Hasil Pemeriksaan Jentik.xlsx
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HASIL PEMERIKSAAN JENTIK BERKALA BULAN : ………………………………………. RT/ RW/ DUSUN DESA KECAMATAN KABAUPATEN NO
: …………………………………….. : …………………………………….. : BLEGA : BANGKALAN
NAMA KK
ALAMAT
JENTIK POSITIF ( + ) NEGATIF ( - )
JUMLAH KONTAINER
1 2 3 4 9 10 11 12 13
Mengetahui, Kepala Desa …………………………
Blega, …………………………………….. Petugas Pemeriksa Jentik
……………………………………………..
……………………………………………..
A
KETERANGAN PARAF PETUGAS
…………………..
………………..
: …………………………………….. : …………………………………….. : BLEGA : BANGKALAN
NAMA KK
ALAMAT
JENTIK POSITIF ( + ) NEGATIF ( - )
JUMLAH KONTAINER
1 2 3 4 9 10 11 12 13
Mengetahui, Kepala Desa …………………………
Blega, …………………………………….. Petugas Pemeriksa Jentik
……………………………………………..
……………………………………………..
A
KETERANGAN PARAF PETUGAS
…………………..
………………..
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