JUMLAH SASARAN BIAS 2017

di KABUPATEN LOMBOK TIMUR

PUSKESMAS : (isi kolom yang berwarna kuning)

JUMLAH SASARAN
No NAMA SEKOLAH I II TOT I + II III IV V VI
L P TOT L P TOT L P TOT L P TOT L P TOT L P TOT L P TOT
1 0 0 0 0 0 0 0 0 0
2 0 0 0 0 0 0 0 0 0
3 0 0 0 0 0 0 0 0 0
4 0 0 0 0 0 0 0 0 0
5 0 0 0 0 0 0 0 0 0
6 0 0 0 0 0 0 0 0 0
7 0 0 0 0 0 0 0 0 0
8 0 0 0 0 0 0 0 0 0
9 0 0 0 0 0 0 0 0 0
10 0 0 0 0 0 0 0 0 0
11 0 0 0 0 0 0 0 0 0
12 0 0 0 0 0 0 0 0 0
13 0 0 0 0 0 0 0 0 0
14 0 0 0 0 0 0 0 0 0
15 0 0 0 0 0 0 0 0 0
16 0 0 0 0 0 0 0 0 0
17 0 0 0 0 0 0 0 0 0
18 0 0 0 0 0 0 0 0 0
19 0 0 0 0 0 0 0 0 0
20 0 0 0 0 0 0 0 0 0
21 0 0 0 0 0 0 0 0 0
22 0 0 0 0 0 0 0 0 0
23 0 0 0 0 0 0 0 0 0
24 0 0 0 0 0 0 0 0 0
25 0 0 0 0 0 0 0 0 0
26 0 0 0 0 0 0 0 0 0
27 0 0 0 0 0 0 0 0 0
28 0 0 0 0 0 0 0 0 0
29 0 0 0 0 0 0 0 0 0
JUMLAH 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui
Kepala Puskesmas................ Yang Melapor
Pengelola Prog. Imunisasi

......................................... .........................................
Nip. ..................... Nip. .....................
TOT KET
(I-VI)
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
AMPRAHAN KEBUTUHAN VAKSIN DAN LOGISTIK IMUNISASI ANAK SEKOLAH ( BIAS ) TAHUN 2017
di KABUPATEN LOMBOK TIMUR
PUSKESMAS :

JUMLAH SASARAN KEBUTUHAN

No NAMA SEKOLAH I II VAKSIN LOGISTIK SAFETY
L P TOT L P TOT CAMPAK DT Td 0.5 5 BOX
1 0 0 0 0 0 0 0 0 0 0 0 0 0
2 0 0 0 0 0 0 0 0 0 0 0 0 0
3 0 0 0 0 0 0 0 0 0 0 0 0 0
4 0 0 0 0 0 0 0 0 0 0 0 0 0
5 0 0 0 0 0 0 0 0 0 0 0 0 0
6 0 0 0 0 0 0 0 0 0 0 0 0 0
7 0 0 0 0 0 0 0 0 0 0 0 0 0
8 0 0 0 0 0 0 0 0 0 0 0 0 0
9 0 0 0 0 0 0 0 0 0 0 0 0 0
10 0 0 0 0 0 0 0 0 0 0 0 0 0
11 0 0 0 0 0 0 0 0 0 0 0 0 0
12 0 0 0 0 0 0 0 0 0 0 0 0 0
13 0 0 0 0 0 0 0 0 0 0 0 0 0
14 0 0 0 0 0 0 0 0 0 0 0 0 0
15 0 0 0 0 0 0 0 0 0 0 0 0 0
16 0 0 0 0 0 0 0 0 0 0 0 0 0
17 0 0 0 0 0 0 0 0 0 0 0 0 0
18 0 0 0 0 0 0 0 0 0 0 0 0 0
19 0 0 0 0 0 0 0 0 0 0 0 0 0
20 0 0 0 0 0 0 0 0 0 0 0 0 0
21 0 0 0 0 0 0 0 0 0 0 0 0 0
22 0 0 0 0 0 0 0 0 0 0 0 0 0
23 0 0 0 0 0 0 0 0 0 0 0 0 0
24 0 0 0 0 0 0 0 0 0 0 0 0 0
25 0 0 0 0 0 0 0 0 0 0 0 0 0
26 0 0 0 0 0 0 0 0 0 0 0 0 0
27 0 0 0 0 0 0 0 0 0 0 0 0 0
28 0 0 0 0 0 0 0 0 0 0 0 0 0
29 0 0 0 0 0 0 0 0 0 0 0 0 0
JUMLAH 0 0 0 0 0 0 0 0 0 0 0 0

Mengetahui
Kepala Seksi P2P Yang Melapor

Budiman Satriadim S.KM Sri Novita Alfiyani, SKM.

Nip. 19751021 199903 1 006 NIP. 19771124 200701 2 019
LAPORAN HASIL PELAKSANAAN BIAS
di KABUPATEN LOMBOK TIMUR TAHUN 2017
PUSKESMAS : (isi kolom yang berwarna kuning)

SASARAN CAKUPAN
CAMPAK DT Td
NO. NAMA SEKOLAH KELAS 1 KELAS 2 TOTAL 1+2
KELAS 1 KELAS 1 KELAS 2
L P TOT L P TOT L P TOT L P TOT % L P TOT % L P TOT %
10 0 0 0 0 0 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
20 0 0 0 0 0 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
30 0 0 0 0 0 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
40 0 0 0 0 0 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
50 0 0 0 0 0 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
60 0 0 0 0 0 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
70 0 0 0 0 0 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
80 0 0 0 0 0 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
90 0 0 0 0 0 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
10 0 0 0 0 0 0 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
11 0 0 0 0 0 0 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
12 0 0 0 0 0 0 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
13 0 0 0 0 0 0 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
14 0 0 0 0 0 0 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
15 0 0 0 0 0 0 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
16 0 0 0 0 0 0 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
17 0 0 0 0 0 0 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
18 0 0 0 0 0 0 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
19 0 0 0 0 0 0 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
20 0 0 0 0 0 0 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
21 0 0 0 0 0 0 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
22 0 0 0 0 0 0 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
23 0 0 0 0 0 0 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
24 0 0 0 0 0 0 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
25 0 0 0 0 0 0 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
26 0 0 0 0 0 0 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
27 0 0 0 0 0 0 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
28 0 0 0 0 0 0 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
29 0 0 0 0 0 0 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!

JUMLAH 0 0 0 0 0 0 0 0 0 #DIV/0! 0 0 0 #DIV/0! 0 0 0 #DIV/0!

Mengetahui …………………….,
Kepala Puskesmas PENGELOLA PROG IMUNISASI

= = =
NIP. NIP.
LAPORAN HASIL PELAKSANAAN BIAS
di KABUPATEN LOMBOK TIMUR TAHUN 2017
PUSKESMAS

PEMAKAIAN VAKSIN
ADS
JUMLAH VIAL IP SAFETY
NO. NAMA SEKOLAH
BOX
CAMPAK DT Td CAMPAK DT Td 0.5 5

10 #DIV/0! #DIV/0! #DIV/0! 0 0 0

20 #DIV/0! #DIV/0! #DIV/0! 0 0 0
30 #DIV/0! #DIV/0! #DIV/0! 0 0 0
40 #DIV/0! #DIV/0! #DIV/0! 0 0 0
50 #DIV/0! #DIV/0! #DIV/0! 0 0 0
60 #DIV/0! #DIV/0! #DIV/0! 0 0 0
70 #DIV/0! #DIV/0! #DIV/0! 0 0 0
80 #DIV/0! #DIV/0! #DIV/0! 0 0 0
90 #DIV/0! #DIV/0! #DIV/0! 0 0 0
10 0 #DIV/0! #DIV/0! #DIV/0! 0 0 0
11 0 #DIV/0! #DIV/0! #DIV/0! 0 0 0
12 0 #DIV/0! #DIV/0! #DIV/0! 0 0 0
13 0 #DIV/0! #DIV/0! #DIV/0! 0 0 0
14 0 #DIV/0! #DIV/0! #DIV/0! 0 0 0
15 0 #DIV/0! #DIV/0! #DIV/0! 0 0 0
16 0 #DIV/0! #DIV/0! #DIV/0! 0 0 0
17 0 #DIV/0! #DIV/0! #DIV/0! 0 0 0
18 0 #DIV/0! #DIV/0! #DIV/0! 0 0 0
19 0 #DIV/0! #DIV/0! #DIV/0! 0 0 0
20 0 #DIV/0! #DIV/0! #DIV/0! 0 0 0
21 0 #DIV/0! #DIV/0! #DIV/0! 0 0 0
22 0 #DIV/0! #DIV/0! #DIV/0! 0 0 0
23 0 #DIV/0! #DIV/0! #DIV/0! 0 0 0
24 0 #DIV/0! #DIV/0! #DIV/0! 0 0 0
25 0 #DIV/0! #DIV/0! #DIV/0! 0 0 0
26 0 #DIV/0! #DIV/0! #DIV/0! 0 0 0
27 0 #DIV/0! #DIV/0! #DIV/0! 0 0 0
28 0 #DIV/0! #DIV/0! #DIV/0! 0 0 0
29 0 #DIV/0! #DIV/0! #DIV/0! 0 0 0
JUMLAH 0 0 0 #DIV/0! #DIV/0! #DIV/0! 0 0 0
 FORMAT PENCATATAN HASIL BIAS (BULAN IMUNISASI ANAK SEKOLAH)
DI UNIT PELAYANAN
KABUPATEN :
PUSKESMAS :
NAMA SD/MI : TANGGAL PELAKSANAAN :

TANGGAL IMUNISASI
UMUR
NO NAMA MURID NAMA ORANG TUA KET
(THN) CAMPAK DT Td
KLS I KLS I KLS II KLS III
1 2 4 5 6 7 8 9 10
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
Mengetahui
Kepala SD/MI___________________ PETUGAS

_______________________________ _______________________________
NIP. NIP.