Formulir Data Abj Supervisor.docx
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FORMULIR DATA ABJ SUPERVISOR UPTD PUSKESMAS DESA/KELURAHAN KECAMATAN BULAN/TANGGAL TAHUN NO
RW JUMLAH
1 2 3 4
RUMAH YANG DIPERIKSA JENTIK POSITIF NEGATIF DEMAM
KETERANGAN ABJ(%)
1 2 3 4 TOTAL
MENGETAHUI KEPALA UPTD PUSKESMAS
PETUGAS DBD
RW JUMLAH
1 2 3 4
RUMAH YANG DIPERIKSA JENTIK POSITIF NEGATIF DEMAM
KETERANGAN ABJ(%)
1 2 3 4 TOTAL
MENGETAHUI KEPALA UPTD PUSKESMAS
PETUGAS DBD
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