1.1.1.d kerangka acuan survey edit.doc

Embed Size (px)

Citation preview

  • 7/24/2019 1.1.1.d kerangka acuan survey edit.doc

    1/10

    PEMERINTAH KABUPATEN BOJONEGORODINAS KESEHATAN

    UPTD PUSKESMAS KANOR

    Bojonegoro, Oktober 201

    Ke!"#"

    No$or % &&0' '&12(&)'201 *t+( S#r( Se$" K"r-"."n #"n

    S/"t % Pent/ng K"r-"."t/ Pke$" K"nor

    "$!/r"n % 3 #/3

    Per/+"4 % Un#"ng"n K a n o r

    Meng+"r"! #eng"n +or$"t "t" ke+"#/r"nn-" ntk #"!"t

    $eng/kt/ !erte$"n beok !"#" 5

    H"r/ ' T"ngg"4 %

    J"$ % 11(00 6IB '# Se4e"/(

    Te$!"t % R"ng !erte$"n Pke$" K"nor

    A7"r" % Perte$"n $/n/4ok"r-"(

    Pe$b"+""n % Ko$/t$en $"-"r"k"t ter+"#"! !e4"-"n"n #/

    Pke$" K"nor

    De$/k/"n "t" !er+"t/"n #"n ke+"#/r"n-" #/"$!"/k"n ter/$" k"/+(

    Koor#/n"tor A#$en Sekret"r/

    N"$" N"$"NIP( NIP(

  • 7/24/2019 1.1.1.d kerangka acuan survey edit.doc

    2/10

    PEMERINTAH KABUPATEN BOJONEGORO

    DINAS KESEHATAN

    UPTD PUSKESMAS KANOR

    Not4enPerte$"n

    N"$" Perte$"n % Pe$b"t"n K//oner Kebt+"n #"nH"r"!"n M"-"r"k"t(

    T"ngg"4 % Pk4 %

    Sn"n A7"r"1( Pe$bk""n2( Pe$b"+""n$"ter/!erte$"n)( Pent!

    Not4en Sebe4$n-" Me$b"+" 7"r" ko$n/k"/ #eng"n !e4"ngg"n

    Pe$b"+""n

    Pe$b"t"n k//oner kebt+"n #"n +"r"!"n $"-"r"k"t /n/"k"n #/!ergn"k"n eb"g"/ b"+"n ntk $eng$!4k"n/nor$"/ ter+"#"! kebt+"n #"n +"r"!"n $"-"r"k"t, A#"!nbentk #"r/ K//oner te4"+ #/e!"k"t/ #eng"n bentk tertt!

    #"n ntk e$" !e4"-"n"n #eng"n !ert"n-"n"n -"ng berk/"r$engen"/ !en#"!"t $"-"r"k"t tent"ng !e4"-"n"n -"ng#/ber/k"n o4e+ !etg" ert" eg"4" "/4/t"n-" 8 BentkK/eoner Ter4"$!/r 9

    Ke/$!4"n K//oner te4"+ #/b"t #"n te4"+ #/e!"k"t/ ber"$"

    Reko$en#"/ Keb/j"k"n Ke!"4" UPTD Pke$" B4"nkD"t"r H"#/r

    No N"$" T"n#" t"ng"n(1 1

    2 2

    ) )

    & &

    : :; ;

    < 4"k/ 2 Pere$!"n

    Pen#/#/k"nTer"k+/r

    % 1 SD Keb"."+ S 1

    % 2 S T P : S 2 Ke"t"% ) S T A ; T/#"keko4"+

    % & D13D)3D& K"$/ % Pk4 0;()0 > 1&(00 6IB(- J$?"t % Pk4 0;()0 > 11(00 6IB(- S"bt % Pk4 0;()0 > 12(00 6IB(

    Jen/ Pe4"-"n"n -"/t %

    Pe4"-"n"n R"."t J"4"n

    1( oket !en#"t"r"n(

  • 7/24/2019 1.1.1.d kerangka acuan survey edit.doc

    4/10

    2( K4/n/k U$$(

    )( K4/n/k G/g/(

    &( K4/n/k Kee+"t"n Ib #"n An"k 8KIA9(

    ( K4/n/k G/@/(

    :( K4/n/k Ber+ent/ Merokok(

    ;( I$$n/"/(

  • 7/24/2019 1.1.1.d kerangka acuan survey edit.doc

    5/10

    NIP ' D"t" "/n %

    ! HARAPAN RESPONDEN TENTAN# PELAYANAN PUBLIK NILAI

    1 B"g"/$"n" +"r"!"n "#"r" tent"ng ke$#"+"n !roe#r !e4"-"n"n #/ UPTDPke$" B4"nk(

    " T/#"k $#"+ 1

    b Kr"ng $#"+ 2

    7 M#"+ )# S"ng"t $#"+ &

    2 B"g"/$"n" +"r"!"n "#"r" tent"ng kee"/"n !er-"r"t"n !e4"-"n"n#eng"n jen/ !e4"-"n"nn-"

    " T/#"k e"/ 1

    b Kr"ng e"/ 2

    7 Se"/ )

    # S"ng"t e"/ &

    ) B"g"/$"n" +"r"!"n "#"r" tent"ng keje4""n #"n ke!"t/"n !etg" -"ng$e4"-"n/

    A T/#"k je4" 1B Kr"ng je4" 2

    C Je4" )

    D S"ng"t je4" &

    & B"g"/$"n" +"r"!"n "#"r" tent"ng ke#//!4/n"n !etg" #"4"$ $e$ber/k"n!e4"-"n"n

    A T/#"k #//!4/n 1

    B Kr"ng #//!4/n 2

    C D//!4/n )

    D S"ng"t #//!4/n &

    B"g"/$"n" +"r"!"n "#"r" tent"ng t"nggng j"."b !etg" #"4"$$e$ber/k"n !e4"-"n"n

    A T/#"k bert"nggng j"."b 1

    B Kr"ng bert"nggng j"."b 2

    C Bert"nggng j"."b )D S"ng"t bert"nggng j"."b &

    : B"g"/$"n" +"r"!"n "#"r" tent"ng ke$"$!"n !etg" #"4"$ $e$ber/k"n!e4"-"n"n

    A T/#"k $"$! 1

    B Kr"ng $"$! 2

    C M"$! )

    D S"ng"t $"$! &

    ; B"g"/$"n" +"r"!"n "#"r" tent"ng ke7e!"t"n !e4"-"n"n #/ !ke$" /n/ NIAI

    A T/#"k 7e!"t 1

    B Kr"ng 7e!"t 2

    C Ce!"t )

    D S"ng"t 7e!"t &

    < B"g"/$"n" +"r"!"n "#"r" tent"ng ke"#/4"n ntk $en#"!"tk"n !e4"-"n"n

  • 7/24/2019 1.1.1.d kerangka acuan survey edit.doc

    6/10

    #/ !ke$" /n/

    A T/#"k "#/4 1B Kr"ng "#/4 2

    C A#/4 )

    D S"ng"t "#/4 &

    = B"g"/$"n" +"r"!"n "#"r" tent"ng keo!"n"n #"n ker"$"+"n !etg"#"4"$ $e$ber/k"n !e4"-"n"n

    A T/#"k o!"n #"n r"$"+ 1B Kr"ng o!"n #"n r"$"+ 2

    C So!"n #"n r"$"+ )D S"ng"t o!"n #"n r"$"+ &

    10 B"g"/$"n" +"r"!"n "#"r" tent"ng ke."j"r"n b/"-" ntk $en#"!"tk"n!e4"-"n"n #/ !ke$" /n/

    A Se4"4 ."j"r 1

    B Kr"ng ."j"r 2C 6"j"r )

    D S"ng"t ."j"r &

    11 B"g"/$"n" +"r"!"n "#"r" tent"ng kee"/"n "nt"r" b/"-" -"ng#/b"-"rk"n #eng"n b/"-" -"ng te4"+ #/tet"!k"n

    A Se4"4 t/#"k e"/ 1B K"#"ng > k"#"ng e"/ 2

    C B"n-"k e"/n-" )D S"ng"t e"/ &

    12 B"g"/$"n" +"r"!"n "#"r" tent"ng kete!"t"n !e4"k"n""n !e4"-"n"nter+"#"! j"#."4 ."kt !e4"-"n"n #/ !ke$" /n/

    A Se4"4 t/#"k te!"t 1

    B K"#"ng > k"#"ng te!"t 2C B"n-"k te!"tn-" )

    D Se4"4 te!"t &

    1) B"g"/$"n" +"r"!"n "#"r" tent"ng ken-"$"n"n !e4"-"n"n #/ 4/ngkng"nn/t !e4"-"n"n /n/

    A T/#"k n-"$"n 1B Kr"ng n-"$"n 2

    C N-"$"n )D S"ng"t n-"$"n &

    1& B"g"/$"n" +"r"!"n "#"r" tent"ng ke"$"n"n !e4"-"n"n #/ 4/ngkng"n n/t!e4"-"n"n

    A T/#"k "$"n 1

    B Kr"ng "$"n 2

    C A$"n )

    D S"ng"t "$"n &

  • 7/24/2019 1.1.1.d kerangka acuan survey edit.doc

    7/10

    Ter/$" k"/+ "t" !"rt//!"/ "n#" #"4"$ "+" !en/ngk"t"n k/nerj" !ke$"

    k"$/, e$" kr/t/k #"n "r"n "k"n #/"+"k"n ntk #/t/n#"k4"njt/(

    PEMERINTAH KABUPATEN BOJONEGORODINAS KESEHATAN

    UPTD PUSKESMAS KANORA4"$"t Pke$" B4"nk

    Te4!( Pke$" B4"nk E$"/4 Pke$" B4"nk

  • 7/24/2019 1.1.1.d kerangka acuan survey edit.doc

    8/10

    Rek"!"n K"j/"n H"r"!"n Pe4"-"n"n #/ Pke$" B4"nk

    No( T"ngg"4S$ber

    Inor$"/I/ Inor$"/ Tj"n Keter"ng"n

    1 1)3:3201& K//oner

    M"-"r"k"t $eng/ng/nk"nke$#"+"n !roe#r!e4"-"n"n -"ng "ng"t$#"+

    Ag"r $"-"r"k"t$#"+$en#"!"tk"n!e4"-"n"n

    2 1)3:3201&

    M"-"r"k"t $eng/ng/nk"nkee"/"n !er-"r"t"n#eng"n jen/ !e4"-"n"n-"ng "ng"t e"/

    Ag"r !e4"ngg"n$#"+$en#"!"tk"n!e4"-"n"n e"/#eng"n!er-"r"t"n-"

    ) 1)3:3201&

    M"-"r"k"t $eng/ng/nk"nkeje4""n #"n ke!"t/"n!etg" -"ng $e4"-"n/"ng"t je4"

    Ag"r $"-"r"k"t$en#"!"tk"nkeje4""n #"nke!"t/"n!etg" -"ng$e4"-"n/

    & 1)3:3201&

    M"-"r"k"t $eng/ng/nk"nke#//!4/n"n ."kt !etg"-"ng #/+"r"!k"n "ng"t#//!4/n

    Ag"r Petg"#"t"ng #"n!4"ng te!"t."kt

    1)3:3201&M"-"r"k"t $eng/ng/nk"nt"nggng j"."b !etg""ng"t bert"nggng j"."b

    Ag"r !etg"$enj"4"nk"ntg"n-" e"/#eng"n t"nggng

    j"."bn-"

    : 1)3:3201&M"-"r"k"t $eng/ng/nk"nke$"$!"n !etg""ng"t $"$!

    Ag"r !etg"#"4"$$e$ber/k"n!e4"-"n"n e"/#eng"nko$!eten/n-"

    ; 1)3:3201&M"-"r"k"t $eng/ng/nk"nke7e!"t"n !e4"-"n"n"ng"t 7e!"t

    Ag"r !etg"7e!"t #"4"$$e$ber/k"n!e4"-"n"n

    < 1=3:3201&

    M"-"r"k"t $eng/ng/nk"nke"#/4"n ntk

    $en#"!"tk"n !e4"-"n"n"ng"t "#/4

    Ag"r !etg"t/#"k$e$be#"k"nt"t ekono$/!e4"ngg"n #"4"$$e$ber/k"n!e4"-"n"n

    = 1=3:3201&

    M"-"r"k"t $eng/ng/nk"nkeo!"n"n #"n ker"$"+"n!etg" "ng"t o!"n #"nr"$"+

    Ag"r !etg"ber/k"! o!"n#"n $r"+en-$

    10 1=3:3201& M"-"r"k"t $eng/ng/nk"nke."j"r"n b/"-" "ng"t."j"r

    M"-"r"k"t$en#"!"tk"nke."j"r"n b/"-"

  • 7/24/2019 1.1.1.d kerangka acuan survey edit.doc

    9/10

    e"/ #eng"n!e4"-"n"n -"ng#/ter/$"

    11 1=3:3201&

    M"-"r"k"t $eng/ng/nk"nkee"/"n "nt"r" b/"-"-"ng b"-"rk"n #eng"n

    -"ng #/tet"!k"n

    B/"-" !e4"-"n"n!e4"ngg"n #//rber#""rk"nk4"//k"/!e4"-"n"n -"ng#/ter/$"!e4"ngg"n

    12 1=3:3201&

    M"-"r"k"t Meng/ng/nk"nkete!"t"n !e4"k"n""n!e4"-"n"n ter+"#"! j"#"4e4"4 te!"t

    Petg" $ene!"t/."kt !e4"-"n"ne"/ #eng"n

    j"#"4 -"ng"#"

    1) 1=3:3201&M"-"r"k"t Meng/ng/nk"nKen-"$"n"n !e4"-"n"n"ng"t n-"$"n(

    M"-"r"k"t$en#"!"tk"nken-"$"n"n#"4"$ !e4"-"n"n

    1& 1=3:3201&M"-"r"k"t $eng/ng/nk"nke"$"n"n "ng"t "$"n

    M"-"r"k"t$en#"!"tk"n

    j"$/n"nke"$"n"ne4"$" #/Pke$"

    Ke!"4" UPTD Pke$" B4"nk Koor#/n"tor A#$en

    #r( er" Agt/n" N"$"

    NIP( NIP(

  • 7/24/2019 1.1.1.d kerangka acuan survey edit.doc

    10/10