monitoring dan evaluasi

4
MONITORING DAN EVALUASI PELAKSANAAN KEGIATAN TUGAS PEMBANTUAN DAN URUSAN BERSAMA DI KECAMATAN TAHUN 2014 DATA RESPONDEN : Nama : (Nama Kepala Puskesmas)......................... Jabatan : ........................................................... ......... Kantor /Dinas : ........................................................... ......... Alamat : ........................................... ......................... No. HP/ Telp : ........................................................... ......... DATA UMUM PROGRAM/KEGIATAN : Nama Program :............................................................. ......... Nama Kegiatan :............................................................. ......... Anggaran : Rp...................... (.......................................) Sumber Dana : Tugas Pembantuan APBN Tahun Anggaran 2014 Lokasi Kegiatan : s/d Kecamatan...............................................

Upload: nurhasan-agung-prabowo

Post on 17-Aug-2015

218 views

Category:

Documents


1 download

DESCRIPTION

lembar monev

TRANSCRIPT

MONITORING DAN EVALUASIPELAKSANAAN KEGIATAN TUGAS PEMBANTUAN DAN URUSAN BERSAMADI KECAMATAN TAHUN 2014DATA RESPONDEN:Nama : (Nama Kepala P!"e!ma!#$$$$$$$$$$$$$$$$$$$$$$$$$%a&a'a(:$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$Ka(')* +D,(a! :$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$Alama' :$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$N)$ HP+ Telp :$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$DATA UMUM PROGRAM+KEGIATAN:Nama P*)-*am :$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$Nama Ke-,a'a( :$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$A(--a*a(: Rp$$$$$$$$$$$$$$$$$$$$$$($$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$#Sm&e* Da(a : T-a! Pem&a('a( APBN Ta.( A(--a*a( 2014L)"a!, Ke-,a'a( : !+/ Ke0ama'a($$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$%mla. Da(a 1a(- la(-!(- "e ma!1a*a"a' : Rp$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$SUBSTANSI :1$ Kela*a( + .a!,l :N)Kela*a(V)lmeSa'a(Ke'e*a(-a( Upa1a "e!e.a'a( p*,)*,'a!Upa1a "e!e.a'a( la,((1a2$Ma(2aa'Se&elm a/a(1a "e-,a'a(Se!/a. a/a(1a "e-,a'a(4$ Pela"!a(aa( P*)-*am + Ke-,a'a( :4$1 Real,!a!, Kea(-a( : Re(0a(a: $$$$3 Real,!a!,:$$$$3 Pe(1e&a& *eal,!a!, "ea(-a( ',/a" !e!a, *e(0a(a + 'a*-e':$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$4$2Real,!a!, 4,!," : Re(0a(a:$$$$$$3 Real,!a!,:$$$$$$3 Pe(1e&a& apa&,la *eal,!a!, 5!," ',/a" !e!a, *e(0a(a + 'a*-e':$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$6$ Dampa" :a$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$&$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$0$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$7$ Ham&a'a( + Ma!ala.:$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$8$ Ca*a Me(-a'a!, Ham&a'a(+ Ma!ala.:$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$9$ U!la( +*e")me(/a!, :$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$S").a*:); $$$$$$$$$$$$$$$Kepala P!"e!ma!$$$$$$$$$$$$$$$$$$$$$$$$$$Nama Kepala P!"e!ma!NIP$