DATA MURID SD SE KECAMATAN WITIHAMA

PUSKESMAS : WITIHAMA
KECAMATAN : WITIHAMA

KELAS
NO NAMA SEKOLAH I II III IV V
L P JLH L P JLH L P JLH L P JLH L P
1 SDK WITIHAMA 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 SDI ORINGBELE 0 0 0 0
3 SDI PLEDO 0 0 0 0
4 SDI MEKO 0 0 0 0
5 MIS WITIHAMA 0 0 0 0
6 SDK LAMABLAWA 0 0 0 0
7 SDI WERANGGERE 0 0 0 0
8 SDK WATOONE 0 0 0 0
9 SDI WATOONE 0 0 0 0
10 SDK HONIHAMA 0 0 0 0
11 SDN ORINGBELE GUNUNG 0 0 0 0
12 SDK WATOLOLONG 0 0 0 0
13 SDK LEWOPULO 0 0 0 0
14 SDK BALAWELING 0 0 0 0
15 SDK LEWOKEMIE 0 0 0 0
16 SDI WAIWURING 0 0 0 0
17 SDI RIANGDULI 0 0 0 0
18 SDI WOKA 0 0 0 0
19 SDI LAMALEKA 0 0 0 0
20 SDK REGONG 0 0 0 0
TOTAL 0 0 0 0 0 0 0 0 0 0 0 0 0 0
SE KECAMATAN WITIHAMA

KELAS
V VI JUMLAH KET
JLH L P JLH L P JLH
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 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 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 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0 0 0
 DATA MURID SD SE KECAMATAN WITIHAMA
PUSKESMAS : WITIHAMA
KECAMATAN : WITIHAMA

KELAS
NO NAMA SEKOLAH I II III IV
L P JLH L P JLH L P JLH L P
1 SDK WITIHAMA 0 0 0 0 0 0 0 0 0 0 0
2 SDI ORINGBELE 0 0 0
3 SDI PLEDO 0 0 0
4 SDI MEKO 0 0 0
5 MIS WITIHAMA 0 0 0
6 SDK LAMABLAWA 0 0 0
7 SDI WERANGGERE 0 0 0
8 SDK WATOONE 0 0 0
9 SDI WATOONE 0 0 0
10 SDK HONIHAMA 0 0 0
11 SDN ORINGBELE GUNUNG 0 0 0
12 SDK WATOLOLONG 0 0 0
13 SDK LEWOPULO 0 0 0
14 SDK BALAWELING 0 0 0
15 SDK LEWOKEMIE 0 0 0
16 SDI WAIWURING 0 0 0
17 SDI RIANGDULI 0 0 0
18 SDI WOKA 0 0 0
19 SDI LAMALEKA 0 0 0
20 SDK REGONG 0 0 0
TOTAL 0 0 0 0 0 0 0 0 0 0 0
CAMATAN WITIHAMA

KELAS
IV V VI JUMLAH KET
JLH L P JLH L P JLH L P JLH
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 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 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 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 0 0 0 0
0 0 0 0 0 0 0 0 0 0
 DATA MURID SD SE KECAMATAN WITIHAMA
PUSKESMAS : WITIHAMA
KECAMATAN : WITIHAMA

KELAS
NO NAMA SEKOLAH I II III IV
L P JLH L P JLH L P JLH L P
1 SDK WITIHAMA 0 0 0 0 0 0 0 0 0 0 0
2 SDI ORINGBELE 0 0 0
3 SDI PLEDO 0 0 0
4 SDI MEKO 0 0 0
5 MIS WITIHAMA 0 0 0
6 SDK LAMABLAWA 0 0 0
7 SDI WERANGGERE 0 0 0
8 SDK WATOONE 0 0 0
9 SDI WATOONE 0 0 0
10 SDK HONIHAMA 0 0 0
11 SDN ORINGBELE GUNUNG 0 0 0
12 SDK WATOLOLONG 0 0 0
13 SDK LEWOPULO 0 0 0
14 SDK BALAWELING 0 0 0
15 SDK LEWOKEMIE 0 0 0
16 SDI WAIWURING 0 0 0
17 SDI RIANGDULI 0 0 0
18 SDI WOKA 0 0 0
19 SDI LAMALEKA 0 0 0
20 SDK REGONG 0 0 0
TOTAL 0 0 0 0 0 0 0 0 0 0 0
CAMATAN WITIHAMA

KELAS
IV V VI JUMLAH KET
JLH L P JLH L P JLH L P JLH
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 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 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 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 0 0 0 0
0 0 0 0 0 0 0 0 0 0
 JADWAL KEGIATAN BIAS CAMPAK DAN PENJARINGAN ANAK SEKOLAH

NO TANGGAL KEGIATAN NAMA SEKOLAH NAMA PETUGAS KETERANGAN NO

1 Friday, August 23, 2013 SDK WITIHAMA Rozita R. O. Lamahoda 1

Emanuela Benga Kian
2 Thursday, August 22, 2013 SDI ORINGBELE Rozita R. O. Lamahoda 2
Emanuela Benga Kian
3 Saturday, August 24, 2013 SDI PLEDO Johoria Palang Sengaji 3
Stevania B. Tokan
Maria Karolinda Kartini 4
4 SDI MEKO Abdul Latif
Maria Karolinda Kartini 5
5 Thursday, August 22, 2013 MIS WITIHAMA Johoria Palang Sengaji
Abdul Latif 6
6 Friday, August 23, 2013 SDK LAMABLAWA Theresia Bahi
Marselina Penaten Baro 7
7 SDI WERANGGERE Melania Ina Bahantewelu
Abdul Latif
8 Friday, August 23, 2013 SDK WATOONE Yasinta Werena Tupen 8
Wardah Ibrahim Dasy
9 Saturday, August 24, 2013 SDI WATOONE Yasinta Werena Tupen 9
Wardah Ibrahim Dasy
10 Saturday, August 24, 2013 SDK HONIHAMA Iksan Kelake Laot 10
Katarina B. Hala
11 SDN ORINGBELE GUNUNG Iksan Kelake Laot 11
Katarina B. Hala
12 Monday, August 26, 2013 SDK WATOLOLONG Rufiana Ola 12
Fransia B. O. Duli
13 Monday, August 26, 2013 SDK LEWOPULO Laurensia Kewa Ola 13
Johoria Palang Sengaji
14 Tuesday, August 27, 2013 SDK BALAWELING Yuliana Ose Wunga 14
Emanuel F. Ola Masan
15 Tuesday, August 27, 2013 SDK LEWOKEMIE Yuliana Rari Sili 15
Agustina Kewa Kian
Monika Kewa Somi
16 Tuesday, August 27, 2013 SDI WAIWURING Abdul Latif 16
Imelda Mala Bean
17 Monday, August 26, 2013 SDI RIANGDULI Mince M.M. Kabelen 17

18 Thursday, August 29, 2013 SDI WOKA Alexia Biti Ola 18

Wilfrida Perada Wisok
19 Thursday, August 29, 2013 SDI LAMALEKA Rozita R.O. Lamahoda 19
Rosalia B. Maran
20 Saturday, August 31, 2013 SDK REGONG Kristina Pati 20
Rufiana

JADWAL KEGIATAN BIAS DT DAN Td

NO TANGGAL KEGIATAN NAMA SEKOLAH NAMA PETUGAS KETERANGAN NO

1 ### SDK WITIHAMA Rozita R. O. Lamahoda 1

Emanuela Benga Kian

2 ### SDI ORINGBELE Rozita R. O. Lamahoda

Emanuela Benga Kian 2

3 ### SDI PLEDO Johoria Palang Sengaji

Stevania B. Tokan

Maria Karolinda Kartini 3

4 ### SDI MEKO Abdul Latif

Maria Karolinda Kartini

5 ### MIS WITIHAMA Johoria Palang Sengaji

Imelda Mala Bean 4

6 ### SDK LAMABLAWA Theresia Bahi

Marselina Penaten Baro

7 ### SDI WERANGGERE Melania Ina Bahantewelu 5

Marselina Penaten Baro

8 ### SDK WATOONE Yasinta Werena Tupen

Wardah Ibrahim Dasy 6

9 ### SDI WATOONE Yasinta Werena Tupen

Wardah Ibrahim Dasy

10 ### SDK HONIHAMA Iksan Kelake Laot 7

 Katarina B. Hala

11 ### SDN ORINGBELE GUNUNG Iksan Kelake Laot

Katarina B. Hala 8

12 ### SDK WATOLOLONG Rufiana Ola

Fransia B. O. Duli

13 ### SDK LEWOPULO Laurensia Kewa Ola 9

Johoria Palang Sengaji

14 ### SDK BALAWELING Yuliana Ose Wunga

Emanuel F. Ola Masan 10

15 ### SDK LEWOKEMIE Yuliana Rari Sili

Wilfrida Perada Wisok

Monika Kewa Somi 11

16 ### SDI WAIWURING Abdul Latif

Imelda Mala Bean

17 ### SDI RIANGDULI Mince M.M. Kabelen 12

Fitria Ridwan

18 ### SDI WOKA Alexia Biti Ola

Wilfrida Perada Wisok 13

19 ### SDI LAMALEKA Rozita R.O. Lamahoda

Rosalia B. Maran

20 ### SDK REGONG Kristina Pati 14

Rufiana Ola

15

16
 17

18

19

20

catatan :

Kelengkapan
1.
2.
3.
 JADWAL KEGIATAN BIAS CAMPAK DAN PENJARINGAN ANAK SEKOLAH

TANGGAL KEGIATAN NAMA SEKOLAH NAMA PETUGAS KETERANGAN

Thursday, August 22, 2013 SDI ORINGBELE Rozita R. O. Lamahoda 1. Sasaran BIAS
Campak adalah siswa
Emanuela Benga Kian SD Kelas I (Laki-lai dan
Thursday, August 22, 2013 MIS WITIHAMA Johoria Palang Sengaji Perempuan).
Abdul Latif
Friday, August 23, 2013 SDK WITIHAMA Rozita R. O. Lamahoda
Emanuela Benga Kian
Friday, August 23, 2013 SDK LAMABLAWA Theresia Bahi
Marselina Penaten Baro 2. Disertai dengan
kegiatan penjaringan
Friday, August 23, 2013 SDI WERANGGERE Melania Ina Bahantewelu anak sekolah siswa
baru masuk sekolah
Abdul Latif (Kelas I SD)
Friday, August 23, 2013 SDK WATOONE Yasinta Werena Tupen
Wardah Ibrahim Dasy
Saturday, August 24, 2013 SDI PLEDO Johoria Palang Sengaji
Stevania B. Tokan
Maria Karolinda Kartini
Saturday, August 24, 2013 SDI WATOONE Yasinta Werena Tupen
Wardah Ibrahim Dasy
Saturday, August 24, 2013 SDK HONIHAMA Iksan Kelake Laot
Katarina B. Hala
Monday, August 26, 2013 SDK WATOLOLONG Rufiana Ola
Fransia B. O. Duli
Monday, August 26, 2013 SDK LEWOPULO Laurensia Kewa Ola
Johoria Palang Sengaji
Monday, August 26, 2013 SDI RIANGDULI Mince M.M. Kabelen

Tuesday, August 27, 2013 SDN ORINGBELE GUNUNG Iksan Kelake Laot
Katarina B. Hala
Tuesday, August 27, 2013 SDK BALAWELING Yuliana Ose Wunga
Emanuel F. Ola Masan
Tuesday, August 27, 2013 SDK LEWOKEMIE Yuliana Rari Sili
Agustina Kewa Kian
Monika Kewa Somi
Tuesday, August 27, 2013 SDI WAIWURING Abdul Latif
Imelda Mala Bean
Thursday, August 29, 2013 SDI WOKA Alexia Biti Ola
Wilfrida Perada Wisok
Thursday, August 29, 2013 SDI LAMALEKA Rozita R.O. Lamahoda
Rosalia B. Maran
Thursday, August 29, 2013 SDI MEKO Abdul Latif
Maria Karolinda Kartini
Saturday, August 31, 2013 SDK REGONG Kristina Pati
Rufiana Ola

JADWAL KEGIATAN BIAS DT DAN Td

TANGGAL KEGIATAN NAMA SEKOLAH NAMA PETUGAS KETERANGAN

### SDK WITIHAMA Rozita R. O. Lamahoda

Imunsasi DT untuk
Emanuela Benga Kian Siswa Kelas I, Td untuk
siswa Kelas II dan III

### SDK WATOONE Yasinta Werena Tupen

Wardah Ibrahim Dasy

### SDI PLEDO Johoria Palang Sengaji

Maria Karolinda Kartini

Stevania B. Tokan

### MIS WITIHAMA Johoria Palang Sengaji

Imelda Mala Bean

### SDK LAMABLAWA Theresia Bahi

Marselina Penaten Baro

### SDK HONIHAMA Iksan Kelake Laot

Katarina B. Hala

### SDK WATOLOLONG Rufiana Ola

 Fransia B. O. Duli

### SDI WAIWURING Abdul Latif

Imelda Mala Bean

### SDI ORINGBELE Rozita R. O. Lamahoda

Emanuela Benga Kian

### SDI MEKO Abdul Latif

Maria Karolinda Kartini

### SDI WERANGGERE Melania Ina Bahantewelu

Marselina Penaten Baro

### SDI WATOONE Yasinta Werena Tupen

Wardah Ibrahim Dasy

### SDI WOKA Alexia Biti Ola

Wilfrida Perada Wisok

### SDI LAMALEKA Rozita R.O. Lamahoda

Rosalia B. Maran

### SDK LEWOPULO Laurensia Kewa Ola

Johoria Palang Sengaji

### SDK BALAWELING Yuliana Ose Wunga

Emanuel F. Ola Masan

 ### SDI RIANGDULI Mince M.M. Kabelen

Fitria Ridwan

### SDN ORINGBELE GUNUNG Iksan Kelake Laot

Adriana Dai Doni

### SDK LEWOKEMIE Yuliana Rari Sili

Wilfrida Perada Wisok

Monika Kewa Somi

### SDK REGONG Kristina Pati

Rufiana Ola

catatan :

Kelengkapan yang harus dibawa saat BIAS :

Surat Tugas
Vaxin dan Alat Suntik
Safety Box
 JADWAL KEGIATAN BIAS DT DAN Td BAGI SISWA/I SD

NO TANGGAL NAMA SEKOLAH KETERANGAN

1 Tuesday, November 19, 2013 SDK WITIHAMA

2 Tuesday, November 19, 2013 SDK WATOONE

3 Tuesday, November 19, 2013 SDI PLEDO

4 Wednesday, November 20, 2013 MIS WITIHAMA

5 Wednesday, November 20, 2013 SDK LAMABLAWA

6 Wednesday, November 20, 2013 SDK HONIHAMA

7 Wednesday, November 20, 2013 SDK WATOLOLONG

8 Thursday, November 21, 2013 SDI ORINGBELE

9 Thursday, November 21, 2013 SDI MEKO

10 Thursday, November 21, 2013 SDI WERANGGERE

11 Thursday, November 21, 2013 SDI WATOONE

12 Friday, November 22, 2013 SDI WOKA

13 Friday, November 22, 2013 SDI LAMALEKA

14 Saturday, November 23, 2013 SDK LEWOPULO

15 Saturday, November 23, 2013 SDK BALAWELING

16 Saturday, November 23, 2013 SDI RIANGDULI

17 Saturday, November 23, 2013 SDI WAIWURING

18 Monday, November 25, 2013 SDN ORINGBELE GUNUNG

19 Monday, November 25, 2013 SDK LEWOKEMIE

20 Tuesday, November 26, 2013 SDK REGONG

Catatan :
Jika Jadwal ini bertabrakan dengan kegiatan Belajar Mengajar di Sekolah, maka
mohon konfirmasi / Menghubungi kami di Nomor : 082146082295 atau 0813 3161 3084
 DATA SASARAN BIAS DT DAN Td BULAN NOPEMBER 2013
PUSKESMAS : WITIHAMA TAHUN :
KECAMATAN : WITIHAMA

JUMLAH SASARAN
NO NAMA SEKOLAH KELAS I KELAS II KELAS III JJLH KELAS I
L P JLH L P JLH L P JLH L
1 SDK WITIHAMA 13 11 24 9 12 21 13 10 23 22
2 SDI ORINGBELE 10 10 20 10 6 16 14 10 24 24
3 SDI PLEDO 21 18 39 21 18 39 15 11 26 36
4 SDI MEKO 6 8 14 7 1 8 2 3 5 9
5 MIS WITIHAMA 13 11 24 12 11 23 11 15 26 23
6 SDK LAMABLAWA 14 8 22 7 5 12 8 10 18 15
7 SDI WERANGGERE 7 3 10 7 2 9 6 6 12 13
8 SDK WATOONE 14 14 28 16 12 28 8 14 22 24
9 SDI WATOONE 13 6 19 9 7 16 13 6 14 22
10 SDK HONIHAMA 11 12 23 24 20 44 16 16 32 40
11 SDN ORINGBELE GUNUNG 1 3 4 4 2 6 1 2 3 5
12 SDK WATOLOLONG 7 8 15 10 9 19 12 6 18 22
13 SDK LEWOPULO 10 7 17 11 10 21 16 15 31 27
14 SDK BALAWELING 20 12 32 17 14 31 10 13 23 27
15 SDK LEWOKEMIE 20 17 37 21 19 40 31 16 47 52
16 SDI WAIWURING 3 5 8 3 5 8 5 4 9 8
17 SDI RIANGDULI 13 11 24 14 10 24 14 13 27 28
18 SDI WOKA 14 4 18 4 5 9 6 3 9 10
19 SDI LAMALEKA 4 7 11 10 3 13 4 5 9 14
20 SDK REGONG 9 10 19 7 5 12 6 3 9 13
TOTAL 223 185 408 223 176 399 211 181 387 434

Mengetahui
Kepala Puskesmas Witihama

Lambertus Ola Rua, Amd, Kep

NIP. 19691008 199103 1 008
AN Td BULAN NOPEMBER 2013
2013

SASARAN LOGISTIK
JJLH KELAS II + III VAXIN ADS KET
P JLH DT Td 0,5 cc
22 44 3.0 6 68
16 40 3.0 5 60
29 65 5.0 8 104
4 13 2.0 2 27
26 49 3.0 6 73
15 30 3.0 4 52
8 21 2.0 3 31
26 50 4.0 6 78
13 30 3.0 4 49
36 76 3.0 10 99
4 9 1.0 2 13
15 37 2.0 5 52
25 52 3.0 7 69
27 54 4.0 7 86
35 87 5.0 11 124
9 17 1.0 3 25
23 51 3.0 6 75
8 18 3.0 2 36
8 22 2.0 3 33
8 21 3.0 3 40
357 786 58.0 100 1194

Witihama, 19 Nopember 2013

Pengelola Imunisasi

Emanuel Fransiskus Ola Masan

NIP. 19800415 200212 1 007
 DATA MURID SD SE KECAMATAN WITIHAMA TAHUN 2013
PUSKESMAS : WITIHAMA
KECAMATAN : WITIHAMA

Jlh Belum Diimun

DATA BAYANGAN DATA RIIL Jlh Diimun
NO NAMA SEKOLAH (Riil)
L P JLH L P JLH L P Jlh L P
1 SDK WITIHAMA 11 14 25 13 11 24 13 11 24
2 SDI ORINGBELE 8 9 17 10 10 20 10 10 20
3 SDI PLEDO 23 21 44 38 38 38 0 38
4 SDI MEKO 7 4 11 15 15 15 0 15
5 MIS WITIHAMA 10 12 22 19 19 19 0 19
6 SDK LAMABLAWA 7 7 14 8 9 17 8 9 17
7 SDI WERANGGERE 7 7 14 7 3 10 7 3 10 2
8 SDK WATOONE 14 11 25 14 14 28 14 14 28 1 2
9 SDI WATOONE 8 10 18 13 6 19 13 6 19 1
10 SDK HONIHAMA 20 20 40 11 12 23 11 12 23 1
11 SDN ORINGBELE GUNUNG 2 7 9 1 3 4 1 3 4 1
12 SDK WATOLOLONG 9 8 17 7 8 15 7 8 15 2
13 SDK LEWOPULO 10 10 20 17 17 17 0 17
14 SDK BALAWELING 20 9 29 20 12 32 20 12 32 3
15 SDK LEWOKEMIE 20 19 39 20 17 37 20 17 37 1 1
16 SDI WAIWURING 3 7 10 3 5 8 3 5 8 1
17 SDI RIANGDULI 14 11 25 13 11 24 13 11 24 3
18 SDI WOKA 7 8 15 14 4 18 14 4 18
19 SDI LAMALEKA 8 9 17 4 7 11 4 7 11
20 SDK REGONG 7 5 12 9 10 19 9 10 19 3 1
TOTAL 215 208 423 256 142 398 256 142 398 16 7
UN 2013

lh Belum Diimun VAXIN

(Riil) KET
Diterima Dipakai
Jlh
0 3 3 Stok Vaxin
0 2 2 Campak
0 4 4
0 2 2 85
0 3 3
0 2 2 Jlh dipakai
2 5 1
3 3 3 48
1 3 3
1 3 3 Sisa Stok
1 1 1
2 2 2 37
0 3 2
3 5 3
2 4 4
1 1 1
3 4 3
0 3 2
0 2 2
4 2 2
23 57 48
 DATA SASARAN BIAS DT DAN Td BULAN NOPEMBER 2013
PUSKESMAS : WITIHAMA TAHUN
KECAMATAN : WITIHAMA

JUMLAH SASARAN
NO NAMA SEKOLAH KELAS I KELAS II KELAS III
L P JLH L P JLH L P
1 SDK WITIHAMA 13 11 24 9 12 21 13 10
2 SDI ORINGBELE 10 10 20 10 6 16 14 10
3 SDI PLEDO 21 18 39 21 18 39 15 11
4 SDI MEKO 6 8 14 7 1 8 2 3
5 MIS WITIHAMA 13 11 24 12 11 23 11 15
6 SDK LAMABLAWA 14 8 22 7 5 12 8 10
7 SDI WERANGGERE 7 3 10 7 2 9 6 6
8 SDK WATOONE 14 14 28 16 12 28 8 14
9 SDI WATOONE 13 6 19 9 7 16 13 6
10 SDK HONIHAMA 11 12 23 24 20 44 16 16
11 SDN ORINGBELE GUNUNG 1 3 4 4 2 6 1 2
12 SDK WATOLOLONG 7 8 15 10 9 19 12 6
13 SDK LEWOPULO 10 7 17 11 10 21 16 15
14 SDK BALAWELING 20 12 32 17 14 31 10 13
15 SDK LEWOKEMIE 20 17 37 21 19 40 31 16
16 SDI WAIWURING 3 5 8 3 5 8 5 4
17 SDI RIANGDULI 13 11 24 14 10 24 14 13
18 SDI WOKA 14 4 18 4 5 9 6 3
19 SDI LAMALEKA 4 7 11 10 3 13 4 5
20 SDK REGONG 9 10 19 7 5 12 6 3
TOTAL 223 185 408 223 176 399 211 181
DT DAN Td BULAN NOPEMBER 2013

H SASARAN LOGISTIK

KELAS III VAXIN KET

JLH DT Td
23 3.0 6
DT untuk siswa
24 3.0 5
Kelas I
26 5.0 8
5 2.0 2
26 3.0 6 Td untuk siswa
18 3.0 4 kelas II dan III
12 2.0 3
22 4.0 6
19 3.0 4
32 3.0 10
3 1.0 2
18 2.0 5
31 3.0 7
23 4.0 7
47 5.0 11
9 1.0 3
27 3.0 6
9 3.0 2
9 2.0 3
9 3.0 3
392 58.0 100
 LAPORAN BIAS DT dan Td
BULAN NOPEMBER 2013
NAMA SEKOLAH : TANGGAL PELAKSANAAN :

Jenis Imunisasi
No Nama Siswa Tgl. Lahir DT Td Ket
Kelas I Kelas II - III
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

Jlh sasaran Jlh Diimunisasi Jlh Belum diimun ADS 0,5 ml Jlh Vaxin DT Jlh Vaxin Td
L P JLH L P JLH L P JLH diterima dipakai diterima dipakai diterima dipakai
Kls I
Kls 2
Kls 3

Mengetahui ......................................
Kepala Sekolah Yang Melapor,

NIP. NIP.
 LOGISTIK
NO NAMA SEKOLAH DT Td VAXIN KET
JLH JLH DT Td
1 SDK WITIHAMA 24 44 3.0 6
40 DT untuk siswa
2 SDI ORINGBELE 20 3.0 5
Kelas I
3 SDI PLEDO 39 65 5.0 8
4 SDI MEKO 14 13 2.0 2
5 MIS WITIHAMA 24 49 3.0 6 Td untuk siswa
6 SDK LAMABLAWA 22 30 3.0 4 kelas II dan III
7 SDI WERANGGERE 10 21 2.0 3
8 SDK WATOONE 28 50 4.0 6
9 SDI WATOONE 19 35 3.0 4
10 SDK HONIHAMA 23 76 3.0 10
11 SDN ORINGBELE GUNUNG 4 9 1.0 2
12 SDK WATOLOLONG 15 37 2.0 5
13 SDK LEWOPULO 17 52 3.0 7
14 SDK BALAWELING 32 54 4.0 7
15 SDK LEWOKEMIE 37 87 5.0 11
16 SDI WAIWURING 8 17 1.0 3
17 SDI RIANGDULI 24 51 3.0 6
18 SDI WOKA 18 18 3.0 2
19 SDI LAMALEKA 11 22 2.0 3
20 SDK REGONG 19 21 3.0 3
TOTAL 408 791 58.0 100