAJAR NUGROHO 1 1 1 1 0 1 1 1 0 0 1 1 0 0 1 1 1 1 1 0 1 1 1 0 0 1 1
27 SUKIMIN 2 2 2 1 1 1 1 1 0 0 2 2 1 1 1 1 1 1 1 1 1 1 1 0 0 1 1
28 MARGONO 2 2 2 1 1 1 1 1 0 1 2 2 1 1 1 1 1 1 1 1 1 1 1 0 1 1 1
29 JADI IRYANTO 2 2 2 1 1 1 1 1 0 1 2 2 1 1 0 1 1 1 1 1 1 1 1 0 1 1 1
30 PAMIN 2 2 2 1 0 1 1 1 1 1 2 2 1 1 1 1 1 1 1 0 1 1 1 1 1 1 1
31 BIBID BUDIANTO 2 2 2 1 1 1 1 1 0 1 2 2 1 1 1 1 1 1 1 1 1 1 1 0 1 1 1
32 PANIADI 2 2 2 1 1 1 1 1 1 1 2 2 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1
33 SUDIMIN 2 2 2 1 1 1 1 1 1 1 2 2 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
34 NURYADI 2 2 2 1 1 1 1 0 0 1 2 2 0 1 0 1 1 1 1 1 1 1 0 0 1 1 1
35 JOKO 2 2 2 1 1 1 1 1 0 1 2 2 1 1 0 1 1 1 1 1 1 1 1 0 1 1 1
36 VINDA 2 2 2 1 1 1 1 1 1 1 2 2 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1
37 ISMORO 2 2 2 1 1 1 1 1 1 1 2 2 1 0 1 1 1 1 1 1 1 1 1 1 1 1 1
38 KASMIJO 2 2 2 1 1 1 1 0 0 0 2 2 1 0 1 1 1 1 1 1 1 1 0 0 0 1 1
39 MUSRAQIN 1 0 0 1 1 1 1 1 0 1 1 1 1 1 0 1 0 0 1 1 1 1 1 0 1 1 1
40 MARYAFET 1 1 0 1 1 1 1 1 0 0 1 1 1 0 0 1 1 0 1 1 1 1 1 0 0 1 1
41
42
43
44
45
46
47
48
49
50
51 JUMLAH 71 66 68 40 28 40 40 40 19 25 74 75 30 29 21 40 35 37 40 28 40 40 38 12 25 40 40

INDIKATOR :
1.    Persalinan ditolong oleh tenaga kesehatan
2.    Memberi bayi ASI ekskusif 
3.    Menimbang bayi dan balita setiap bulan 
4.    Menggunakan air bersih 
5.    Mencuci tangan dengan air bersih yang mengalir dan sabun
6.    Menggunakan jamban sehat
7.    Memberantas jentik di rumah 
8.    Melakukan aktivitas fisik setiap hari 
9.    Makan sayur dan buah setiap hari
10.  Tidak merokok di dalam rumah 
11.  Ibu Hamil memeriksakan kehamilan
12.  Bayi di imunisasi secara lengkap sesuai usianya
13.  Gosok gigi minimal 2 kali sehari sehabis makan pagi dan sebelum tidur malam
14.  Mengelola sampah dan limbah cair rumah tangga
15.  Mempunyai Jaminan Pemeliharaan Kesehatan (jamkesmas, Jamkesos, askes, asuransi kesehatan, dll)

PETUNJUK PENGISIAN :
0. Jika jawaban" tidak"
1. Jawaban "YA" (artinya perilaku sesuai dengan indikator)
2. Tidak ada sasaran
Strata :
I         :   1 -5 indikator  terpenuhi
II        :   6-10 indikator  terpenuhi
III       :  11-15 indikator  terpenuhi
PHBS :  Jika indikator 1 sampai dengan indikator 10 terpenuhi

AN PHBS TATANAN KELUARGA TINGKAT RT

PHBS SASARAN PS STRATA
13 14 15 1 2 3 8 9 11 12 1 2 3 8 9 11 12 I II III PHBS
1 1 0 12 0 0 0 1 1 0 0 0 0 0 1 0 0 0 0 0 1 0
0 1 1 12 0 0 0 1 1 0 0 0 0 0 1 0 0 0 0 0 1 0
0 1 1 11 0 0 0 1 1 0 0 0 0 0 1 0 0 0 0 0 1 0
1 0 1 13 0 0 0 1 1 0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 1 10 1 1 1 1 1 0 0 1 0 1 1 0 0 0 0 1 0 0
1 1 0 12 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 1 0
1 1 0 12 0 0 0 1 1 0 0 0 0 0 1 0 0 0 0 0 1 0
1 1 0 12 0 0 0 1 1 0 0 0 0 0 1 0 0 0 0 0 1 0
1 0 0 13 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 1 1
0 1 0 10 0 0 0 1 1 0 0 0 0 0 1 0 0 0 0 1 0 0
1 1 1 12 0 0 0 1 1 0 0 0 0 0 1 0 0 0 0 0 1 0
1 1 1 14 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 1 0
1 1 0 12 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0
1 0 1 13 0 0 0 1 1 0 0 0 0 0 1 0 0 0 0 0 1 0
0 1 0 11 1 1 1 1 0 0 0 1 0 0 1 0 0 0 0 0 1 0
1 1 0 12 0 0 0 1 1 0 0 0 0 0 1 0 0 0 0 0 1 0
1 1 0 12 1 1 1 1 1 0 0 1 0 1 1 0 0 0 0 0 1 0
1 1 1 14 0 0 0 1 1 0 0 0 0 0 1 0 0 0 0 0 1 0
1 1 1 14 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0
0 1 0 10 1 1 1 1 1 1 1 1 0 1 1 0 1 1 0 1 0 0
0 0 0 10 0 0 0 1 1 0 0 0 0 0 1 0 0 0 0 1 0 0
1 0 1 13 1 1 1 1 0 1 0 1 1 1 1 0 1 0 0 0 1 0
1 1 0 13 1 1 1 1 1 1 1 1 1 1 1 0 1 1 0 0 1 0
1 1 1 15 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 1 1
1 1 1 13 0 0 0 1 1 0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 1 10 1 1 1 1 1 1 1 1 1 1 1 0 1 1 0 1 0 0
1 1 1 13 0 0 0 1 1 0 0 0 0 0 1 0 0 0 0 0 1 0
1 1 1 14 0 0 0 1 1 0 0 0 0 0 1 0 0 0 0 0 1 0
1 1 0 13 0 0 0 1 1 0 0 0 0 0 1 0 0 0 0 0 1 0
1 1 1 14 0 0 0 1 1 0 0 0 0 0 1 1 0 0 0 0 1 0
1 1 1 14 0 0 0 1 1 0 0 0 0 0 1 0 0 0 0 0 1 0
0 0 1 13 0 0 0 1 1 0 0 0 0 0 1 1 0 0 0 0 1 1
1 1 1 15 0 0 0 1 1 0 0 0 0 0 1 1 0 0 0 0 1 1
0 1 0 11 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 1 0
1 1 0 13 0 0 0 1 1 0 0 0 0 0 1 0 0 0 0 0 1 0
1 1 0 14 0 0 0 1 1 0 0 0 0 0 1 1 0 0 0 0 1 1
1 0 1 14 0 0 0 1 1 0 0 0 0 0 1 1 0 0 0 0 1 1
1 0 1 11 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 1 0
1 1 0 11 1 1 1 1 1 1 1 1 0 0 1 0 1 1 0 0 1 0
1 0 0 10 1 1 1 1 1 1 1 1 1 0 1 0 1 1 0 1 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
30 29 21 495 9 9 9 38 33 6 5 9 4 6 36 5 6 5 0 6 34 6

KADER REKAPITULASI HASIL PEMANTA Tahun : 2015 Semester : RT :2 Dusun : Desa : Kecamatan : INDIKATOR No Nama Kepala Rumah Tangga 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 1 2 1 HAJI SUTRISNO 2 2 2 1 1 1 1 1 0 0 2 2 1 1 0 1 1 2 IMAM SUWONDO 2 2 2 1 0 1 1 1 0 1 2 2 0 1 1 1 1 3 WASIRIN 2 2 2 1 0 1 1 1 0 0 2 2 0 1 1 1 1 4 SARWANTO 2 2 2 1 1 1 1 1 0 1 2 2 1 0 1 1 1 5 TOMI KURNIAWAN 1 0 1 1 1 1 1 1 0 0 2 2 0 0 1 1 0 6 KASMANTO 2 2 2 1 0 1 1 1 2 0 2 2 1 1 0 1 1 7 SURATNO 2 2 2 1 0 1 1 1 0 1 2 2 1 1 0 1 1 8 JOKO INDRONO 2 2 2 1 1 1 1 1 0 0 2 2 1 1 0 1 1 9 IMAM SUPANGAT 2 2 2 1 1 1 1 1 2 1 2 2 1 0 0 1 1 10 SUHARNO 2 2 2 1 0 1 1 0 0 0 2 2 0 1 0 1 1 11 ANDRE 2 2 2 1 0 1 1 1 0 0 2 2 1 1 1 1 1 12 INDRA 2 2 2 1 1 1 1 1 2 0 2 2 1 1 1 1 1 13 BAKRI 2 2 2 1 0 1 1 2 0 1 2 2 1 1 0 1 1 14 SUHARJONO 2 2 2 1 1 1 1 1 0 1 2 2 1 0 1 1 1 15 MESANTARA 1 0 0 1 1 1 1 1 2 1 2 2 0 1 0 1 0 16 WARDANI 2 2 2 1 1 1 1 1 0 0 2 2 1 1 0 1 1 17 SUKOCO 1 0 1 1 1 1 1 1 0 1 2 2 1 1 0 1 0 18 BASYKI 2 2 2 1 1 1 1 1 0 1 2 2 1 1 1 1 1 19 KASBI 2 2 2 1 0 1 1 2 2 1 2 2 1 1 1 1 1 20 ATUN 1 0 1 1 1 1 1 1 0 0 1 1 0 1 0 1 0 21 SLAMET RAHAYU 2 2 2 1 1 1 1 1 0 0 2 2 0 0 0 1 1 22 SIGIT AHMADI 1 1 1 1 0 1 1 1 2 1 1 2 1 0 1 1 1 23 SUROSO 1 1 1 1 1 1 1 1 0 1 1 1 1 1 0 1 1 24 TUKIMIN 2 2 2 1 1 1 1 1 2 1 2 2 1 1 1 1 1 25 HARYANTI 2 2 2 1 0 1 1 1 0 1 2 2 1 1 1 1 1 26 RAHARJO 1 1 1 1 0 1 1 1 0 0 1 1 0 0 1 1 1 27 SLAMET RIYADI 2 2 2 1 1 1 1 1 0 0 2 2 1 1 1 1 1 28 SUPRIHANTO 2 2 2 1 1 1 1 1 0 1 2 2 1 1 1 1 1 29 SUMARJI 2 2 2 1 1 1 1 1 0 1 2 2 1 1 0 1 1 30 MARYADI 2 2 2 1 0 1 1 1 1 1 2 2 1 1 1 1 1 31 MARYONO 2 2 2 1 1 1 1 1 0 1 2 2 1 1 1 1 1 32 SUPARDI 2 2 2 1 1 1 1 1 1 1 2 2 0 0 1 1 1 33 MARYONO 2 2 2 1 1 1 1 1 1 1 2 2 1 1 1 1 1 34 TASWAN 2 2 2 1 1 1 1 0 0 1 2 2 0 1 0 1 1 35 WANTOYO 2 2 2 1 1 1 1 1 0 1 2 2 1 1 0 1 1 36 .

  Tidak merokok di dalam rumah  11. askes.  Ibu Hamil memeriksakan kehamilan 12.  Mempunyai Jaminan Pemeliharaan Kesehatan (jamkesmas.37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 JUMLAH 63 59 62 35 23 35 35 35 17 22 66 67 25 27 19 35 31 INDIKATOR : 1. Tidak ada sasaran Strata : I         :   1 -5 indikator  terpenuhi II        :   6-10 indikator  terpenuhi III       :  11-15 indikator  terpenuhi PHBS :  Jika indikator 1 sampai dengan indikator 10 terpenuhi . dll) PETUNJUK PENGISIAN : 0. Jamkesos. asuransi kesehatan. Jawaban "YA" (artinya perilaku sesuai dengan indikator) 2. Jika jawaban" tidak" 1.    Memberantas jentik di rumah  8.  Gosok gigi minimal 2 kali sehari sehabis makan pagi dan sebelum tidur malam 14.    Memberi bayi ASI ekskusif  3.    Menggunakan air bersih  5.    Mencuci tangan dengan air bersih yang mengalir dan sabun 6.    Persalinan ditolong oleh tenaga kesehatan 2.  Mengelola sampah dan limbah cair rumah tangga 15.    Makan sayur dan buah setiap hari 10.    Menimbang bayi dan balita setiap bulan  4.  Bayi di imunisasi secara lengkap sesuai usianya 13.    Menggunakan jamban sehat 7.    Melakukan aktivitas fisik setiap hari  9.

ASI HASIL PEMANTAUAN PHBS TATANAN KELUARGA TINGKAT RT INDIKATOR INDIKATOR INDIKATOR 3 4 5 6 7 8 9 10 11 12 13 14 15 1 2 3 8 9 11 12 1 2 3 1 1 1 1 1 1 0 0 1 1 1 1 0 12 0 0 0 1 1 0 0 0 0 0 1 1 0 1 1 1 0 1 1 1 0 1 1 12 0 0 0 1 1 0 0 0 0 0 1 1 0 1 1 1 0 0 1 1 0 1 1 11 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 0 1 1 1 1 0 1 13 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 0 0 1 1 0 0 1 10 1 1 1 1 1 0 0 1 0 1 1 1 0 1 1 1 1 0 1 1 1 1 0 12 0 0 0 1 0 0 0 0 0 0 1 1 0 1 1 1 0 1 1 1 1 1 0 12 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 0 0 1 1 1 1 0 12 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 0 0 13 0 0 0 1 0 0 0 0 0 0 1 1 0 1 1 0 0 0 1 1 0 1 0 9 0 0 0 1 1 0 0 0 0 0 1 1 0 1 1 1 0 0 1 1 1 1 1 12 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 1 0 1 1 1 1 1 14 0 0 0 1 0 0 0 0 0 0 1 1 0 1 1 1 0 1 1 1 1 1 0 12 0 0 0 0 1 0 0 0 0 0 1 1 1 1 1 1 0 1 1 1 1 0 1 13 0 0 0 1 1 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 0 1 0 11 1 1 1 1 0 0 0 1 0 0 1 1 1 1 1 1 0 0 1 1 1 1 0 12 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 0 1 1 1 1 1 0 12 1 1 1 1 1 0 0 1 0 1 1 1 1 1 1 1 0 1 1 1 1 1 1 14 0 0 0 1 1 0 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 1 1 14 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0 1 1 0 1 0 10 1 1 1 1 1 1 1 1 0 1 1 1 1 1 1 1 0 0 1 1 0 0 0 10 0 0 0 1 1 0 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 0 1 13 1 1 1 1 0 1 0 1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 0 13 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 15 0 0 0 1 0 0 0 0 0 0 1 1 0 1 1 1 0 1 1 1 1 1 1 13 0 0 0 1 1 0 0 0 0 0 1 1 0 1 1 1 0 0 1 1 0 0 1 10 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 1 1 1 1 1 13 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 0 1 1 1 1 1 1 14 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 0 1 1 1 1 1 0 13 0 0 0 1 1 0 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 1 1 14 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 0 1 1 1 1 1 1 14 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 0 0 1 13 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 15 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 0 0 1 1 1 0 1 0 11 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 0 1 1 1 1 1 0 13 0 0 0 1 1 0 0 0 0 0 .

34 35 23 35 35 33 10 22 35 35 25 27 19 434 7 7 7 33 28 4 3 7 3 6 .

INDIKATOR STRATA 8 9 11 12 I II III PHBS 1 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 1 0 0 0 0 1 0 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 1 1 0 0 0 0 0 1 0 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 1 0 1 1 0 1 0 0 1 0 0 0 0 1 0 0 1 0 1 0 0 0 1 0 1 0 1 1 0 0 1 0 1 0 0 0 0 0 1 1 1 0 0 0 0 0 1 0 1 0 1 1 0 1 0 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 1 1 0 0 0 0 1 0 1 0 0 0 0 0 1 0 1 1 0 0 0 0 1 1 1 1 0 0 0 0 1 1 0 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 0 0 0 0 .

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 31 3 4 3 0 5 30 4 .

45345646 .

KADER REKAPITULASI HASIL PEMAN Tahun : 2015 Semester : RT :3 Dusun : Desa : Kecamatan : INDIKATOR No Nama Kepala Rumah Tangga 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 1 ANWAR 2 2 2 1 1 1 1 1 0 0 2 2 1 1 0 2 HAJAR 2 2 2 1 0 1 1 1 0 1 2 2 0 1 1 3 FAIS 2 2 2 1 0 1 1 1 2 0 2 2 0 1 1 4 JUMBADI 2 2 2 1 1 1 1 1 2 1 2 2 1 0 1 5 YUONO 1 0 1 1 1 1 1 1 0 0 2 2 0 0 1 6 MUNAWIR 2 2 2 1 0 1 1 1 2 0 2 2 1 1 0 7 BUDI HARJONO 2 2 2 1 0 1 1 1 0 1 2 2 1 1 0 8 GRENDI 2 2 2 1 1 1 1 1 0 0 2 2 1 1 0 9 SARDI 2 2 2 1 1 1 1 1 2 1 2 2 1 0 0 10 NGADIYO 2 2 2 1 0 1 1 1 2 0 2 2 0 1 0 11 MUJILAN 2 2 2 1 0 1 1 1 0 0 2 2 1 1 1 12 TAUFAN ISMAIL 2 2 2 1 1 1 1 1 2 0 2 2 1 1 1 13 SARIMAN 2 2 2 1 0 1 1 2 0 1 2 2 1 1 0 14 NUGROHO 2 2 2 1 1 1 1 1 0 1 2 2 1 0 1 15 NGATIMAN 1 0 0 1 1 1 1 1 2 1 2 2 0 1 0 16 SUPRIYADI 2 2 2 1 1 1 1 1 0 0 2 2 1 1 0 17 SUGIARTO 1 0 1 1 1 1 1 1 0 1 2 2 1 1 0 18 AAN SUGIARTO 2 2 2 1 1 1 1 1 0 1 2 2 1 1 1 19 TIMBUL 2 2 2 1 0 1 1 2 2 1 2 2 1 1 1 20 NUR WAHYUDI 1 0 1 1 1 1 1 1 0 0 1 1 0 1 0 21 H. SUBOWO 2 2 2 1 1 1 1 1 0 0 2 2 0 0 0 22 PURWANTI 1 1 1 1 0 1 1 1 2 1 1 2 1 0 1 23 HANDOKO 1 1 1 1 1 1 1 1 0 1 1 1 1 1 0 24 ARIF 2 2 2 1 1 1 1 1 2 1 2 2 1 1 1 25 AMAT ZAENURI 2 2 2 1 0 1 1 1 0 1 2 2 1 1 1 26 TEDI 1 1 1 1 0 1 1 1 0 0 1 1 0 0 1 27 SUPIYATI 2 2 2 1 1 1 1 1 0 0 2 2 1 1 1 28 DARSONO 2 2 2 1 1 1 1 1 0 1 2 2 1 1 1 29 PRAPTO 2 2 2 1 1 1 1 1 0 1 2 2 1 1 0 30 SUMADI 2 2 2 1 0 1 1 1 1 1 2 2 1 1 1 31 TABAH 2 2 2 1 1 1 1 1 0 1 2 2 1 1 1 32 DARMIDI 2 2 2 1 1 1 1 1 1 1 2 2 0 0 1 33 SUPRIYADI 2 2 2 1 1 1 1 1 1 1 2 2 1 1 1 34 IRIYANTO 2 2 2 1 0 1 1 0 0 1 2 2 0 1 0 35 GERSANG 2 2 2 1 1 1 1 1 0 1 2 2 1 1 0 36 LUKMAN HAKIM 2 2 2 1 1 1 1 1 1 1 2 2 1 1 0 37 SASTRO DIHARJO 2 2 2 1 1 1 1 1 1 1 2 2 1 0 1 38 SUPRIYADI 2 2 2 1 1 1 1 0 0 0 2 2 1 0 1 39 RAHMAT 1 0 0 1 1 1 1 1 0 1 1 1 1 1 0 .

  Mengelola sampah dan limbah cair rumah tangga 15.    Menggunakan air bersih  5.  Gosok gigi minimal 2 kali sehari sehabis makan pagi dan sebelum tidur malam 14. Tidak ada sasaran Strata : I         :   1 -5 indikator  terpenuhi II        :   6-10 indikator  terpenuhi III       :  11-15 indikator  terpenuhi PHBS :  Jika indikator 1 sampai dengan indikator 10 terpenuhi .40 LILIK 1 1 0 1 1 1 1 1 0 0 1 1 1 0 0 41 SARBANI 2 2 2 1 0 1 1 1 0 0 2 2 1 1 1 42 AMAT KEMI 2 2 2 1 0 1 1 0 0 1 2 2 0 0 0 43 SATARI 2 2 2 1 1 1 1 0 0 1 2 2 0 0 1 44 SARDIYONO 2 2 2 1 1 1 1 0 0 1 2 2 0 0 0 45 DARMANTYAS 2 2 2 1 0 1 1 0 0 1 2 2 0 0 0 46 SUGENG 2 2 2 1 1 1 1 1 1 1 2 2 0 0 1 47 TUKIJAN 2 2 2 1 1 1 1 1 1 1 2 2 1 1 1 48 PURWANTO 2 2 2 1 1 1 1 0 0 1 2 2 0 1 0 49 DARMO SUWITO 2 2 2 1 0 1 1 1 0 1 2 2 1 1 0 50 WAHYUDI 2 2 2 1 1 1 1 1 1 1 2 2 1 1 0 51 SUNIARYO 2 2 2 1 1 1 1 1 1 1 2 2 1 0 1 52 EDI 2 2 2 1 1 1 1 0 0 0 2 2 1 0 1 53 MUSTOFA 1 1 1 1 1 1 1 1 0 1 1 1 1 1 0 54 SARWANTO 1 1 0 1 1 1 1 1 0 0 1 1 1 0 0 55 WARJONO 2 2 2 1 0 1 1 1 0 0 2 2 1 1 1 56 suhardiman 2 2 2 1 1 1 1 1 0 1 2 2 1 1 0 57 salimin 2 2 2 1 1 1 1 1 0 1 2 2 1 1 0 58 suro sudirjo 2 2 2 1 1 1 1 1 0 0 2 2 1 1 0 59 alimin 2 2 2 1 1 1 1 1 0 1 2 2 1 1 1 60 subur 2 2 2 1 1 1 1 1 0 1 2 2 1 1 0 61 Jumlah 109 104 105 60 42 60 60 54 29 40 112 113 44 41 29 INDIKATOR : 1.    Menggunakan jamban sehat 7.  Ibu Hamil memeriksakan kehamilan 12. Jawaban "YA" (artinya perilaku sesuai dengan indikator) 2.    Menimbang bayi dan balita setiap bulan  4. askes. dll) PETUNJUK PENGISIAN : 0.    Mencuci tangan dengan air bersih yang mengalir dan sabun 6.    Melakukan aktivitas fisik setiap hari  9.    Memberi bayi ASI ekskusif  3.    Memberantas jentik di rumah  8. Jika jawaban" tidak" 1.    Makan sayur dan buah setiap hari 10.  Bayi di imunisasi secara lengkap sesuai usianya 13. asuransi kesehatan.    Persalinan ditolong oleh tenaga kesehatan 2.  Tidak merokok di dalam rumah  11. Jamkesos.  Mempunyai Jaminan Pemeliharaan Kesehatan (jamkesmas.

PITULASI HASIL PEMANTAUAN PHBS TATANAN KELUARGA TINGKAT RT INDIKATOR INDIKATOR 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 1 2 3 8 9 11 12 1 1 1 1 1 1 1 1 0 0 1 1 1 1 0 12 0 0 0 1 1 0 0 1 1 1 1 0 1 1 1 0 1 1 1 0 1 1 12 0 0 0 1 1 0 0 1 1 1 1 0 1 1 1 1 0 1 1 0 1 1 12 0 0 0 1 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 14 0 0 0 1 0 0 0 1 0 1 1 1 1 1 1 0 0 1 1 0 0 1 10 1 1 1 1 1 0 0 1 1 1 1 0 1 1 1 1 0 1 1 1 1 0 12 0 0 0 1 0 0 0 1 1 1 1 0 1 1 1 0 1 1 1 1 1 0 12 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 0 1 1 1 1 0 12 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 13 0 0 0 1 0 0 0 1 1 1 1 0 1 1 1 1 0 1 1 0 1 0 11 0 0 0 1 0 0 0 1 1 1 1 0 1 1 1 0 0 1 1 1 1 1 12 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 14 0 0 0 1 0 0 0 1 1 1 1 0 1 1 1 0 1 1 1 1 1 0 12 0 0 0 0 1 0 0 1 1 1 1 1 1 1 1 0 1 1 1 1 0 1 13 0 0 0 1 1 0 0 1 0 0 1 1 1 1 1 1 1 1 1 0 1 0 11 1 1 1 1 0 0 0 1 1 1 1 1 1 1 1 0 0 1 1 1 1 0 12 0 0 0 1 1 0 0 1 0 1 1 1 1 1 1 0 1 1 1 1 1 0 12 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 1 1 1 1 1 1 14 0 0 0 1 1 0 0 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 14 0 0 0 0 0 0 0 1 0 1 1 1 1 1 1 0 0 1 1 0 1 0 10 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 1 1 0 0 0 10 0 0 0 1 1 0 0 1 1 1 1 0 1 1 1 1 1 1 1 1 0 1 13 1 1 1 1 0 1 0 1 1 1 1 1 1 1 1 0 1 1 1 1 1 0 13 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 15 0 0 0 1 0 0 0 1 1 1 1 0 1 1 1 0 1 1 1 1 1 1 13 0 0 0 1 1 0 0 1 1 1 1 0 1 1 1 0 0 1 1 0 0 1 10 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 1 1 1 1 1 13 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 1 1 1 1 1 1 14 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 1 1 1 1 1 0 13 0 0 0 1 1 0 0 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 14 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 1 1 1 1 1 1 14 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 1 1 0 0 1 13 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 15 0 0 0 1 1 0 0 1 1 1 1 0 1 1 0 0 1 1 1 0 1 0 10 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 1 1 1 1 1 0 13 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 14 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 14 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 0 1 1 1 0 1 11 0 0 0 1 1 0 0 1 0 0 1 1 1 1 1 0 1 1 1 1 1 0 11 1 1 1 1 1 1 1 .

1 1 0 1 1 1 1 1 0 0 1 1 1 0 0 10 1 1 1 1 1 1 1 1 1 1 1 0 1 1 1 0 0 1 1 1 1 1 12 0 0 0 1 1 0 0 1 1 1 1 0 1 1 0 0 1 1 1 0 0 0 9 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 1 1 1 0 0 1 11 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 1 1 1 0 0 0 10 0 0 0 1 1 0 0 1 1 1 1 0 1 1 0 0 1 1 1 0 0 0 9 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 1 1 0 0 1 13 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 15 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 1 1 1 0 1 0 11 0 0 0 1 1 0 0 1 1 1 1 0 1 1 1 0 1 1 1 1 1 0 12 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 14 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 14 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 0 1 1 1 0 1 11 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 1 1 1 1 1 0 13 1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 0 0 1 1 1 0 0 10 1 1 1 1 1 1 1 1 1 1 1 0 1 1 1 0 0 1 1 1 1 1 12 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 1 1 1 1 1 0 13 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 1 1 1 1 1 0 13 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 0 1 1 1 1 0 12 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 1 1 1 1 1 1 14 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 1 1 1 1 1 0 13 0 0 0 1 1 0 0 60 55 56 60 42 60 60 52 19 40 60 60 44 41 29 738 11 11 11 58 50 8 7 .

INDIKATOR STRATA 1 2 3 8 9 11 12 I II III PHBS 0 0 0 1 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 1 1 0 0 0 1 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 1 0 1 0 0 1 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 1 0 1 0 1 1 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 1 0 1 1 0 1 1 0 1 0 0 0 0 0 1 0 0 0 0 1 0 0 1 1 1 1 0 1 0 0 0 1 0 1 1 1 1 0 1 1 0 0 1 0 0 0 0 1 0 0 0 0 0 1 1 0 0 0 1 0 0 0 0 0 1 0 1 1 1 1 0 1 1 0 1 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 1 1 0 0 0 1 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 1 1 0 0 0 1 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 1 0 1 1 0 0 1 0 .

1 1 0 1 0 1 1 0 1 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 0 0 0 0 1 1 0 0 0 1 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 1 1 0 0 0 1 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 0 1 1 1 1 0 1 1 0 0 1 0 1 1 0 1 0 1 1 0 1 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 1 0 11 6 7 50 9 8 7 0 10 50 11 .

KADER REKAPITULASI HASIL PEMANTA Tahun : 2015 Semester : RT :4 Dusun : Desa : Kecamatan : INDIKATOR No Nama Kepala Rumah Tangga 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 1 1 RISWIMARNO 2 2 2 1 1 1 1 1 0 0 2 2 1 1 0 1 2 SUHUDI 2 2 2 1 0 1 1 1 0 1 2 2 0 1 1 1 3 SUPARWO 2 2 2 1 0 1 1 1 0 0 2 2 0 1 1 1 4 LUTFI 2 2 2 1 1 1 1 1 0 1 2 2 1 0 1 1 5 DANANG 1 0 1 1 1 1 1 1 0 0 2 2 0 0 1 1 6 SUGIYANTO 2 2 2 1 0 1 1 1 2 0 2 2 1 1 0 1 7 MUJIYO 2 2 2 1 0 1 1 1 0 1 2 2 1 1 0 1 8 TRIJOKO 2 2 2 1 1 1 1 1 0 0 2 2 1 1 0 1 9 WAHYUDI 2 2 2 1 1 1 1 1 2 1 2 2 1 0 0 1 10 SUNI 2 2 2 1 0 1 1 1 0 0 2 2 0 1 0 1 11 BENI 2 2 2 1 0 1 1 1 0 0 2 2 1 1 1 1 12 SADIONO 2 2 2 1 1 1 1 1 2 0 2 2 1 1 1 1 13 PRABOWO 2 2 2 1 0 1 1 2 0 1 2 2 1 1 0 1 14 HENDI 2 2 2 1 1 1 1 1 0 1 2 2 1 0 1 1 15 SUSIKNAN 1 0 0 1 1 1 1 1 2 1 2 2 0 1 0 1 16 MARYADI 2 2 2 1 1 1 1 1 0 0 2 2 1 1 0 1 17 JUNI SUDARWA 1 0 1 1 1 1 1 1 0 1 2 2 1 1 0 1 18 KUNCORO 2 2 2 1 1 1 1 1 0 1 2 2 1 1 1 1 19 SURADAL 2 2 2 1 0 1 1 2 2 1 2 2 1 1 1 1 20 NUR ISLAMI 1 0 1 1 1 1 1 1 0 0 1 1 0 1 0 1 21 KHOLID ZULFA 2 2 2 1 1 1 1 1 0 0 2 2 0 0 0 1 22 AGUNG 1 1 1 1 0 1 1 1 2 1 1 2 1 0 1 1 23 BUDI SUPRAPTO 1 1 1 1 1 1 1 1 0 1 1 1 1 1 0 1 24 SURASINEM 2 2 2 1 1 1 1 1 2 1 2 2 1 1 1 1 25 AGUS 2 2 2 1 0 1 1 1 0 1 2 2 1 1 1 1 26 SUKATMAN 1 1 1 1 0 1 1 1 0 0 1 1 0 0 1 1 27 SUWARTI 2 2 2 1 1 1 1 1 0 0 2 2 1 1 1 1 28 RIKA 2 2 2 1 1 1 1 1 0 1 2 2 1 1 1 1 29 SIGIT 2 2 2 1 1 1 1 1 0 1 2 2 1 1 0 1 30 SUYITNO 2 2 2 1 0 1 1 1 1 1 2 2 1 1 1 1 31 PUJIHARJO 2 2 2 1 1 1 1 1 0 1 2 2 1 1 1 1 32 ABDUL HAKIM 2 2 2 1 1 1 1 1 1 1 2 2 0 0 1 1 33 SAHRIR 2 2 2 1 1 1 1 1 1 1 2 2 1 1 1 1 34 WAGIMAN 2 2 2 1 0 1 1 0 0 1 2 2 0 1 0 1 35 SUHERJAN 2 2 2 1 1 1 1 1 0 1 2 2 1 1 0 1 36 DIDIK 2 2 2 1 1 1 1 1 1 1 2 2 1 1 0 1 .

ACHDAL 2 2 2 1 1 1 1 1 1 1 2 2 1 1 0 1 . MARDI SUYATNO 2 2 2 1 1 1 1 1 1 1 2 2 1 1 1 1 67 RANANDA 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 68 A. FAHRUDIN 2 2 2 1 1 1 1 1 1 1 2 2 1 1 1 1 69 SUROSO 2 2 2 1 1 1 1 1 1 1 2 2 1 1 0 1 70 PRASETYO 2 2 1 1 1 1 1 1 1 1 2 1 1 1 0 1 71 SRININGSIH 2 2 2 1 1 1 1 1 1 1 2 2 1 1 0 1 72 MAYA 2 2 2 1 1 1 1 1 1 1 2 2 1 1 1 1 73 JOKO 2 2 1 1 1 1 1 1 1 1 2 2 1 1 0 1 74 WIJI 2 2 2 1 1 1 1 1 1 1 2 2 1 1 0 1 75 YANTO 2 2 2 1 1 1 1 1 1 1 2 2 1 1 0 1 76 ARIFIN 2 2 2 1 1 1 1 1 1 1 2 2 1 1 0 1 77 BUDI WINARMO 2 2 2 1 1 1 1 1 1 1 2 2 1 1 1 1 78 SUSENO 2 2 2 1 1 1 1 1 1 1 2 2 1 1 0 1 79 MUJIRAH 2 2 2 1 1 1 1 1 1 1 2 2 1 1 1 1 80 SUDIBYO 2 2 2 1 1 1 1 1 1 1 2 2 1 1 1 1 81 AGUS YULIANTO 2 2 2 1 1 1 1 1 1 1 2 2 1 1 0 1 82 NGADENAH 2 2 2 1 1 1 1 1 1 1 2 2 1 1 0 1 83 USMAN 2 2 2 1 1 1 1 1 1 1 2 2 1 1 0 1 84 MOH.37 IWAN 2 2 2 1 1 1 1 1 1 1 2 2 1 0 1 1 38 SURYADI 2 2 2 1 1 1 1 0 0 0 2 2 1 0 1 1 39 NGATIJAN 1 0 0 1 1 1 1 1 0 1 1 1 1 1 0 1 40 SLAMET IRIBADI 1 1 0 1 1 1 1 1 0 0 1 1 1 0 0 1 41 SUGENG 2 2 2 1 0 1 1 1 0 0 2 2 1 1 1 1 42 ENDANG 2 2 2 1 0 1 1 0 0 1 2 2 0 0 0 1 43 TITIK 2 2 2 1 1 1 1 0 0 1 2 2 0 0 1 1 44 NUNIK 2 2 2 1 1 1 1 0 0 1 2 2 0 0 0 1 45 TUMIJO 2 2 2 1 0 1 1 0 0 1 2 2 0 0 0 1 46 HERI RISWANTO 2 2 2 1 1 1 1 1 1 1 2 2 0 0 1 1 47 ISNUGROHO 2 2 2 1 1 1 1 1 1 1 2 2 1 1 1 1 48 BASUKI 2 2 2 1 1 1 1 0 0 1 2 2 0 1 0 1 49 MUJIONO 2 2 2 1 0 1 1 1 0 1 2 2 1 1 0 1 50 HARJO DINOMO 2 2 2 1 1 1 1 1 1 1 2 2 1 1 0 1 51 DARSILAH 2 2 2 1 1 1 1 1 1 1 2 2 1 0 1 1 52 SUMARNO 2 2 2 1 1 1 1 0 0 0 2 2 1 0 1 1 53 MUJIMAN 1 1 1 1 1 1 1 1 0 1 1 1 1 1 0 1 54 SUDI 1 1 0 1 1 1 1 1 0 0 1 1 1 0 0 1 55 SUPARDI 2 2 2 1 0 1 1 1 0 0 2 2 1 1 1 1 56 SUHARDI 2 2 2 1 1 1 1 1 0 1 2 2 1 1 0 1 57 SUHARYANTO 2 2 2 1 1 1 1 1 0 1 2 2 1 1 0 1 58 SUDIMAN 2 2 2 1 1 1 1 1 0 0 2 2 1 1 0 1 59 PAWIROREJO 2 2 2 1 1 1 1 1 0 1 2 2 1 1 1 1 60 NGADIRAN 2 2 2 1 1 1 1 1 0 1 2 2 1 1 0 1 61 TUKIJAN 2 2 2 1 1 1 1 1 0 1 1 1 1 1 1 1 62 AGUS 1 1 1 1 1 1 1 1 0 1 1 1 1 1 0 1 63 AZIZ 1 1 1 1 1 1 1 1 0 1 1 1 1 1 0 1 64 ARJO SILAM 2 2 2 1 1 1 1 1 1 1 2 2 1 1 1 1 65 SUKIMIN 2 2 2 1 1 1 1 1 1 1 2 2 1 1 1 1 66 R.

    Menimbang bayi dan balita setiap bulan  4.  Mempunyai Jaminan Pemeliharaan Kesehatan (jamkesmas.  Mengelola sampah dan limbah cair rumah tangga 15. asuransi kesehatan.    Memberi bayi ASI ekskusif  3.    Mencuci tangan dengan air bersih yang mengalir dan sabun 6.  Gosok gigi minimal 2 kali sehari sehabis makan pagi dan sebelum tidur malam 14.  Tidak merokok di dalam rumah  11.  Bayi di imunisasi secara lengkap sesuai usianya 13.    Memberantas jentik di rumah  8.  Ibu Hamil memeriksakan kehamilan 12.    Persalinan ditolong oleh tenaga kesehatan 2. Tidak ada sasaran Strata : I         :   1 -5 indikator  terpenuhi II        :   6-10 indikator  terpenuhi III       :  11-15 indikator  terpenuhi PHBS :  Jika indikator 1 sampai dengan indikator 10 terpenuhi .85 SURONO 2 2 1 1 1 1 1 1 1 1 2 1 1 1 1 1 Jumlah 107 106 101 57 50 57 57 49 31 50 106 104 49 45 25 57 INDIKATOR : 1.    Melakukan aktivitas fisik setiap hari  9. askes. Jika jawaban" tidak" 1. Jawaban "YA" (artinya perilaku sesuai dengan indikator) 2.    Menggunakan jamban sehat 7. Jamkesos. dll) PETUNJUK PENGISIAN : 0.    Menggunakan air bersih  5.    Makan sayur dan buah setiap hari 10.

ULASI HASIL PEMANTAUAN PHBS TATANAN KELUARGA TINGKAT RT INDIKATOR INDIKATOR INDIKATOR 2 3 4 5 6 7 8 9 10 11 12 13 14 15 1 2 3 8 9 11 12 1 2 1 1 1 1 1 1 1 0 0 1 1 1 1 0 12 0 0 0 1 1 0 0 0 0 1 1 1 0 1 1 1 0 1 1 1 0 1 1 12 0 0 0 1 1 0 0 0 0 1 1 1 0 1 1 1 0 0 1 1 0 1 1 11 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 0 1 1 1 1 0 1 13 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 0 0 1 1 0 0 1 10 1 1 1 1 1 0 0 1 0 1 1 1 0 1 1 1 1 0 1 1 1 1 0 12 0 0 0 1 0 0 0 0 0 1 1 1 0 1 1 1 0 1 1 1 1 1 0 12 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 0 0 1 1 1 1 0 12 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 0 0 13 0 0 0 1 0 0 0 0 0 1 1 1 0 1 1 1 0 0 1 1 0 1 0 10 0 0 0 1 1 0 0 0 0 1 1 1 0 1 1 1 0 0 1 1 1 1 1 12 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 0 1 1 1 1 1 14 0 0 0 1 0 0 0 0 0 1 1 1 0 1 1 1 0 1 1 1 1 1 0 12 0 0 0 0 1 0 0 0 0 1 1 1 1 1 1 1 0 1 1 1 1 0 1 13 0 0 0 1 1 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 0 1 0 11 1 1 1 1 0 0 0 1 0 1 1 1 1 1 1 1 0 0 1 1 1 1 0 12 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 0 1 1 1 1 1 0 12 1 1 1 1 1 0 0 1 0 1 1 1 1 1 1 1 0 1 1 1 1 1 1 14 0 0 0 1 1 0 0 0 0 1 1 1 0 1 1 1 1 1 1 1 1 1 1 14 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0 1 1 0 1 0 10 1 1 1 1 1 1 1 1 0 1 1 1 1 1 1 1 0 0 1 1 0 0 0 10 0 0 0 1 1 0 0 0 0 1 1 1 0 1 1 1 1 1 1 1 1 0 1 13 1 1 1 1 0 1 0 1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 0 13 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 15 0 0 0 1 0 0 0 0 0 1 1 1 0 1 1 1 0 1 1 1 1 1 1 13 0 0 0 1 1 0 0 0 0 1 1 1 0 1 1 1 0 0 1 1 0 0 1 10 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 1 1 1 1 1 13 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 0 1 1 1 1 1 1 14 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 0 1 1 1 1 1 0 13 0 0 0 1 1 0 0 0 0 1 1 1 0 1 1 1 1 1 1 1 1 1 1 14 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 0 1 1 1 1 1 1 14 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 0 0 1 13 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 15 0 0 0 1 1 0 0 0 0 1 1 1 0 1 1 0 0 1 1 1 0 1 0 10 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 0 1 1 1 1 1 0 13 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 0 14 0 0 0 1 1 0 0 0 0 .

1 1 1 1 1 1 1 1 1 1 1 1 0 1 14 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 0 0 0 1 1 1 0 1 11 0 0 0 1 1 0 0 0 0 0 0 1 1 1 1 1 0 1 1 1 1 1 0 11 1 1 1 1 1 1 1 1 0 1 0 1 1 1 1 1 0 0 1 1 1 0 0 10 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 1 0 0 1 1 1 1 1 12 0 0 0 1 1 0 0 0 0 1 1 1 0 1 1 0 0 1 1 1 0 0 0 9 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 0 0 1 1 1 0 0 1 11 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 0 0 1 1 1 0 0 0 10 0 0 0 1 1 0 0 0 0 1 1 1 0 1 1 0 0 1 1 1 0 0 0 9 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 0 0 1 13 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 15 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 0 0 1 1 1 0 1 0 11 0 0 0 1 1 0 0 0 0 1 1 1 0 1 1 1 0 1 1 1 1 1 0 12 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 0 14 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 0 1 14 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 0 0 0 1 1 1 0 1 11 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 0 1 1 1 1 1 0 13 1 1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 0 0 1 1 1 0 0 10 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 1 0 0 1 1 1 1 1 12 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 0 1 1 1 1 1 0 13 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 0 1 1 1 1 1 0 13 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 0 0 1 1 1 1 0 12 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 0 1 1 1 1 1 1 14 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 0 1 1 1 1 1 0 13 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 0 1 1 1 1 1 1 14 0 0 0 1 1 1 1 0 0 1 1 1 1 1 1 1 0 1 1 1 1 1 0 13 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 0 13 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 15 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 15 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 15 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 15 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 15 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 0 14 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 0 14 0 0 1 1 1 0 1 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 0 14 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 15 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 0 14 0 0 1 1 1 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 0 14 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 0 14 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 0 14 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 15 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 0 14 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 15 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 15 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 0 14 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 0 14 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 0 14 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 0 14 0 0 0 1 1 0 0 0 0 .

1 1 1 1 1 1 1 1 1 1 1 1 1 1 15 0 0 1 1 1 0 1 0 0 56 54 57 50 57 57 49 31 50 57 57 49 45 25 751 7 7 10 57 57 8 10 7 6 .

INDIKATOR STRATA
3 8 9 11 12 I II III PHBS
0 1 0 0 0 0 0 1 0
0 1 0 0 0 0 0 1 0
0 1 0 0 0 0 0 1 0
0 1 0 0 0 0 0 1 0
1 1 0 0 0 0 1 0 0
0 1 0 0 0 0 0 1 0
0 1 0 0 0 0 0 1 0
0 1 0 0 0 0 0 1 0
0 1 0 0 0 0 0 1 1
0 1 0 0 0 0 1 0 0
0 1 0 0 0 0 0 1 0
0 1 0 0 0 0 0 1 0
0 0 0 0 0 0 0 1 0
0 1 0 0 0 0 0 1 0
0 1 0 0 0 0 0 1 0
0 1 0 0 0 0 0 1 0
1 1 0 0 0 0 0 1 0
0 1 0 0 0 0 0 1 0
0 0 0 0 0 0 0 1 0
1 1 0 1 1 0 1 0 0
0 1 0 0 0 0 1 0 0
1 1 0 1 0 0 0 1 0
1 1 0 1 1 0 0 1 0
0 1 0 0 0 0 0 1 1
0 1 0 0 0 0 0 1 0
1 1 0 1 1 0 1 0 0
0 1 0 0 0 0 0 1 0
0 1 0 0 0 0 0 1 0
0 1 0 0 0 0 0 1 0
0 1 1 0 0 0 0 1 0
0 1 0 0 0 0 0 1 0
0 1 1 0 0 0 0 1 1
0 1 1 0 0 0 0 1 1
0 0 0 0 0 0 1 0 0
0 1 0 0 0 0 0 1 0
0 1 1 0 0 0 0 1 1

0 1 1 0 0 0 0 1 1
0 0 0 0 0 0 0 1 0
0 1 0 1 1 0 0 1 0
0 1 0 1 1 0 1 0 0
0 1 0 0 0 0 0 1 0
0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 0
0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 1 0 0
0 1 1 0 0 0 0 1 1
0 1 1 0 0 0 0 1 1
0 0 0 0 0 0 0 1 0
0 1 0 0 0 0 0 1 0
0 1 1 0 0 0 0 1 1
0 1 1 0 0 0 0 1 1
0 0 0 0 0 0 0 1 0
1 1 0 1 1 0 0 1 0
0 1 0 1 1 0 1 0 0
0 1 0 0 0 0 0 1 0
0 1 0 0 0 0 0 1 0
0 1 0 0 0 0 0 1 0
0 1 0 0 0 0 0 1 0
0 1 0 0 0 0 0 1 0
0 1 0 0 0 0 0 1 0
0 1 0 1 1 0 0 1 0
1 1 0 1 1 0 0 1 0
1 1 0 1 1 0 0 1 0
0 1 1 0 0 0 0 1 1
0 1 1 0 0 0 0 1 1
0 1 1 0 0 0 0 1 1
1 1 1 1 1 0 0 1 1
0 1 1 0 0 0 0 1 1
0 1 1 0 0 0 0 1 1
1 1 1 0 1 0 0 1 1
0 1 1 0 0 0 0 1 1
0 1 1 0 0 0 0 1 1
1 1 1 0 0 0 0 1 1
0 1 1 0 0 0 0 1 1
0 1 1 0 0 0 0 1 1
0 1 1 0 0 0 0 1 1
0 1 1 0 0 0 0 1 1
0 1 1 0 0 0 0 1 1
0 1 1 0 0 0 0 1 1
0 1 1 0 0 0 0 1 1
0 1 1 0 0 0 0 1 1
0 1 1 0 0 0 0 1 1
0 1 1 0 0 0 0 1 1
0 1 1 0 0 0 0 1 1

1 1 1 0 1 0 0 1 1
7 49 31 8 10 0 11 74 32

REKAPITULASI HASIL PEMANTA Tahun : 2015 Semester : RT :5 Dusun : Desa : Kecamatan : INDIKATOR No Nama Kepala Rumah Tangga 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 1 2 1 JUMAN 2 2 2 1 1 1 1 1 0 0 2 2 1 1 0 1 1 2 TAMANSARI 2 2 2 1 0 1 1 1 0 1 2 2 0 1 1 1 1 3 NGALIM 2 2 2 1 0 1 1 1 0 0 2 2 0 1 1 1 1 4 BARMAN 2 2 2 1 1 1 1 1 0 1 2 2 1 0 1 1 1 5 YUDHA 1 0 1 1 1 1 1 1 0 0 2 2 0 0 1 1 0 6 FAHRI HASYIM 2 2 2 1 0 1 1 1 2 0 2 2 1 1 0 1 1 7 RIDWAN 2 2 2 1 0 1 1 1 0 1 2 2 1 1 0 1 1 8 ASRORI 2 2 2 1 1 1 1 1 0 0 2 2 1 1 0 1 1 9 FATHONAH 2 2 2 1 1 1 1 1 2 1 2 2 1 0 0 1 1 10 MULYANA 2 2 2 1 0 1 1 1 0 0 2 2 0 1 0 1 1 11 KASMIN 2 2 2 1 0 1 1 1 0 0 2 2 1 1 1 1 1 12 HARDIYONO 2 2 2 1 1 1 1 1 2 0 2 2 1 1 1 1 1 13 HENDIARYA 2 2 2 1 0 1 1 2 0 1 2 2 1 1 0 1 1 14 MUGIONO 2 2 2 1 1 1 1 1 0 1 2 2 1 0 1 1 1 15 AJI PURNOMO 1 0 0 1 1 1 1 1 2 1 2 0 0 1 0 1 0 16 ABDUL ROCHIM 2 2 2 1 1 1 1 1 0 0 2 2 1 1 0 1 1 17 SUTOPO 1 0 1 1 1 1 1 1 0 1 2 2 1 1 0 1 0 18 ISTIARSIH 2 2 2 1 1 1 1 1 0 1 2 2 1 1 1 1 1 19 FAIZAL AMIN 2 2 2 1 0 1 1 2 2 1 2 2 1 1 1 1 1 20 ZAINAL 1 0 1 1 1 1 1 1 0 0 1 1 0 1 0 1 0 21 KUNCORO 2 2 2 1 1 1 1 1 0 0 2 2 0 0 0 1 1 22 SYAMSIYAH 1 1 1 1 0 1 1 1 2 1 1 2 1 0 1 1 1 23 NGADERI 1 1 1 1 1 1 1 1 0 1 1 1 1 1 0 1 1 24 MARYANTI 2 2 2 1 1 1 1 1 2 1 2 2 1 1 1 1 1 25 FARID 2 2 2 1 0 1 1 1 0 1 2 2 1 1 1 1 1 26 HERU 1 1 1 1 0 1 1 1 0 0 1 1 0 0 1 1 1 27 GATHOT 2 2 2 1 1 1 1 1 0 0 2 2 1 1 1 1 1 28 ISMUYANTO 2 2 2 1 1 1 1 1 0 1 2 2 1 1 1 1 1 29 DYO 2 2 2 1 1 1 1 1 0 1 2 2 1 1 0 1 1 30 SUROSO 2 2 2 1 0 1 1 1 1 1 2 2 1 1 1 1 1 31 MALA 2 2 2 1 1 1 1 1 0 1 2 2 1 1 1 1 1 32 ASEP 2 2 2 1 1 1 1 1 1 1 2 2 0 0 1 1 1 33 ARI PRABOWO 2 2 2 1 1 1 1 1 1 1 2 2 1 1 1 1 1 34 JUMAN 2 2 2 1 0 1 1 0 0 1 2 2 0 1 0 1 1 35 TAMANSARI 2 2 2 1 1 1 1 1 0 1 2 2 1 1 0 1 1 36 NGALIM 2 2 2 1 1 1 1 1 1 1 2 2 1 1 0 1 1 .

    Menimbang bayi dan balita setiap bulan  4.    Makan sayur dan buah setiap hari 10.37 BARMAN 2 2 2 1 1 1 1 1 1 1 2 2 1 0 1 1 1 38 YUDHA 2 2 2 1 1 1 1 0 0 0 2 2 1 0 1 1 1 39 FAHRI HASYIM 1 0 0 1 1 1 1 1 0 1 1 1 1 1 0 1 0 40 RIDWAN 1 1 0 1 1 1 1 1 0 0 1 1 1 0 0 1 1 41 ASRORI 2 2 2 1 0 1 1 1 0 0 2 2 1 1 1 1 1 42 FATHONAH 2 2 2 1 0 1 1 0 0 1 2 2 0 0 0 1 1 43 MULYANA 2 2 2 1 1 1 1 0 0 1 2 2 0 0 1 1 1 44 KASMIN 2 2 2 1 1 1 1 0 0 1 2 2 0 0 0 1 1 45 HARDIYONO 2 2 2 1 0 1 1 0 0 1 2 2 0 0 0 1 1 46 HENDIARYA 2 2 2 1 1 1 1 1 1 1 2 2 0 0 1 1 1 47 MUGIONO 2 2 2 1 1 1 1 1 1 1 2 2 1 1 1 1 1 48 AJI PURNOMO 2 2 2 1 1 1 1 0 0 1 2 2 0 1 0 1 1 49 ABDUL ROCHIM 2 2 2 1 0 1 1 1 0 1 2 2 1 1 0 1 1 50 SUTOPO 2 2 2 1 1 1 1 1 1 1 2 2 1 1 0 1 1 51 ISTIARSIH 2 2 2 1 1 1 1 1 1 1 2 2 1 0 1 1 1 52 FAIZAL AMIN 2 2 2 1 1 1 1 0 0 0 2 2 1 0 1 1 1 53 ZAINAL 1 1 1 1 1 1 1 1 0 1 1 1 1 1 0 1 1 54 KUNCORO 1 1 0 1 1 1 1 1 0 0 1 1 1 0 0 1 1 55 SYAMSIYAH 2 2 2 1 0 1 1 1 0 0 2 2 1 1 1 1 1 56 NGADERI 2 2 2 1 1 1 1 1 0 1 2 2 1 1 0 1 1 57 MARYANTI 2 2 2 1 1 1 1 1 0 1 2 2 1 1 0 1 1 58 FARID 2 2 2 1 1 1 1 1 0 0 2 2 1 1 0 1 1 59 HERU 2 2 2 1 1 1 1 1 0 1 2 2 1 1 1 1 1 60 GATHOT 2 2 2 1 1 1 1 1 0 1 2 2 1 1 0 1 1 61 ISMUYANTO 2 2 2 1 1 1 1 1 0 1 1 1 1 1 1 1 1 62 DYO 1 1 1 1 1 1 1 1 0 1 1 1 1 1 0 1 1 63 SUROSO 1 1 1 1 1 1 1 1 0 1 1 1 1 1 0 1 1 64 MALA 2 2 2 1 1 1 1 1 1 1 2 2 1 1 0 1 1 65 ASEP 2 2 2 1 1 1 1 1 1 1 2 2 1 1 0 1 1 66 ARI PRABOWO 2 2 2 1 1 1 1 1 1 1 2 2 1 1 1 1 1 67 WAGIMAN 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 1 68 SUHERJAN 2 2 2 1 1 1 1 1 1 1 2 2 1 0 1 1 1 69 DIDIK 2 2 2 1 1 1 1 1 1 1 2 2 1 1 0 1 1 70 IWAN 2 2 1 1 1 1 1 1 1 1 2 1 1 1 0 1 1 Jumlah 77 76 73 42 35 42 42 34 16 35 76 75 34 28 18 42 41 INDIKATOR : 1.    Mencuci tangan dengan air bersih yang mengalir dan sabun 6.    Menggunakan air bersih  5.    Memberantas jentik di rumah  8.    Melakukan aktivitas fisik setiap hari  9.  Tidak merokok di dalam rumah  11.    Menggunakan jamban sehat 7.    Memberi bayi ASI ekskusif  3.    Persalinan ditolong oleh tenaga kesehatan 2.  Ibu Hamil memeriksakan kehamilan 12.  Bayi di imunisasi secara lengkap sesuai usianya .

 Jamkesos.  Mempunyai Jaminan Pemeliharaan Kesehatan (jamkesmas. askes. asuransi kesehatan. Jawaban "YA" (artinya perilaku sesuai dengan indikator) 2.  Gosok gigi minimal 2 kali sehari sehabis makan pagi dan sebelum tidur malam 14. dll) PETUNJUK PENGISIAN : 0. Jika jawaban" tidak" 1. Tidak ada sasaran Strata : I         :   1 -5 indikator  terpenuhi II        :   6-10 indikator  terpenuhi III       :  11-15 indikator  terpenuhi PHBS :  Jika indikator 1 sampai dengan indikator 10 terpenuhi .13.  Mengelola sampah dan limbah cair rumah tangga 15.

ASI HASIL PEMANTAUAN PHBS TATANAN KELUARGA TINGKAT RT INDIKATOR INDIKATOR INDIKATOR 3 4 5 6 7 8 9 10 11 12 13 14 15 1 2 3 8 9 11 12 1 2 3 1 1 1 1 1 1 0 0 1 1 1 1 0 12 0 0 0 1 1 0 0 0 0 0 1 1 0 1 1 1 0 1 1 1 0 1 1 12 0 0 0 1 1 0 0 0 0 0 1 1 0 1 1 1 0 0 1 1 0 1 1 11 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 0 1 1 1 1 0 1 13 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 0 0 1 1 0 0 1 10 1 1 1 1 1 0 0 1 0 1 1 1 0 1 1 1 1 0 1 1 1 1 0 12 0 0 0 1 0 0 0 0 0 0 1 1 0 1 1 1 0 1 1 1 1 1 0 12 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 0 0 1 1 1 1 0 12 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 0 0 13 0 0 0 1 0 0 0 0 0 0 1 1 0 1 1 1 0 0 1 1 0 1 0 10 0 0 0 1 1 0 0 0 0 0 1 1 0 1 1 1 0 0 1 1 1 1 1 12 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 1 0 1 1 1 1 1 14 0 0 0 1 0 0 0 0 0 0 1 1 0 1 1 1 0 1 1 1 1 1 0 12 0 0 0 0 1 0 0 0 0 0 1 1 1 1 1 1 0 1 1 1 1 0 1 13 0 0 0 1 1 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0 1 0 10 1 1 1 1 0 0 1 1 0 0 1 1 1 1 1 1 0 0 1 1 1 1 0 12 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 0 1 1 1 1 1 0 12 1 1 1 1 1 0 0 1 0 1 1 1 1 1 1 1 0 1 1 1 1 1 1 14 0 0 0 1 1 0 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 1 1 14 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0 1 1 0 1 0 10 1 1 1 1 1 1 1 1 0 1 1 1 1 1 1 1 0 0 1 1 0 0 0 10 0 0 0 1 1 0 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 0 1 13 1 1 1 1 0 1 0 1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 0 13 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 15 0 0 0 1 0 0 0 0 0 0 1 1 0 1 1 1 0 1 1 1 1 1 1 13 0 0 0 1 1 0 0 0 0 0 1 1 0 1 1 1 0 0 1 1 0 0 1 10 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 1 1 1 1 1 13 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 0 1 1 1 1 1 1 14 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 0 1 1 1 1 1 0 13 0 0 0 1 1 0 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 1 1 14 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 0 1 1 1 1 1 1 14 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 0 0 1 13 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 15 0 0 0 1 1 0 0 0 0 0 1 1 0 1 1 0 0 1 1 1 0 1 0 10 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 0 1 1 1 1 1 0 13 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 0 14 0 0 0 1 1 0 0 0 0 0 .

1 1 1 1 1 1 1 1 1 1 1 0 1 14 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 0 1 11 0 0 0 1 1 0 0 0 0 0 0 1 1 1 1 1 0 1 1 1 1 1 0 11 1 1 1 1 1 1 1 1 0 0 0 1 1 1 1 1 0 0 1 1 1 0 0 10 1 1 1 1 1 1 1 1 1 0 1 1 0 1 1 1 0 0 1 1 1 1 1 12 0 0 0 1 1 0 0 0 0 0 1 1 0 1 1 0 0 1 1 1 0 0 0 9 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 0 0 1 1 1 0 0 1 11 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 0 0 1 1 1 0 0 0 10 0 0 0 1 1 0 0 0 0 0 1 1 0 1 1 0 0 1 1 1 0 0 0 9 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 0 0 1 13 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 15 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 0 0 1 1 1 0 1 0 11 0 0 0 1 1 0 0 0 0 0 1 1 0 1 1 1 0 1 1 1 1 1 0 12 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 0 14 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 0 1 14 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 0 1 11 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 0 1 1 1 1 1 0 13 1 1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 0 0 1 1 1 0 0 10 1 1 1 1 1 1 1 1 1 0 1 1 0 1 1 1 0 0 1 1 1 1 1 12 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 0 1 1 1 1 1 0 13 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 0 1 1 1 1 1 0 13 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 0 0 1 1 1 1 0 12 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 0 1 1 1 1 1 1 14 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 0 1 1 1 1 1 0 13 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 0 1 1 1 1 1 1 14 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 0 1 1 1 1 1 0 13 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 0 13 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 14 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 0 14 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 15 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 0 1 14 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 14 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 0 14 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 0 14 0 0 1 1 1 0 1 0 0 1 39 42 35 42 42 34 16 35 42 42 34 28 18 532 7 7 8 42 42 8 9 7 6 5 .

INDIKATOR STRATA 8 9 11 12 I II III PHBS 1 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 1 0 0 0 0 1 0 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 1 1 1 0 0 0 0 1 0 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 1 0 0 0 0 1 0 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 1 0 1 1 0 1 0 0 1 0 0 0 0 1 0 0 1 0 1 0 0 0 1 0 1 0 1 1 0 0 1 0 1 0 0 0 0 0 1 1 1 0 0 0 0 0 1 0 1 0 1 1 0 1 0 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 1 1 0 0 0 0 1 0 1 0 0 0 0 0 1 0 1 1 0 0 0 0 1 1 1 1 0 0 0 0 1 1 0 0 0 0 0 1 0 0 1 0 0 0 0 0 1 0 1 1 0 0 0 0 1 1 .

1 1 0 0 0 0 1 1 0 0 0 0 0 0 1 0 1 0 1 1 0 0 1 0 1 0 1 1 0 1 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 1 1 0 0 0 0 1 1 1 1 0 0 0 0 1 1 0 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 1 1 0 0 0 0 1 1 1 1 0 0 0 0 1 1 0 0 0 0 0 0 1 0 1 0 1 1 0 0 1 0 1 0 1 1 0 1 0 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 1 0 1 1 0 0 1 0 1 0 1 1 0 0 1 0 1 0 1 1 0 0 1 0 1 1 0 0 0 0 1 1 1 1 0 0 0 0 1 1 1 1 0 0 0 0 1 1 1 1 1 1 0 0 1 1 1 1 0 0 0 0 1 1 1 1 0 0 0 0 1 1 1 1 0 1 0 0 1 1 34 16 8 9 0 12 58 17 .

REKAPITULASI HASIL PEMANTA Tahun : 2015 Semester : RT :6 Dusun : Desa : Kecamatan : INDIKATOR No Nama Kepala Rumah Tangga 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 1 1 ERLANTO TRI N 2 2 2 1 1 1 1 1 1 0 2 2 1 0 1 1 2 MURTINAH 2 2 2 1 1 1 1 1 1 1 2 2 1 0 0 1 3 PARIMUN 2 2 2 1 1 1 1 1 1 1 2 2 1 1 1 1 4 SUBARDI 2 2 2 1 1 1 1 1 1 1 2 2 1 1 1 1 5 RUMI HARTONO 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 6 NOR HANDAYAMTO 1 1 1 1 1 1 0 1 1 1 2 1 1 0 1 1 7 SRIYAMI 2 2 2 1 1 1 1 1 1 0 2 2 0 0 1 1 8 SUHARJITO 2 2 2 1 1 1 1 1 1 1 2 2 1 1 1 1 9 AGUS SUBEKTI 2 2 2 1 0 1 1 2 1 0 2 2 1 1 1 1 10 SUSETYO MARDI 2 2 2 1 1 1 1 1 1 0 2 2 1 0 1 1 11 SUTIMAN 2 2 2 1 1 1 1 1 1 0 2 2 1 0 0 1 12 PURWANTO 2 2 2 1 1 0 1 2 1 0 2 2 1 1 0 1 13 KARSIPI 2 2 2 1 1 0 1 1 1 1 2 2 1 0 0 1 14 HIDAYANTA 2 2 2 1 1 1 1 2 1 0 2 2 0 0 0 1 15 DWIYONO 2 2 2 0 1 1 1 1 1 0 2 2 1 1 0 1 16 FLORENTINUS JOKO T. 2 2 2 1 1 1 1 2 1 0 2 2 1 0 1 1 17 SUYANTO 2 2 2 1 0 1 1 1 1 0 2 2 1 0 0 1 18 PONIRIN 1 1 0 1 1 0 1 1 1 0 2 1 1 1 0 1 19 SUSANTO 2 2 2 0 1 1 1 1 1 0 2 2 1 1 1 1 20 WANIATI 2 2 2 1 1 1 1 1 1 1 2 2 1 1 1 1 21 KUNCARA MURTI 2 2 2 1 1 1 1 1 1 1 2 2 1 1 1 1 22 HIDAYAT SASONGKO 2 2 2 0 1 1 0 1 1 1 2 2 1 0 0 1 23 NGADIMAH 2 2 2 1 1 1 1 1 1 1 2 2 0 1 0 1 24 JABONO 2 2 2 1 1 1 1 1 1 0 2 2 1 1 0 1 25 SUMARJONO 2 2 2 1 1 1 1 1 1 0 2 2 1 1 0 1 26 MUJARI 2 2 2 1 1 1 1 1 1 1 2 2 1 0 1 1 27 SUDIMAN 2 2 2 0 0 1 0 1 1 1 2 2 0 0 1 1 28 CIPTO HANDOYO 2 2 2 1 1 0 1 1 1 1 2 2 1 1 1 1 29 SUYANTO 2 2 2 1 1 0 1 1 1 1 2 2 1 1 1 1 30 RISMANTO 2 2 2 1 1 1 1 1 1 1 2 2 1 1 0 1 31 SIGIT PURWANTO 2 2 2 1 1 1 1 1 1 0 2 2 1 1 1 1 32 ALEX HARIYANTO 2 2 2 1 1 1 1 1 1 0 2 0 1 0 0 1 33 HENDRIK SETIAWAN 2 2 2 1 1 1 1 1 1 0 1 2 1 0 1 1 34 SUPRIYADI 2 2 2 1 1 0 1 1 1 0 2 2 1 0 1 1 35 WARIDJAN NS 2 2 2 1 1 1 1 1 1 0 2 2 0 0 1 1 36 EDDY SARJONO 2 2 2 1 1 1 1 1 1 0 0 2 1 0 0 1 .

 asuransi kesehatan.  Gosok gigi minimal 2 kali sehari sehabis makan pagi dan sebelum tidur malam 14.    Menggunakan air bersih  5.  Bayi di imunisasi secara lengkap sesuai usianya 13.    Persalinan ditolong oleh tenaga kesehatan 2.    Makan sayur dan buah setiap hari 10.    Mencuci tangan dengan air bersih yang mengalir dan sabun 6. Jawaban "YA" (artinya perilaku sesuai dengan indikator) 2.  Ibu Hamil memeriksakan kehamilan 12.37 HERI SUSILO 2 2 2 1 1 1 1 1 1 1 2 2 1 0 1 1 38 YAYA SUNTANA 2 2 2 1 1 1 1 1 1 0 2 2 1 0 0 1 39 RIYANTO 1 1 1 1 1 1 1 1 1 0 0 1 1 1 1 1 40 UNTUNG SUMARYADI 2 2 2 1 1 1 1 1 1 0 2 2 1 1 0 1 41 ROBBY CAHYADI 2 2 2 1 1 1 1 1 1 0 2 2 1 0 1 1 42 MUHAMMAD KURNIADI 2 2 2 1 1 1 1 1 1 0 2 2 1 0 0 1 43 MUSTAKIM 2 2 2 1 1 1 1 1 1 0 2 2 1 0 0 1 44 SITI ZAIMAH ASRIYATI 2 2 2 1 1 1 1 1 1 1 2 2 0 1 1 1 45 DEBY HASTONO 2 2 2 1 1 1 1 1 1 0 2 2 1 1 1 1 46 NUR HASAN 2 2 2 1 1 1 1 1 1 0 2 2 1 0 0 1 47 JUMINAH 2 2 2 1 1 1 1 0 1 1 2 2 1 0 0 1 48 DEDIK HARYANTO 2 2 2 1 1 1 1 1 1 1 2 2 1 0 1 1 49 ARFAN ARIYANTO 2 2 2 1 1 1 1 1 1 1 2 2 1 0 1 1 50 WAHYUDI 2 2 2 1 1 1 1 1 1 0 2 2 1 0 1 1 51 DIYONO/HADI S 2 2 2 1 1 1 1 1 1 0 2 2 1 1 1 1 52 HARI PRASETYO 1 1 1 1 1 1 1 1 1 0 1 1 0 0 1 1 53 MARDIYONO/SALIMAN 2 2 2 1 1 1 1 1 1 0 1 2 1 1 0 1 54 SARDJITO 2 2 2 1 1 1 1 1 1 1 2 2 1 0 1 1 55 NAGDIMUN 2 2 2 1 0 1 1 1 0 0 2 2 1 1 1 1 Jumlah 105 105 104 51 51 49 52 58 54 22 102 103 48 24 33 55 INDIKATOR : 1. askes.    Menggunakan jamban sehat 7.    Memberi bayi ASI ekskusif  3.    Memberantas jentik di rumah  8. dll) PETUNJUK PENGISIAN : 0.    Melakukan aktivitas fisik setiap hari  9. Tidak ada sasaran Strata : I         :   1 -5 indikator  terpenuhi II        :   6-10 indikator  terpenuhi III       :  11-15 indikator  terpenuhi PHBS :  Jika indikator 1 sampai dengan indikator 10 terpenuhi . Jamkesos.  Tidak merokok di dalam rumah  11.    Menimbang bayi dan balita setiap bulan  4. Jika jawaban" tidak" 1.  Mengelola sampah dan limbah cair rumah tangga 15.  Mempunyai Jaminan Pemeliharaan Kesehatan (jamkesmas.

ULASI HASIL PEMANTAUAN PHBS TATANAN KELUARGA TINGKAT RT INDIKATOR INDIKATOR INDIKATOR 2 3 4 5 6 7 8 9 10 11 12 13 14 15 1 2 3 8 9 11 12 1 2 1 1 1 1 1 1 1 1 0 1 1 1 0 1 13 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 0 0 13 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 15 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 15 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 0 1 14 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 1 0 1 13 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 0 1 1 0 0 1 12 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 15 0 0 0 1 1 0 0 0 0 1 1 1 0 1 1 1 1 0 1 1 1 1 1 13 0 0 0 0 1 0 0 0 0 1 1 1 1 1 1 1 1 0 1 1 1 0 1 13 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 0 1 1 1 0 0 12 0 0 0 1 1 0 0 0 0 1 1 1 1 0 1 1 1 0 1 1 1 1 0 12 0 0 0 0 1 0 0 0 0 1 1 1 1 0 1 1 1 1 1 1 1 0 0 12 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 0 1 1 0 0 0 11 0 0 0 0 1 0 0 0 0 1 1 0 1 1 1 1 1 0 1 1 1 1 0 12 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 0 1 1 1 0 1 13 0 0 0 0 1 0 0 0 0 1 1 1 0 1 1 1 1 0 1 1 1 0 0 11 0 0 0 1 1 0 0 0 0 1 0 1 1 0 1 1 1 0 1 1 1 1 0 11 1 1 1 1 1 0 1 1 1 1 1 0 1 1 1 1 1 0 1 1 1 1 1 13 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 15 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 15 0 0 0 1 1 0 0 0 0 1 1 0 1 1 0 1 1 1 1 1 1 0 0 11 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 0 1 0 13 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 0 1 1 1 1 0 13 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 0 1 1 1 1 0 13 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 0 1 14 0 0 0 1 1 0 0 0 0 1 1 0 0 1 0 1 1 1 1 1 0 0 1 10 0 0 0 1 1 0 0 0 0 1 1 1 1 0 1 1 1 1 1 1 1 1 1 14 0 0 0 1 1 0 0 0 0 1 1 1 1 0 1 1 1 1 1 1 1 1 1 14 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 0 14 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 0 1 1 1 1 1 14 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 0 1 0 1 0 0 11 0 0 0 1 1 0 1 0 0 1 1 1 1 1 1 1 1 0 1 1 1 0 1 13 0 0 0 1 1 1 0 0 0 1 1 1 1 0 1 1 1 0 1 1 1 0 1 12 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 0 1 1 0 0 1 12 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 0 0 1 1 0 0 11 0 0 0 1 1 1 0 0 0 .

1 1 1 1 1 1 1 1 1 1 1 1 0 1 14 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 0 1 1 1 0 0 12 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 0 0 1 1 1 1 13 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 1 1 0 13 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 0 1 1 1 0 1 13 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 0 1 1 1 0 0 12 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 0 1 1 1 0 0 12 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 0 1 1 14 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 0 1 1 1 1 1 14 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 0 1 1 1 0 0 12 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 0 1 1 1 1 1 0 0 12 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 0 1 14 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 0 1 14 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 0 1 1 1 0 1 13 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 0 1 1 1 1 1 14 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 0 1 1 0 0 1 12 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 1 1 0 13 0 0 0 1 1 1 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 0 1 14 0 0 0 1 1 0 0 0 0 1 1 1 0 1 1 1 0 0 1 1 1 1 1 12 0 0 0 1 1 0 0 0 0 55 54 51 51 49 52 54 54 22 53 54 48 24 33 709 5 5 5 51 55 6 6 5 5 .

INDIKATOR STRATA 3 8 9 11 12 I II III PHBS 0 1 1 0 0 0 0 1 0 0 1 1 0 0 0 0 1 1 0 1 1 0 0 0 0 1 1 0 1 1 0 0 0 0 1 1 1 1 1 1 1 0 0 1 1 1 1 1 0 1 0 0 1 0 0 1 1 0 0 0 0 1 0 0 1 1 0 0 0 0 1 1 0 0 1 0 0 0 0 1 0 0 1 1 0 0 0 0 1 0 0 1 1 0 0 0 0 1 0 0 0 1 0 0 0 0 1 0 0 1 1 0 0 0 0 1 0 0 0 1 0 0 0 0 1 0 0 1 1 0 0 0 0 1 0 0 0 1 0 0 0 0 1 0 0 1 1 0 0 0 0 1 0 0 1 1 0 1 0 0 1 0 0 1 1 0 0 0 0 1 0 0 1 1 0 0 0 0 1 1 0 1 1 0 0 0 0 1 1 0 1 1 0 0 0 0 1 0 0 1 1 0 0 0 0 1 1 0 1 1 0 0 0 0 1 0 0 1 1 0 0 0 0 1 0 0 1 1 0 0 0 0 1 1 0 1 1 0 0 0 1 0 0 0 1 1 0 0 0 0 1 0 0 1 1 0 0 0 0 1 0 0 1 1 0 0 0 0 1 1 0 1 1 0 0 0 0 1 0 0 1 1 0 0 0 0 1 0 0 1 1 1 0 0 0 1 0 0 1 1 0 0 0 0 1 0 0 1 1 0 0 0 0 1 0 0 1 1 0 0 0 0 1 0 .

0 1 1 0 0 0 0 1 1 0 1 1 0 0 0 0 1 0 1 1 1 0 1 0 0 1 0 0 1 1 0 0 0 0 1 0 0 1 1 0 0 0 0 1 0 0 1 1 0 0 0 0 1 0 0 1 1 0 0 0 0 1 0 0 1 1 0 0 0 0 1 1 0 1 1 0 0 0 0 1 0 0 1 1 0 0 0 0 1 0 0 0 1 0 0 0 0 1 0 0 1 1 0 0 0 0 1 1 0 1 1 0 0 0 0 1 1 0 1 1 0 0 0 0 1 0 0 1 1 0 0 0 0 1 0 1 1 1 1 1 0 0 1 0 0 1 1 1 0 0 0 1 0 0 1 1 0 0 0 0 1 1 0 1 0 0 0 0 0 1 0 4 50 54 4 5 0 1 54 15 .

SITI K 2 2 2 1 1 1 1 1 1 1 2 2 1 1 0 1 6 A. 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 30 PRAYOGO 2 2 2 1 1 1 1 1 1 1 2 2 1 0 1 1 31 HERI P. ARIFIN H. 2 2 2 1 1 1 1 1 1 1 2 2 1 0 1 1 10 SISWO HARJO 2 2 2 1 1 1 1 1 1 0 2 2 1 0 0 1 11 HANDOKO S. 2 2 2 1 1 1 1 1 1 1 2 2 0 0 0 1 22 SUTINI 2 2 2 0 1 1 1 1 1 1 2 2 1 0 1 1 23 SUKARDI 2 2 2 1 1 1 1 1 1 1 2 2 0 0 1 1 24 WAJIRAN 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 1 25 SUKIYO 2 2 2 1 1 1 1 1 1 1 2 2 1 0 0 1 26 ST PAIDI S 1 1 1 1 0 1 1 1 1 1 1 1 1 0 0 1 27 SUPOYO 2 2 2 1 1 1 1 1 1 1 2 2 1 0 1 1 28 AGUNG R. RAPINGUN 2 2 2 1 1 1 1 1 1 0 2 2 1 0 0 1 7 HADI PRAYITNO 2 2 2 1 1 1 1 1 1 1 2 2 0 1 0 1 8 RINARDI 2 2 2 1 1 1 0 1 1 1 2 2 1 1 0 1 9 M. 1 1 1 1 1 1 1 1 1 0 1 1 1 1 0 1 29 HERMAN Y. 2 2 2 1 1 1 1 1 1 1 2 2 1 0 0 1 32 DANANG A. 1 1 1 1 1 1 1 1 1 0 1 1 1 0 1 1 21 BUANG R. 2 2 2 1 1 0 0 1 1 0 2 2 1 1 1 1 12 PURWOTO JONY 2 2 2 1 1 1 0 1 1 0 2 2 1 1 0 1 13 MUJIYONO 2 2 2 1 1 1 1 1 1 0 2 2 0 1 0 1 14 ANTON SUPARNO 2 2 2 1 1 1 1 1 1 0 2 2 1 0 0 1 15 DWI B 1 1 1 0 1 1 1 1 1 1 1 1 1 1 0 1 16 EKO T 1 1 1 1 1 1 1 1 1 0 1 1 1 1 0 1 17 I DEWA PUTU 2 2 2 1 1 1 1 1 1 0 2 2 1 0 0 1 18 SIRWANTO 2 2 2 1 0 1 1 1 1 1 2 2 1 1 0 1 19 SUMIRAH 2 2 2 1 1 1 1 1 1 1 2 2 1 1 1 1 20 ALEXANDER S. 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 36 TUHONO 2 2 2 0 1 1 1 1 1 0 2 2 1 1 1 1 . REKAPITULASI HASIL PEMANTA Tahun : 2015 Semester : RT :7 Dusun : Desa : Kecamatan : INDIKATOR No Nama Kepala Rumah Tangga 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 1 1 SAHIDIN 2 2 2 1 1 1 1 1 1 0 2 2 1 0 1 1 2 MADIYONO 2 2 2 1 1 1 1 1 1 0 2 2 1 0 0 1 3 TUKIYAT 2 2 2 1 1 1 1 1 1 1 2 2 1 0 0 1 4 TUMIYATI 1 1 1 1 0 1 0 1 1 0 2 1 1 1 1 1 5 CH. 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 33 TUKIJAN 2 2 2 1 1 1 1 1 1 0 2 2 1 0 1 1 34 SUGITO SH 2 2 2 1 1 1 1 1 1 1 2 2 1 0 0 1 35 IRFAN I.

    Menggunakan jamban sehat 7. 1 1 1 1 1 1 1 1 1 0 1 1 1 0 0 1 50 TRIYOGO 2 2 2 1 1 1 1 1 1 1 2 2 1 1 0 1 51 BAMBANG J. AHYARI 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 1 55 RIANTI ATUN 2 2 2 1 1 1 1 1 1 1 2 2 1 0 1 1 56 PAWIRO R 2 2 2 1 1 1 1 1 1 0 2 2 1 1 1 1 57 KARTO W 2 2 2 1 1 1 1 1 1 0 2 2 1 1 0 1 58 JARIYAH 2 2 2 1 1 1 1 1 1 1 2 2 1 0 1 1 59 NARWANTO 2 2 2 1 1 1 1 1 1 0 2 2 1 1 0 1 60 SAELAN 2 2 2 1 1 1 1 1 1 1 2 2 1 0 1 1 61 WITO S 2 2 2 1 1 1 1 1 1 0 2 2 1 0 1 1 62 HARTONO 2 2 2 1 1 1 1 1 1 0 2 2 1 1 1 1 63 MUJINEM 2 2 2 1 1 1 1 1 1 1 2 2 1 0 1 1 64 SUJIYANTO 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 65 SUKIRNO 2 2 2 1 1 1 1 1 1 0 2 2 1 0 1 1 Jumlah 113 113 113 62 62 63 61 65 65 35 113 113 59 24 31 46 INDIKATOR : 1.  Bayi di imunisasi secara lengkap sesuai usianya 13.    Melakukan aktivitas fisik setiap hari  9.  Tidak merokok di dalam rumah  11.    Persalinan ditolong oleh tenaga kesehatan 2. 2 2 2 1 1 1 1 1 1 0 2 2 1 0 0 1 52 BASUKI 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 1 53 MEYNA 2 2 2 1 1 1 1 1 1 0 2 2 1 0 0 1 54 M. Jamkesos. SUNAR R. 2 2 2 1 1 1 1 1 1 1 2 2 1 0 1 1 47 SURODJO 2 2 2 1 1 1 1 1 1 0 2 2 1 0 0 1 48 JAENAP N.  Mempunyai Jaminan Pemeliharaan Kesehatan (jamkesmas.37 YATIMAN 2 2 2 1 1 1 1 1 1 0 2 2 1 0 1 1 38 SUGIMIN 1 1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 39 AGUS LESMANA 2 2 2 1 1 0 1 1 1 0 2 2 0 0 1 1 40 SARIYANTO 1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 1 41 DALWADI 2 2 2 1 1 1 1 1 1 0 2 2 1 0 0 1 42 PAGIYANTO 2 2 2 1 1 1 1 1 1 1 2 2 1 0 1 1 43 WIDODO 2 2 2 1 1 1 1 1 1 1 2 2 1 0 1 1 44 TRI WIDIYANTO 1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 1 45 YAMTINAH 2 2 2 1 1 1 1 1 1 1 2 2 1 0 0 1 46 IR. 2 2 2 1 1 1 1 1 1 1 2 2 0 0 0 1 49 ISNEN P. askes.    Menggunakan air bersih  5.  Gosok gigi minimal 2 kali sehari sehabis makan pagi dan sebelum tidur malam 14.    Menimbang bayi dan balita setiap bulan  4.    Memberantas jentik di rumah  8. dll) PETUNJUK PENGISIAN : . asuransi kesehatan.  Mengelola sampah dan limbah cair rumah tangga 15.  Ibu Hamil memeriksakan kehamilan 12.    Mencuci tangan dengan air bersih yang mengalir dan sabun 6.    Makan sayur dan buah setiap hari 10.    Memberi bayi ASI ekskusif  3.

0. Tidak ada sasaran Strata : I         :   1 -5 indikator  terpenuhi II        :   6-10 indikator  terpenuhi III       :  11-15 indikator  terpenuhi PHBS :  Jika indikator 1 sampai dengan indikator 10 terpenuhi . Jawaban "YA" (artinya perilaku sesuai dengan indikator) 2. Jika jawaban" tidak" 1.

ULASI HASIL PEMANTAUAN PHBS TATANAN KELUARGA TINGKAT RT INDIKATOR INDIKATOR INDIKATOR 2 3 4 5 6 7 8 9 10 11 12 13 14 15 1 2 3 8 9 11 12 1 2 1 1 1 1 1 1 1 1 0 1 1 1 0 1 13 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 0 1 1 1 0 0 12 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 0 0 13 0 0 0 1 1 0 0 0 0 1 1 1 0 1 0 1 1 0 1 1 1 1 1 12 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 14 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 0 1 1 1 0 0 12 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 0 1 0 13 0 0 0 1 1 0 0 0 0 1 1 1 1 1 0 1 1 1 1 1 1 1 0 13 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 0 1 14 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 0 1 1 1 0 0 12 0 0 0 1 1 0 0 0 0 1 1 1 1 0 0 1 1 0 1 1 1 1 1 12 0 0 0 1 1 0 0 0 0 1 1 1 1 1 0 1 1 0 1 1 1 1 0 12 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 0 1 1 0 1 0 12 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 0 1 1 1 0 0 12 0 0 0 1 1 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 1 1 0 13 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 1 1 0 13 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 1 0 0 12 0 0 0 1 1 0 0 0 0 1 1 1 0 1 1 1 1 1 1 1 1 1 0 13 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 15 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 0 1 1 1 0 1 13 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 12 0 0 0 1 1 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 1 0 1 13 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 0 0 1 13 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 0 0 13 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 13 0 0 0 1 1 0 0 0 0 1 1 1 0 1 1 1 1 1 1 1 1 0 0 12 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 14 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 0 1 1 1 1 0 13 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 15 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 14 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 0 0 13 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 0 14 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 1 0 1 13 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 0 0 13 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 15 1 1 1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 0 1 1 1 1 1 13 0 0 0 1 1 0 0 0 0 .

1 1 1 1 1 1 1 1 0 1 1 1 0 1 13 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 1 0 1 1 1 1 14 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 1 0 1 1 0 0 1 11 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 0 1 1 1 1 1 14 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 1 0 0 12 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 0 1 14 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 0 1 14 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 0 1 1 1 1 1 14 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 13 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 0 1 14 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 0 1 1 1 0 0 12 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 0 0 0 12 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 0 1 1 1 0 0 12 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 14 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 0 1 1 1 0 0 12 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 0 0 13 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 1 0 0 12 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 0 0 13 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 14 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 0 1 1 1 1 1 14 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 0 1 1 1 1 0 13 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 0 1 14 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 0 1 1 1 1 0 13 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 0 1 14 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 0 1 1 1 0 1 13 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 0 1 1 1 1 1 14 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 0 1 14 0 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 0 1 14 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 1 0 1 13 0 0 0 1 1 0 0 0 0 46 46 43 43 44 42 46 46 26 45 46 41 19 22 601 13 13 13 46 46 12 13 13 13 .

INDIKATOR STRATA 3 8 9 11 12 I II III PHBS 0 1 1 0 0 0 0 1 0 0 1 1 0 0 0 0 1 0 0 1 1 0 0 0 0 1 1 1 1 1 0 1 0 0 1 0 0 1 1 0 0 0 0 1 1 0 1 1 0 0 0 0 1 0 0 1 1 0 0 0 0 1 1 0 1 1 0 0 0 0 1 0 0 1 1 0 0 0 0 1 1 0 1 1 0 0 0 0 1 0 0 1 1 0 0 0 0 1 0 0 1 1 0 0 0 0 1 0 0 1 1 0 0 0 0 1 0 0 1 1 0 0 0 0 1 0 1 1 1 1 1 0 0 1 0 1 1 1 1 1 0 0 1 0 0 1 1 0 0 0 0 1 0 0 1 1 0 0 0 0 1 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 0 0 1 0 0 1 1 0 0 0 0 1 1 0 1 1 0 0 0 0 1 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 0 0 1 1 0 1 1 0 0 0 0 1 1 1 1 1 1 1 0 0 1 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 0 0 1 0 1 1 1 1 1 0 0 1 1 0 1 1 0 0 0 0 1 1 0 1 1 0 0 0 0 1 1 1 1 1 1 1 0 0 1 1 0 1 1 0 0 0 0 1 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 0 0 1 1 0 1 1 0 0 0 0 1 0 .

0 1 1 0 0 0 0 1 0 1 1 1 0 1 0 0 1 1 0 1 1 0 0 0 0 1 0 1 1 1 1 1 0 0 1 0 0 1 1 0 0 0 0 1 0 0 1 1 0 0 0 0 1 1 0 1 1 0 0 0 0 1 1 1 1 1 1 1 0 0 1 0 0 1 1 0 0 0 0 1 1 0 1 1 0 0 0 0 1 1 0 1 1 0 0 0 0 1 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 0 0 1 0 0 1 1 0 0 0 0 1 1 0 1 1 0 0 0 0 1 0 1 1 1 1 1 0 0 1 1 0 1 1 0 0 0 0 1 0 1 1 1 1 1 0 0 1 1 0 1 1 0 0 0 0 1 1 0 1 1 0 0 0 0 1 0 0 1 1 0 0 0 0 1 0 0 1 1 0 0 0 0 1 1 0 1 1 0 0 0 0 1 0 0 1 1 0 0 0 0 1 1 0 1 1 0 0 0 0 1 0 0 1 1 0 0 0 0 1 0 0 1 1 0 0 0 0 1 1 1 1 1 1 1 0 0 1 1 0 1 1 0 0 0 0 1 0 13 46 46 11 13 0 0 65 30 .

REKAPITULASI HASIL PEMANTA Tahun : 2015 Semester : RT :8 Dusun : Desa : Kecamatan : INDIKATOR No Nama Kepala Rumah Tangga 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 1 2 1 KUWADIYONO 2 2 2 1 1 1 1 1 1 0 2 2 1 0 1 1 1 2 SUHARSO 2 2 2 1 1 1 1 1 1 0 2 2 1 0 1 1 1 3 MUJIYO 2 2 2 1 1 1 1 1 1 0 2 2 1 0 1 1 1 4 SUTRISMAN 2 2 2 1 1 1 1 1 1 0 2 2 1 1 1 1 1 5 S. AGUSTIN 2 2 2 0 1 1 1 1 1 0 1 2 0 0 1 1 1 6 TOPAN NARA RIYADI 2 1 1 1 1 0 1 1 1 1 2 1 1 0 1 1 1 7 JAMRONO 2 2 2 1 1 1 1 1 1 0 2 2 1 1 1 1 1 8 BUDI 2 1 1 1 1 1 1 1 1 1 2 1 1 0 1 1 1 9 PURNOMO SINGGIH 2 2 2 1 1 1 1 1 1 0 2 2 1 0 1 1 1 10 JOKO WINTOLO 2 0 1 1 1 1 0 1 1 0 2 2 1 0 1 1 0 11 ERNAWAN 2 2 2 1 1 1 1 1 1 1 2 2 0 0 1 1 1 12 MUHIDIN 2 1 1 1 1 1 1 1 1 1 2 1 1 0 1 1 1 13 AMINAH MODJO 2 2 2 1 1 1 1 1 1 0 2 2 0 1 1 1 1 14 SUPRIYANTO 2 2 2 1 1 1 0 1 1 0 2 2 1 0 1 1 1 15 EKO FAJAR 2 2 2 0 1 1 1 1 1 0 2 2 1 0 1 1 1 16 NGATIMAN 2 2 2 1 1 1 1 1 1 0 2 2 1 0 1 1 1 17 SURONTO 2 2 2 1 1 0 1 1 2 0 2 2 1 0 1 1 1 18 SRI MUJIYATINI 2 2 2 1 1 1 0 1 1 0 2 2 1 0 1 1 1 19 WALJINO 2 2 2 1 1 1 1 1 1 0 2 2 1 0 1 1 1 20 TUKINO 2 1 1 1 1 1 1 1 1 1 2 1 1 0 1 1 1 21 RUBIYO 2 2 2 1 1 1 1 1 1 0 2 2 0 0 1 1 1 22 SUPARMAN 2 2 2 0 1 1 1 1 1 0 2 2 1 0 1 1 1 23 SUDARNO 2 2 2 1 1 1 1 1 1 0 2 2 1 1 1 1 1 24 SUTANTO 2 2 2 1 1 1 1 2 1 0 2 2 1 0 1 1 1 25 WAHONO 2 2 2 1 1 1 1 1 1 0 2 2 1 0 1 1 1 26 KARDIMAN 2 2 2 1 1 1 1 1 1 0 2 2 1 0 1 1 1 27 WIJANG SUKMONO 2 1 1 1 1 1 1 1 1 1 2 1 0 1 1 1 1 28 MURTIJO 2 2 2 1 1 1 1 1 1 0 1 2 1 1 1 1 1 29 TRIYANTONO 2 2 2 1 1 1 1 1 1 0 2 2 1 0 1 1 1 30 ZAENURI 2 2 2 1 1 1 1 1 2 0 2 2 1 1 1 1 1 31 ISWANDI 2 2 2 1 1 1 1 1 1 1 2 2 1 0 1 1 1 32 SUBARI 2 1 1 1 1 0 1 1 1 1 2 1 1 1 1 1 1 33 MUJIMAN 2 2 2 1 1 1 1 2 1 0 2 2 1 0 1 1 1 34 PUPUT 2 2 1 1 1 1 1 1 1 0 1 1 1 1 1 1 1 35 DION ROSELO 2 1 1 1 1 1 1 1 1 0 1 1 1 0 1 1 1 36 SAEFUL 2 2 2 1 1 1 1 1 0 1 1 1 1 1 1 1 1 .

Jika jawaban" tidak" 1.    Makan sayur dan buah setiap hari 10.  Mempunyai Jaminan Pemeliharaan Kesehatan (jamkesmas. Jawaban "YA" (artinya perilaku sesuai dengan indikator) 2.37 WARSO 1 1 1 1 1 1 1 1 0 1 1 1 1 1 0 1 1 38 WASKITO 1 1 1 0 1 1 1 1 0 1 1 1 0 1 0 1 1 39 NANDA 2 2 2 1 1 1 1 1 1 1 2 2 1 0 1 1 1 40 LANDUNG 2 2 2 1 1 1 0 1 1 1 2 2 1 0 1 1 1 41 DARSONO 2 2 2 1 1 1 1 1 1 1 2 2 1 0 0 1 1 42 MUJIYO 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 43 MASDUKI 2 2 2 1 1 0 1 1 1 1 2 2 1 0 1 1 1 44 HARJONO 2 2 2 1 1 1 1 1 1 1 2 2 1 1 0 1 1 45 RIZKI 2 2 1 1 1 1 1 1 1 1 2 1 1 1 0 1 1 46 47 48 49 50 Jumlah 87 78 77 41 45 41 41 47 44 18 82 77 39 15 40 45 44 INDIKATOR : 1.    Persalinan ditolong oleh tenaga kesehatan 2.    Menggunakan jamban sehat 7.  Gosok gigi minimal 2 kali sehari sehabis makan pagi dan sebelum tidur malam 14. Jamkesos. asuransi kesehatan. dll) PETUNJUK PENGISIAN : 0. askes.    Memberantas jentik di rumah  8.  Tidak merokok di dalam rumah  11.    Menimbang bayi dan balita setiap bulan  4.  Ibu Hamil memeriksakan kehamilan 12.    Menggunakan air bersih  5.    Mencuci tangan dengan air bersih yang mengalir dan sabun 6.    Memberi bayi ASI ekskusif  3. Tidak ada sasaran Strata : I         :   1 -5 indikator  terpenuhi II        :   6-10 indikator  terpenuhi III       :  11-15 indikator  terpenuhi PHBS :  Jika indikator 1 sampai dengan indikator 10 terpenuhi .  Bayi di imunisasi secara lengkap sesuai usianya 13.  Mengelola sampah dan limbah cair rumah tangga 15.    Melakukan aktivitas fisik setiap hari  9.

ASI HASIL PEMANTAUAN PHBS TATANAN KELUARGA TINGKAT RT INDIKATOR INDIKATOR INDIKATOR 3 4 5 6 7 8 9 10 11 12 13 14 15 1 2 3 8 9 11 12 1 2 3 1 1 1 1 1 1 1 0 1 1 1 0 1 13 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 1 0 1 1 1 0 1 13 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 1 0 1 1 1 0 1 13 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 1 0 1 1 1 1 1 14 0 0 0 1 1 0 0 0 0 0 1 0 1 1 1 1 1 0 1 1 0 0 1 11 0 0 0 1 1 1 0 0 0 0 1 1 1 0 1 1 1 1 1 1 1 0 1 13 0 1 1 1 1 0 1 0 1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 14 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 0 1 14 0 1 1 1 1 0 1 0 1 1 1 1 1 1 1 1 1 0 1 1 1 0 1 13 0 0 0 1 1 0 0 0 0 0 1 1 1 1 0 1 1 0 1 1 1 0 1 11 0 1 1 1 1 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 0 0 1 13 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 0 1 14 0 1 1 1 1 0 1 0 1 1 1 1 1 1 1 1 1 0 1 1 0 1 1 13 0 0 0 1 1 0 0 0 0 0 1 1 1 1 0 1 1 0 1 1 1 0 1 12 0 0 0 1 1 0 0 0 0 0 1 0 1 1 1 1 1 0 1 1 1 0 1 12 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 1 0 1 1 1 0 1 13 0 0 0 1 1 0 0 0 0 0 1 1 1 0 1 1 1 0 1 1 1 0 1 12 0 0 0 1 0 0 0 0 0 0 1 1 1 1 0 1 1 0 1 1 1 0 1 12 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 1 0 1 1 1 0 1 13 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 0 1 14 0 1 1 1 1 0 1 0 1 1 1 1 1 1 1 1 1 0 1 1 0 0 1 12 0 0 0 1 1 0 0 0 0 0 1 0 1 1 1 1 1 0 1 1 1 0 1 12 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 1 0 1 1 1 1 1 14 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 1 0 1 1 1 0 1 13 0 0 0 0 1 0 0 0 0 0 1 1 1 1 1 1 1 0 1 1 1 0 1 13 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 1 0 1 1 1 0 1 13 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 0 1 1 14 0 1 1 1 1 0 1 0 1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 14 0 0 0 1 1 1 0 0 0 0 1 1 1 1 1 1 1 0 1 1 1 0 1 13 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 1 0 1 1 1 1 1 14 0 0 0 1 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 0 1 14 0 0 0 1 1 0 0 0 0 0 1 1 1 0 1 1 1 1 1 1 1 1 1 14 0 1 1 1 1 0 1 0 1 1 1 1 1 1 1 1 1 0 1 1 1 0 1 13 0 0 0 0 1 0 0 0 0 0 1 1 1 1 1 1 1 0 1 1 1 1 1 14 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 1 1 1 0 1 13 0 1 1 1 1 1 1 0 1 1 1 1 1 1 1 1 0 1 1 1 1 1 1 14 0 0 0 1 1 1 1 0 0 0 .

1 1 1 1 1 1 0 1 1 1 1 1 0 13 1 1 1 1 1 1 1 1 1 1 1 0 1 1 1 1 0 1 1 1 0 1 0 11 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 14 0 0 0 1 1 0 0 0 0 0 1 1 1 1 0 1 1 1 1 1 1 0 1 13 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 0 0 13 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 15 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 1 1 0 1 13 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 0 14 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 0 14 0 0 1 1 1 0 1 0 0 1 45 41 45 41 41 45 42 18 45 45 39 15 40 591 3 11 13 43 43 8 13 3 10 13 .

INDIKATOR STRATA 8 9 11 12 I II III PHBS 1 1 0 0 0 0 1 0 1 1 0 0 0 0 1 0 1 1 0 0 0 0 1 0 1 1 0 0 0 0 1 0 1 1 1 0 0 0 1 0 1 1 0 1 0 0 1 0 1 1 0 0 0 0 1 0 1 1 0 1 0 0 1 1 1 1 0 0 0 0 1 0 1 1 0 0 0 0 1 0 1 1 0 0 0 0 1 1 1 1 0 1 0 0 1 1 1 1 0 0 0 0 1 0 1 1 0 0 0 0 1 0 1 1 0 0 0 0 1 0 1 1 0 0 0 0 1 0 1 0 0 0 0 0 1 0 1 1 0 0 0 0 1 0 1 1 0 0 0 0 1 0 1 1 0 1 0 0 1 1 1 1 0 0 0 0 1 0 1 1 0 0 0 0 1 0 1 1 0 0 0 0 1 0 0 1 0 0 0 0 1 0 1 1 0 0 0 0 1 0 1 1 0 0 0 0 1 0 1 1 0 1 0 0 1 1 1 1 1 0 0 0 1 0 1 1 0 0 0 0 1 0 1 0 0 0 0 0 1 0 1 1 0 0 0 0 1 1 1 1 0 1 0 0 1 0 0 1 0 0 0 0 1 0 1 1 1 1 0 0 1 0 1 1 1 1 0 0 1 0 1 0 1 1 0 0 1 0 .

1 0 1 1 0 0 1 0 1 0 1 1 0 0 1 0 1 1 0 0 0 0 1 1 1 1 0 0 0 0 1 0 1 1 0 0 0 0 1 1 1 1 1 1 0 0 1 1 1 1 0 0 0 0 1 0 1 1 0 0 0 0 1 1 1 1 0 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 43 40 8 13 0 0 45 11 .

1 1 1 1 1 1 1 1 0 1 1 1 1 1 0 1 1 28 SUKOCO 2 2 2 1 0 1 1 1 0 1 2 2 1 0 0 1 1 29 CAHYONO S. 2 2 2 1 1 1 1 1 0 1 2 2 1 1 1 1 1 20 SUHARSONO 2 2 2 0 1 1 1 1 0 1 2 2 1 1 0 1 1 21 HARTO S. 2 2 2 1 1 0 1 1 1 0 2 2 1 1 1 1 1 30 MURYANTO 1 1 1 1 1 1 1 1 0 0 1 1 1 1 0 1 1 31 PURNOMO 2 2 2 0 1 1 1 1 0 0 2 2 0 1 0 1 1 32 TASLIM 2 2 2 1 1 1 1 1 1 0 2 2 1 1 0 1 1 33 HERI ISKANDAR 2 2 2 1 1 1 1 1 0 0 2 2 1 1 0 1 1 34 IMAM PRASTYO 2 2 2 1 1 1 1 1 0 1 2 2 1 1 0 1 1 35 EKO DORWADI 2 2 2 1 1 1 1 1 0 0 2 2 1 1 1 1 1 36 WIDODO 2 2 2 1 0 1 1 1 1 1 2 2 1 0 0 1 1 . REKAPITULASI HASIL PEMANTA Tahun : 2015 Semester : RT :9 Dusun : Desa : Kecamatan : INDIKATOR No Nama Kepala Rumah Tangga 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 1 2 1 SAGARDI 2 2 2 1 1 1 1 1 1 1 2 2 1 1 1 1 1 2 IDA RUSTINATUN 2 2 2 1 1 1 1 1 1 1 2 2 1 1 1 1 1 3 JOYO UTOMO 2 2 2 1 1 1 1 1 1 1 2 2 1 1 1 1 1 4 ISMADI 2 2 2 1 1 1 1 1 1 1 2 2 1 1 1 1 1 5 BARJO 2 2 2 1 1 1 1 1 1 1 2 2 1 0 1 1 1 6 BEJO KASONO 2 2 2 1 1 1 1 1 0 0 2 2 1 1 0 1 1 7 SARJIMIN 2 2 2 1 1 1 1 1 0 1 2 2 1 1 1 1 1 8 MUTIA S. 2 2 2 1 1 0 1 1 1 1 2 2 1 1 1 1 1 9 SUMARDI 2 2 2 1 1 1 1 1 0 1 2 2 1 1 1 1 1 10 SUNARDI 1 1 1 1 1 1 1 1 0 1 1 1 0 1 0 1 1 11 SUPRAN 2 2 2 1 1 1 1 1 0 0 2 2 1 1 0 1 1 12 SURIP 2 2 2 1 0 1 1 1 0 0 2 2 1 0 1 1 1 13 SARIMIN 2 2 2 1 1 1 1 1 1 1 2 2 1 1 1 1 1 14 JUMINEM 2 2 2 1 1 1 1 1 0 1 2 2 1 1 1 1 1 15 DENI S. 2 2 2 1 1 1 1 1 0 1 2 2 0 1 0 1 1 22 SUHARYADI 2 2 2 1 1 1 1 1 1 0 2 2 1 1 0 1 1 23 DAROMI 2 2 2 1 0 1 1 1 0 1 2 2 1 1 1 1 1 24 IMANULLOH DUHA 2 2 2 1 1 1 1 1 0 1 2 2 1 1 0 1 1 25 JOKO W. 2 2 2 1 1 1 1 1 0 1 2 2 1 1 0 1 1 16 ANANG RAKMADI 1 1 1 1 1 1 1 1 0 1 1 1 1 1 0 1 1 17 DAGIYAH 2 2 2 1 1 1 1 1 0 1 2 2 1 1 1 1 1 18 SLAMET 2 2 2 1 1 0 1 1 0 1 2 2 1 1 0 1 1 19 SITI M. 2 2 2 1 1 1 1 1 0 1 1 1 1 1 1 1 1 26 SRI MULYANTO EKO 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 27 SLAMET Y.

 Tidak ada sasaran Strata : I         :   1 -5 indikator  terpenuhi II        :   6-10 indikator  terpenuhi III       :  11-15 indikator  terpenuhi PHBS :  Jika indikator 1 sampai dengan indikator 10 terpenuhi . asuransi kesehatan. Jika jawaban" tidak" 1.  Mengelola sampah dan limbah cair rumah tangga 15.  Bayi di imunisasi secara lengkap sesuai usianya 13.  Ibu Hamil memeriksakan kehamilan 12.    Menggunakan air bersih  5.    Memberantas jentik di rumah  8.  Mempunyai Jaminan Pemeliharaan Kesehatan (jamkesmas.    Memberi bayi ASI ekskusif  3.  Gosok gigi minimal 2 kali sehari sehabis makan pagi dan sebelum tidur malam 14. Jamkesos.    Menimbang bayi dan balita setiap bulan  4.37 JOKO SUSILO 2 2 2 1 1 1 1 1 1 1 2 2 1 1 1 1 1 38 GUNARDI 2 2 1 1 1 1 1 1 1 1 2 2 1 0 0 1 1 39 LANDUNG 2 2 2 1 1 1 1 1 1 1 2 2 1 1 0 1 1 40 MUJIONO 2 2 2 1 1 1 1 1 1 1 2 2 1 1 0 1 1 Jumlah 75 75 74 38 36 37 40 40 16 30 74 74 37 35 18 40 40 INDIKATOR : 1.    Persalinan ditolong oleh tenaga kesehatan 2.    Menggunakan jamban sehat 7.    Makan sayur dan buah setiap hari 10. Jawaban "YA" (artinya perilaku sesuai dengan indikator) 2.    Mencuci tangan dengan air bersih yang mengalir dan sabun 6. askes.    Melakukan aktivitas fisik setiap hari  9.  Tidak merokok di dalam rumah  11. dll) PETUNJUK PENGISIAN : 0.

ASI HASIL PEMANTAUAN PHBS TATANAN KELUARGA TINGKAT RT INDIKATOR INDIKATOR INDIKATOR 3 4 5 6 7 8 9 10 11 12 13 14 15 1 2 3 8 9 11 12 1 2 3 1 1 1 1 1 1 1 1 1 1 1 1 1 15 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 15 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 15 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 15 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 0 1 14 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 0 0 1 1 1 1 0 12 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 0 1 1 1 1 1 1 14 0 0 0 1 1 0 0 0 0 0 1 1 1 0 1 1 1 1 1 1 1 1 1 14 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 0 1 1 1 1 1 1 14 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 0 1 1 1 0 1 0 12 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 1 1 1 1 0 12 0 0 0 1 1 0 0 0 0 0 1 1 0 1 1 1 0 0 1 1 1 0 1 11 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 15 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 0 1 1 1 1 1 1 14 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 0 1 1 1 1 1 0 13 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 0 1 1 1 1 1 0 13 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 1 14 0 0 0 1 1 0 0 0 0 0 1 1 1 0 1 1 0 1 1 1 1 1 0 12 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 0 1 1 1 1 1 1 14 0 0 0 1 1 0 0 0 0 0 1 0 1 1 1 1 0 1 1 1 1 1 0 12 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 0 1 1 1 0 1 0 12 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 1 0 1 1 1 1 0 13 0 0 0 1 1 0 0 0 0 0 1 1 0 1 1 1 0 1 1 1 1 1 1 13 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 0 1 1 1 1 1 0 13 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 0 1 1 1 1 1 1 14 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 0 14 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 0 13 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 1 0 1 1 1 1 0 0 11 0 0 0 1 1 0 0 0 0 0 1 1 1 0 1 1 1 0 1 1 1 1 1 13 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 0 0 1 1 1 1 0 12 1 1 1 1 1 1 1 1 1 1 1 0 1 1 1 1 0 0 1 1 0 1 0 10 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 1 0 1 1 1 1 0 13 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 0 0 1 1 1 1 0 12 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 0 1 1 1 1 1 0 13 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 0 0 1 1 1 1 1 13 0 0 0 1 1 0 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 0 0 12 0 0 0 1 1 0 0 0 0 0 .

1 1 1 1 1 1 1 1 1 1 1 1 1 15 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 0 0 13 0 0 1 1 1 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 0 14 0 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 0 14 0 0 0 1 1 0 0 0 0 0 40 38 36 37 40 40 16 30 40 40 37 35 18 527 5 5 6 40 40 6 6 5 5 6 .

INDIKATOR STRATA 8 9 11 12 I II III PHBS 1 1 0 0 0 0 1 1 1 1 0 0 0 0 1 1 1 1 0 0 0 0 1 1 1 1 0 0 0 0 1 1 1 1 0 0 0 0 1 1 1 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 1 1 0 0 0 0 1 0 1 0 0 0 0 0 1 0 1 0 1 1 0 0 1 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 1 1 0 0 0 0 1 1 1 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 1 0 1 1 0 0 1 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 1 1 0 0 0 0 1 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 1 0 1 1 0 0 1 0 1 1 1 1 0 0 1 1 1 0 1 1 0 0 1 0 1 0 0 0 0 0 1 0 1 1 0 0 0 0 1 0 1 0 1 1 0 0 1 0 1 0 0 0 0 1 0 0 1 1 0 0 0 0 1 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 1 1 0 0 0 0 1 0 .

1 1 0 0 0 0 1 1 1 1 0 0 0 0 1 1 1 1 0 0 0 0 1 1 1 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 40 16 6 6 0 1 39 11 .

REKAPITULASI HASIL PEMA Tahun : 2015 Semester : RT : 10 Dusun : Desa : Kecamatan : INDIKATOR No Nama Kepala Rumah Tangga 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 1 MARJONO 2 2 2 1 1 1 1 1 1 0 2 2 1 1 1 2 HERI CAHYONO 2 2 2 1 1 1 1 1 1 1 2 2 1 1 0 3 SUTINI NARJONO 2 2 2 0 1 1 1 1 1 1 2 2 1 0 1 4 INA KUSUMA 2 2 2 1 1 1 0 1 1 1 2 2 1 0 1 5 SARDI 1 1 1 1 0 1 0 1 1 1 1 1 1 0 1 6 MULYONO 1 1 1 1 1 1 1 1 1 1 2 1 1 1 1 7 M. PURWOHADI 2 2 2 1 1 1 1 1 1 0 2 2 1 0 0 25 HASAN SUBAGYO 2 2 2 0 1 1 1 1 1 0 2 2 1 0 0 26 WIGNYO 2 2 2 1 1 1 0 1 1 1 2 2 1 0 1 27 SURIPTO 2 2 2 1 1 1 1 1 1 1 2 2 1 1 1 28 SLAMET WIDODO 2 2 2 1 0 0 1 1 1 1 2 2 1 0 1 29 TRI WAHYUDI 2 2 2 1 1 0 1 1 1 1 2 2 1 1 1 30 MARSUTI 2 2 2 1 1 1 0 1 1 1 2 2 1 0 0 31 KAHONO 2 2 2 1 1 1 1 1 1 0 2 2 0 0 1 32 SUKARJONO 2 2 2 1 1 1 1 1 1 0 2 2 0 1 0 33 SUYATMIN SAMSHON 2 2 2 0 1 1 1 1 1 0 1 2 1 0 1 34 HARTO WAJILAH 2 2 2 1 1 0 1 1 1 0 2 2 1 0 1 35 MIYEM 2 2 2 1 1 1 1 1 1 0 2 2 1 1 1 36 DJONO MARTOWIYONO 2 2 2 1 1 1 1 1 1 0 2 2 1 0 0 37 HARYADI 2 2 2 1 1 1 1 1 1 1 2 2 1 0 1 38 JUMIRAN 2 2 2 1 1 1 1 1 1 0 2 2 1 0 0 39 SUDARMIN 1 1 1 0 1 1 1 1 1 0 2 1 0 1 1 . 2 2 2 1 0 1 1 1 1 0 2 2 1 1 1 20 ARDIAN NDARU SUPRANA 2 2 2 1 1 1 1 1 1 1 1 2 1 0 1 21 JIMMY SAPUTRA 2 2 2 1 1 1 1 1 1 1 1 2 0 0 1 22 SLAMET MULYONO 2 2 2 1 1 1 1 1 1 1 1 2 1 0 0 23 TRI WARSONO 2 2 2 1 1 1 1 1 1 1 2 2 1 0 0 24 AG. SULKHAN 2 2 2 1 1 1 1 1 1 0 2 2 1 0 1 8 SUKISMIRAN 2 2 2 1 1 1 1 1 1 1 2 2 0 0 1 9 IRWAN SETIAWAN 2 2 2 1 1 1 1 1 1 0 2 0 1 0 1 10 SUGIH SRI KADARMAN 2 2 2 1 1 1 1 1 1 0 2 2 1 0 1 11 SLAMET RIYADI 2 2 2 1 1 1 1 1 1 0 2 2 1 0 0 12 TRI JOKO WIDARTO 2 2 2 1 1 0 1 1 1 0 1 0 1 0 0 13 HERI SISWANTO 2 2 2 1 1 0 0 1 1 1 1 2 1 0 0 14 WALUYO JATI 2 2 2 1 0 1 0 1 1 0 1 2 1 0 0 15 KATIYEM 2 2 2 0 1 1 1 1 1 0 2 2 1 0 0 16 ARJO PERWITO 2 2 2 1 1 1 1 1 1 0 2 2 1 0 1 17 NANANG TRI JATMIKO 2 2 2 1 1 1 1 1 1 0 2 2 0 0 0 18 SIREP SUNARTI 1 1 0 1 1 0 1 1 1 0 1 1 1 1 0 19 SLAMETO RAHMAD D.

 Jawaban "YA" (artinya perilaku sesuai dengan indikator) 2.  Bayi di imunisasi secara lengkap sesuai usianya 13.    Menggunakan jamban sehat 7.  Mengelola sampah dan limbah cair rumah tangga 15.    Memberantas jentik di rumah  8.    Mencuci tangan dengan air bersih yang mengalir dan sabun 6.    Menggunakan air bersih  5.    Melakukan aktivitas fisik setiap hari  9.  Tidak merokok di dalam rumah  11.    Menimbang bayi dan balita setiap bulan  4.40 MARTONO 2 2 2 1 1 1 1 1 1 0 2 2 1 0 0 41 ROLAND WATIMURI 2 2 2 1 1 1 1 1 1 0 2 2 1 0 1 42 NURYONO 2 2 2 1 1 1 1 1 1 0 2 2 1 0 0 43 R.    Persalinan ditolong oleh tenaga kesehatan 2.    Memberi bayi ASI ekskusif  3.  Ibu Hamil memeriksakan kehamilan 12. Tidak ada sasaran Strata : I         :   1 -5 indikator  terpenuhi II        :   6-10 indikator  terpenuhi III       :  11-15 indikator  terpenuhi PHBS :  Jika indikator 1 sampai dengan indikator 10 terpenuhi . AGUS SUPRIYANTO 2 2 2 1 1 1 1 1 1 0 2 2 1 0 0 44 SAMA'UN 2 2 2 1 1 1 1 1 1 1 2 2 1 0 1 45 YAMAN SUSILO 2 2 2 1 1 1 1 1 1 0 2 2 1 0 1 46 SUDIONO 2 2 2 1 1 1 1 1 1 0 2 2 1 0 0 47 WAKIDI 2 2 2 0 1 1 1 0 1 1 2 2 1 0 0 48 JUNIANTO 2 2 2 1 1 1 1 1 1 1 2 2 1 0 1 49 TAMAR 2 2 2 1 1 1 1 1 1 1 2 2 1 0 1 50 JUNMIYO 2 2 2 1 1 1 1 1 1 0 2 2 1 0 1 Jumlah 96 96 95 44 46 44 44 49 50 21 91 92 44 10 29 INDIKATOR : 1. Jamkesos.    Makan sayur dan buah setiap hari 10.  Mempunyai Jaminan Pemeliharaan Kesehatan (jamkesmas. asuransi kesehatan. askes. dll) PETUNJUK PENGISIAN : 0. Jika jawaban" tidak" 1.  Gosok gigi minimal 2 kali sehari sehabis makan pagi dan sebelum tidur malam 14.

ITULASI HASIL PEMANTAUAN PHBS TATANAN KELUARGA TINGKAT RT INDIKATOR INDIKATOR 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 1 2 3 8 9 11 12 1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 14 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 14 0 0 0 1 1 0 0 1 1 1 0 1 1 1 1 1 1 1 1 1 0 1 13 0 0 0 1 1 0 0 1 1 1 1 1 1 0 1 1 1 1 1 1 0 1 13 0 0 0 1 1 0 0 1 1 1 1 0 1 0 1 1 1 1 1 1 0 1 12 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 15 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 0 1 1 1 0 1 13 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 1 1 0 0 1 13 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 0 1 0 1 0 1 12 0 0 0 1 1 0 1 1 1 1 1 1 1 1 1 1 0 1 1 1 0 1 13 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 0 1 1 1 0 0 12 0 0 0 1 1 0 0 1 1 1 1 1 0 1 1 1 0 1 0 1 0 0 10 0 0 0 1 1 1 1 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 11 0 0 0 1 1 1 0 1 1 1 1 0 1 0 1 1 0 1 1 1 0 0 10 0 0 0 1 1 1 0 1 1 1 0 1 1 1 1 1 0 1 1 1 0 0 11 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 0 1 1 1 0 1 13 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 0 1 1 0 0 0 11 0 0 0 1 1 0 0 1 1 0 1 1 0 1 1 1 0 1 1 1 1 0 11 1 1 1 1 1 1 1 1 1 1 1 0 1 1 1 1 0 1 1 1 1 1 13 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 14 0 0 0 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 0 0 1 13 0 0 0 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 13 0 0 0 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 13 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 0 1 1 1 0 0 12 0 0 0 1 1 0 0 1 1 1 0 1 1 1 1 1 0 1 1 1 0 0 11 0 0 0 1 1 0 0 1 1 1 1 1 1 0 1 1 1 1 1 1 0 1 13 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 15 0 0 0 1 1 0 0 1 1 1 1 0 0 1 1 1 1 1 1 1 0 1 12 0 0 0 1 1 0 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 14 0 0 0 1 1 0 0 1 1 1 1 1 1 0 1 1 1 1 1 1 0 0 12 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 0 1 1 0 0 1 12 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 0 1 1 0 1 0 12 0 0 0 1 1 0 0 1 1 1 0 1 1 1 1 1 0 1 1 1 0 1 12 0 0 0 1 1 1 0 1 1 1 1 1 0 1 1 1 0 1 1 1 0 1 12 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 14 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 0 1 1 1 0 0 12 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 14 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 0 1 1 1 0 0 12 0 0 0 1 1 0 0 1 1 1 0 1 1 1 1 1 0 1 1 0 1 1 12 1 1 1 1 1 0 1 .

1 1 1 1 1 1 1 1 1 0 1 1 1 0 0 12 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 0 1 1 1 0 1 13 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 0 1 1 1 0 0 12 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 0 1 1 1 0 0 12 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 14 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 0 1 1 1 0 1 13 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 0 1 1 1 0 0 12 0 0 0 1 1 0 0 1 1 1 0 1 1 1 0 1 1 1 1 1 0 0 11 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 14 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 14 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 0 1 1 1 0 1 13 0 0 0 1 1 0 0 50 50 49 44 46 44 44 49 50 21 50 48 44 10 29 628 4 4 4 50 50 9 6 .

INDIKATOR STRATA 1 2 3 8 9 11 12 I II III PHBS 0 0 0 1 1 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 1 1 0 0 0 1 1 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 1 0 1 1 1 1 1 1 1 0 0 1 0 1 1 1 1 1 0 1 0 0 1 1 0 0 0 1 1 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 1 1 0 0 0 1 1 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 1 0 0 0 0 1 1 1 0 0 1 0 0 0 0 0 1 1 1 0 0 0 1 0 0 0 0 1 1 1 0 0 1 0 0 0 0 0 1 1 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 1 0 1 1 0 1 1 1 1 0 0 1 0 0 0 0 1 1 0 0 0 0 1 0 0 0 0 1 1 1 0 0 0 1 1 0 0 0 1 1 1 0 0 0 1 1 0 0 0 1 1 1 0 0 0 1 1 0 0 0 1 1 0 0 0 0 1 1 0 0 0 1 1 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 1 1 0 0 0 1 1 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 1 0 0 0 0 1 1 1 0 0 0 1 0 0 0 0 1 1 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 1 1 0 0 0 1 1 0 0 0 0 1 0 1 1 1 1 1 0 1 0 0 1 0 .

0 0 0 1 1 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 1 1 0 0 0 1 1 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 1 1 0 0 0 1 1 0 0 0 0 1 1 0 0 0 1 1 0 0 0 0 1 0 4 4 3 49 50 9 4 0 2 48 12 .

48% 81.00% 78.40% INDIKATOR : 1.    Menggunakan air bersih  5.  Ibu Hamil memeriksakan kehamilan .    Makan sayur dan buah setiap hari 10.  Tidak merokok di dalam rumah  11.    Menggunakan jamban sehat 7.    Mencuci tangan dengan air bersih yang mengalir dan sabun 6.    Melakukan aktivitas fisik setiap hari  9.    Menimbang bayi dan balita setiap bulan  4.    Memberantas jentik di rumah  8.    Persalinan ditolong oleh tenaga kesehatan 2.    Memberi bayi ASI ekskusif  3. Tahun : 2015 Semester : Dusun  : Desa : Kecamatan : JML RUMAH No RT TANGGA (isi 1 2 3 manual) P S PS P S PS P 1 RT 1 40 40 9 9 35 9 4 37 2 RT 2 35 35 7 7 31 7 3 34 3 RT 3 60 60 11 11 55 11 6 56 4 RT 4 85 57 7 7 56 7 6 54 5 RT 5 70 42 7 7 41 7 6 39 6 RT 6 55 55 5 5 55 5 5 54 7 RT 7 65 46 13 13 46 13 13 46 8 RT 8 45 45 3 3 44 11 10 45 9 RT 9 40 40 5 5 40 5 5 40 10 RT 10 50 50 4 4 50 4 4 49 11 12 13 14 15 Jumlah 545 470 71 71 453 79 62 454 Persentase 100.

  Gosok gigi minimal 2 kali sehari sehabis makan pagi dan sebelum tidur malam 14. Kolom 3 : di isi dengan jumlah KK yang dipantau di RT tersebut 4. askes. dll) PETUNJUK PENGISIAN : 1.  Mengelola sampah dan limbah cair rumah tangga 15. Kolom 1 : di isi dengan nomor 2.  Bayi di imunisasi secara lengkap sesuai usianya 13. Kolom 20 s/d 23 : di isi dengan jumlah KK yang dipantau dan memenuhi strata . Kolom 4 s/d 19 : di isi dengan jumlah KK yang dipantau dan memenuhi indikator 5. Kolom 2 : di isi dengan nama RT 3.  Mempunyai Jaminan Pemeliharaan Kesehatan (jamkesmas. asuransi kesehatan. Jamkesos.12.

81% .12% 93.45% 60. REKAPITULASI HASIL PEMANTAUAN PHBS TATANAN KELUARGA TINGKAT RT INDIKATOR 3 4 5 6 7 8 9 S PS P P P P P S PS P S 9 6 40 28 40 40 38 38 36 12 33 7 6 35 23 35 35 33 33 31 10 28 11 7 60 42 60 60 52 58 50 19 50 10 7 57 50 57 57 49 57 49 31 57 8 5 42 35 42 42 34 42 34 16 42 5 4 51 51 49 52 54 51 50 54 55 13 13 43 43 44 42 46 46 46 46 46 13 13 41 45 41 41 45 43 43 42 43 6 6 38 36 37 40 40 40 40 16 40 4 3 44 46 44 44 49 50 49 50 50 86 70 451 399 449 453 440 458 428 296 444 81.21% 82.75% 73.39% 83.40% 82.

ELUARGA TINGKAT RT 9 10 11 12 13 14 15 PS P P S PS P S PS P P P 5 25 40 6 6 40 5 5 30 29 21 3 22 35 4 4 35 3 3 25 27 19 9 40 60 8 8 60 7 7 44 41 29 31 50 57 8 8 57 10 10 49 45 25 16 35 42 8 8 42 9 9 34 28 18 54 22 53 6 4 54 6 5 48 24 33 46 26 45 12 11 46 13 13 41 19 22 40 18 45 8 8 45 13 13 39 15 40 16 30 40 6 6 40 6 6 37 35 18 50 21 50 9 9 48 6 4 44 10 29 270 289 467 75 72 467 78 75 391 273 254 60.00% 96.09% 46.81% 53.03% 96.15% 71.74% 50.61% .

00% 8.81% 91.19% 27.34% . STRATA I II III PHBS (20) (21) (22) (23) 0 6 34 6 0 5 30 4 0 10 50 11 0 11 74 32 0 12 58 17 0 1 54 15 0 0 65 30 0 0 45 11 0 1 39 11 0 2 48 12 0 48 497 149 0.

. Tahun 2015 5 73.81% 10 53...40% 82. Capaian 1 100.19% Strata I Strata II Strata III 8.09% 40.34% 72.66% .00% 2 78.15% 60...61% 20.81% Strata III 91.48% Persentase Rumah Tangga ber-P 3 4 81.00% 13 71.45% 100.21% 6 82.00% 12 96.00% 15 46.00% 1 2 3 4 5 6 7 8 9 10 Strata Strata Keluarga Ber-PHBS Strata I 0.19% PHBS 27.39% 120..03% 80.00% 9 60..00% 0.81% 91. Tahun 2015 Strata II 8..00% 11 96..00% 7 83.34% Tidak ber-PHBS 72.75% Dusun .66% Persentase Rumah Tangga ber PHBS Tidak ber-PHBS 27..74% 14 50.12% 8 93.00% di Dusun ..

66% .Persentase Rumah Tangga ber PHBS Tidak ber-PHBS 27.34% 72.

. Tahun 2015 I Strata II Strata III 8.....19% e Rumah Tangga ber-PHBS PHBS Tidak ber-PHBS 27..81% 91.....66% . Tahun 2015 6 7 8 9 10 11 12 13 14 15 eluarga Ber-PHBS n ..34% 2. umah Tangga ber-PHBS .

e Rumah Tangga ber-PHBS PHBS Tidak ber-PHBS 27.34% 2.66% .