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  • FORM EVALUASI UKM (Identifikasi, Analisis, RTL, TL)

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    Oviokta Rama
    7 views5 pages
    form evalusi

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    FORM EVALUASI UKM ( identifikasi,analisis,RTL,TL)

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    form evalusi

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    7 views5 pages

    FORM EVALUASI UKM (Identifikasi, Analisis, RTL, TL)

    Uploaded by

    Oviokta Rama
    form evalusi

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 5

    PEMERINTAH KABUPATEN BLORA

    DINAS KESEHATAN
    UPTD PUSKESMAS TODANAN
    Alamat : Rt.02/ Rw.03 Ds. TodananKec. Todanan 58256
    Email : todananpuskesmas@yahoo.co.id

    ===================================================================================================

    IDENTIFIKASI KEGIATAN UPAYA............

    TAHUN.......................

    NO KEGIATAN MASALAH

    Mengetahui : Todanan, 20...


    Kepala UPTD Pusk. Todanan Ketua Pelaksana ............

    …............................. …..................................
    NIP. NIP
    PEMERINTAH KABUPATEN BLORA
    DINAS KESEHATAN
    UPTD PUSKESMAS TODANAN
    Alamat : Rt.02/ Rw.03 Ds. TodananKec. Todanan 58256
    Email : todananpuskesmas@yahoo.co.id

    ===================================================================================================

    ANALISIS KEGIATAN UPAYA...............

    TAHUN................

    NO MASALAH PENYEBAB RTL

    Mengetahui : Todanan, 20...


    Kepala UPTD Pusk. Todanan Ketua Pelaksana ............

    …............................. …..................................
    NIP. NIP
    PEMERINTAH KABUPATEN BLORA
    DINAS KESEHATAN
    UPTD PUSKESMAS TODANAN
    Alamat : Rt.02/ Rw.03 Ds. TodananKec. Todanan 58256
    Email : todananpuskesmas@yahoo.co.id

    RENCANA TINDAK LANJUT KEGIATAN UPAYA….......


    TAHUN.................

    NO KEGIATAN TUJUAN SASARAN TEMPAT WAKTU PELAKSANA DANA

    Mengetahui : Todanan, 20...


    Kepala UPTD Pusk. Todanan Ketua Pelaksana ............

    …............................. …..................................
    NIP. NIP
    PEMERINTAH KABUPATEN BLORA
    DINAS KESEHATAN
    UPTD PUSKESMAS TODANAN
    Alamat : Rt.02/ Rw.03 Ds. TodananKec. Todanan 58256
    Email : todananpuskesmas@yahoo.co.id

    TINDAK LANJUT KEGIATAN UPAYA…..............


    TAHUN…...........
    No Kegiatan Sasaran Tempat Waktu Pelaksana Evaluasi Hasil

    Mengetahui : Todanan, 20...


    Kepala UPTD Pusk. Todanan Ketua Pelaksana ............
    …............................. …..................................
    NIP. NIP

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