Sie sind auf Seite 1von 148

REKAPITULASI HASIL PEMANTAUAN STBM TATANAN RUMAH TANGGA TINGKAT RT

Tahun : 2023
Semester :
RT :
Dusun :
Desa :
Kecamatan :
Anggota keluarga :
INDIKATOR
No Nama Kepala Rumah Tangga
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REKAPITULASI HASIL PEMANTAUAN PHBS TATANAN RUMAH TANGGA TINGKAT RT
Tahun 2022
Semester :
RT :1
Dusun :
Desa :
Kecamatan :

INDIKATOR PHBS
No Nama Kepala Rumah Tangga
1 2 3 4 5 6 7 8 9 10 11 12 13 1 2 3 4 5 6 7 8 9 10 11
1 0 0 0 0 0 0 0 0 0 0 0
2 0 0 0 0 0 0 0 0 0 0 0
3 0 0 0 0 0 0 0 0 0 0 0
4 0 0 0 0 0 0 0 0 0 0 0
5 0 0 0 0 0 0 0 0 0 0 0
6 0 0 0 0 0 0 0 0 0 0 0
7 0 0 0 0 0 0 0 0 0 0 0
8 0 0 0 0 0 0 0 0 0 0 0
9 0 0 0 0 0 0 0 0 0 0 0
10 0 0 0 0 0 0 0 0 0 0 0
11 0 0 0 0 0 0 0 0 0 0 0
12 0 0 0 0 0 0 0 0 0 0 0
13 0 0 0 0 0 0 0 0 0 0 0
14 0 0 0 0 0 0 0 0 0 0 0
15 0 0 0 0 0 0 0 0 0 0 0
16 0 0 0 0 0 0 0 0 0 0 0
17 0 0 0 0 0 0 0 0 0 0 0
18 0 0 0 0 0 0 0 0 0 0 0
19 0 0 0 0 0 0 0 0 0 0 0
20 0 0 0 0 0 0 0 0 0 0 0
21 0 0 0 0 0 0 0 0 0 0 0
22 0 0 0 0 0 0 0 0 0 0 0
23 0 0 0 0 0 0 0 0 0 0 0
24 0 0 0 0 0 0 0 0 0 0 0
25 0 0 0 0 0 0 0 0 0 0 0
26 0 0 0 0 0 0 0 0 0 0 0
27 0 0 0 0 0 0 0 0 0 0 0
28 0 0 0 0 0 0 0 0 0 0 0
29 0 0 0 0 0 0 0 0 0 0 0
30 0 0 0 0 0 0 0 0 0 0 0
31 0 0 0 0 0 0 0 0 0 0 0
32 0 0 0 0 0 0 0 0 0 0 0
33 0 0 0 0 0 0 0 0 0 0 0
34 0 0 0 0 0 0 0 0 0 0 0
35 0 0 0 0 0 0 0 0 0 0 0
36 0 0 0 0 0 0 0 0 0 0 0
37 0 0 0 0 0 0 0 0 0 0 0
38 0 0 0 0 0 0 0 0 0 0 0
39 0 0 0 0 0 0 0 0 0 0 0
40 0 0 0 0 0 0 0 0 0 0 0
41 0 0 0 0 0 0 0 0 0 0 0
42 0 0 0 0 0 0 0 0 0 0 0
43 0 0 0 0 0 0 0 0 0 0 0
44 0 0 0 0 0 0 0 0 0 0 0
45 0 0 0 0 0 0 0 0 0 0 0
46 0 0 0 0 0 0 0 0 0 0 0
47 0 0 0 0 0 0 0 0 0 0 0
48 0 0 0 0 0 0 0 0 0 0 0
49 0 0 0 0 0 0 0 0 0 0 0
50 0 0 0 0 0 0 0 0 0 0 0
51 0 0 0 0 0 0 0 0 0 0 0
52 0 0 0 0 0 0 0 0 0 0 0
53 0 0 0 0 0 0 0 0 0 0 0
54 0 0 0 0 0 0 0 0 0 0 0
55 0 0 0 0 0 0 0 0 0 0 0
56 0 0 0 0 0 0 0 0 0 0 0
57 0 0 0 0 0 0 0 0 0 0 0
58 0 0 0 0 0 0 0 0 0 0 0
59 0 0 0 0 0 0 0 0 0 0 0
60 0 0 0 0 0 0 0 0 0 0 0
61 0 0 0 0 0 0 0 0 0 0 0
62 0 0 0 0 0 0 0 0 0 0 0
63 0 0 0 0 0 0 0 0 0 0 0
64 0 0 0 0 0 0 0 0 0 0 0
65 0 0 0 0 0 0 0 0 0 0 0
66 0 0 0 0 0 0 0 0 0 0 0
67 0 0 0 0 0 0 0 0 0 0 0
68 0 0 0 0 0 0 0 0 0 0 0
69 0 0 0 0 0 0 0 0 0 0 0
70 0 0 0 0 0 0 0 0 0 0 0
71 0 0 0 0 0 0 0 0 0 0 0
72 0 0 0 0 0 0 0 0 0 0 0
73 0 0 0 0 0 0 0 0 0 0 0
74 0 0 0 0 0 0 0 0 0 0 0
75 0 0 0 0 0 0 0 0 0 0 0
76 0 0 0 0 0 0 0 0 0 0 0
77 0 0 0 0 0 0 0 0 0 0 0
78 0 0 0 0 0 0 0 0 0 0 0
79 0 0 0 0 0 0 0 0 0 0 0
80 0 0 0 0 0 0 0 0 0 0 0
81 0 0 0 0 0 0 0 0 0 0 0
82 0 0 0 0 0 0 0 0 0 0 0
83 0 0 0 0 0 0 0 0 0 0 0
84 0 0 0 0 0 0 0 0 0 0 0
85 0 0 0 0 0 0 0 0 0 0 0
86 0 0 0 0 0 0 0 0 0 0 0
87 0 0 0 0 0 0 0 0 0 0 0
88 0 0 0 0 0 0 0 0 0 0 0
89 0 0 0 0 0 0 0 0 0 0 0
90 0 0 0 0 0 0 0 0 0 0 0
91 0 0 0 0 0 0 0 0 0 0 0
92 0 0 0 0 0 0 0 0 0 0 0
93 0 0 0 0 0 0 0 0 0 0 0
94 0 0 0 0 0 0 0 0 0 0 0
95 0 0 0 0 0 0 0 0 0 0 0
96 0 0 0 0 0 0 0 0 0 0 0
97 0 0 0 0 0 0 0 0 0 0 0
98 0 0 0 0 0 0 0 0 0 0 0
99 0 0 0 0 0 0 0 0 0 0 0
100 0 0 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 0 0 0

INDIKATOR :
1.    Persalinan ditolong oleh tenaga kesehatan
2.    Memberi bayi ASI ekskusif
3.    Menimbang bayi dan balita setiap bulan
4.    Menggunakan air bersih
5. Cuci tangan pakai sabun
6. Pengelolaan air minum dan makan di rumah tangga
7. Menggunakan jamban sehat (stop BABS)
8. Pengelolaan limbah cair di rumah tangga
9. Membuang sampah pada tempatnya
10.  Memberantas jentik di rumah
11.  Makan sayur dan buah setiap hari
12.  Melakukan aktifitas fisik minimal 30 menit per hari
13.  Tidak merokok di dalam rumah

PETUNJUK PENGISIAN :
0. Jika jawaban" tidak"
1. Jawaban "YA" (artinya perilaku sesuai dengan indikator)
2. Tidak ada sasaran

PHBS : Jika indikator 1 sampai dengan indikator 13 terpenuhi


NGGA TINGKAT RT

SASARAN PS
12 13 1 2 3 11 12 1 2 3 11 12 PHBS
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 100 100 100 100 100 0 0 0 0 0 0
REKAPITULASI HASIL PEMANTAUAN PHBS TATANAN RUMAH TANGGA TINGKAT RT
Tahun : 2022
Semester :
RT :2
Dusun :
Desa :
Kecamatan :

INDIKATOR PHBS
No Nama Kepala Rumah Tangga
1 2 3 4 5 6 7 8 9 10 11 12 13 1 2 3 4 5 6 7 8 9 10 11
1 0 0 0 0 0 0 0 0 0 0 0
2 0 0 0 0 0 0 0 0 0 0 0
3 0 0 0 0 0 0 0 0 0 0 0
4 0 0 0 0 0 0 0 0 0 0 0
5 0 0 0 0 0 0 0 0 0 0 0
6 0 0 0 0 0 0 0 0 0 0 0
7 0 0 0 0 0 0 0 0 0 0 0
8 0 0 0 0 0 0 0 0 0 0 0
9 0 0 0 0 0 0 0 0 0 0 0
10 0 0 0 0 0 0 0 0 0 0 0
11 0 0 0 0 0 0 0 0 0 0 0
12 0 0 0 0 0 0 0 0 0 0 0
13 0 0 0 0 0 0 0 0 0 0 0
14 0 0 0 0 0 0 0 0 0 0 0
15 0 0 0 0 0 0 0 0 0 0 0
16 0 0 0 0 0 0 0 0 0 0 0
17 0 0 0 0 0 0 0 0 0 0 0
18 0 0 0 0 0 0 0 0 0 0 0
19 0 0 0 0 0 0 0 0 0 0 0
20 0 0 0 0 0 0 0 0 0 0 0
21 0 0 0 0 0 0 0 0 0 0 0
22 0 0 0 0 0 0 0 0 0 0 0
23 0 0 0 0 0 0 0 0 0 0 0
24 0 0 0 0 0 0 0 0 0 0 0
25 0 0 0 0 0 0 0 0 0 0 0
26 0 0 0 0 0 0 0 0 0 0 0
27 0 0 0 0 0 0 0 0 0 0 0
28 0 0 0 0 0 0 0 0 0 0 0
29 0 0 0 0 0 0 0 0 0 0 0
30 0 0 0 0 0 0 0 0 0 0 0
31 0 0 0 0 0 0 0 0 0 0 0
32 0 0 0 0 0 0 0 0 0 0 0
33 0 0 0 0 0 0 0 0 0 0 0
34 0 0 0 0 0 0 0 0 0 0 0
35 0 0 0 0 0 0 0 0 0 0 0
36 0 0 0 0 0 0 0 0 0 0 0
37 0 0 0 0 0 0 0 0 0 0 0
38 0 0 0 0 0 0 0 0 0 0 0
39 0 0 0 0 0 0 0 0 0 0 0
40 0 0 0 0 0 0 0 0 0 0 0
41 0 0 0 0 0 0 0 0 0 0 0
42 0 0 0 0 0 0 0 0 0 0 0
43 0 0 0 0 0 0 0 0 0 0 0
44 0 0 0 0 0 0 0 0 0 0 0
45 0 0 0 0 0 0 0 0 0 0 0
46 0 0 0 0 0 0 0 0 0 0 0
47 0 0 0 0 0 0 0 0 0 0 0
48 0 0 0 0 0 0 0 0 0 0 0
49 0 0 0 0 0 0 0 0 0 0 0
50 0 0 0 0 0 0 0 0 0 0 0
51 0 0 0 0 0 0 0 0 0 0 0
52 0 0 0 0 0 0 0 0 0 0 0
53 0 0 0 0 0 0 0 0 0 0 0
54 0 0 0 0 0 0 0 0 0 0 0
55 0 0 0 0 0 0 0 0 0 0 0
56 0 0 0 0 0 0 0 0 0 0 0
57 0 0 0 0 0 0 0 0 0 0 0
58 0 0 0 0 0 0 0 0 0 0 0
59 0 0 0 0 0 0 0 0 0 0 0
60 0 0 0 0 0 0 0 0 0 0 0
61 0 0 0 0 0 0 0 0 0 0 0
62 0 0 0 0 0 0 0 0 0 0 0
63 0 0 0 0 0 0 0 0 0 0 0
64 0 0 0 0 0 0 0 0 0 0 0
65 0 0 0 0 0 0 0 0 0 0 0
66 0 0 0 0 0 0 0 0 0 0 0
67 0 0 0 0 0 0 0 0 0 0 0
68 0 0 0 0 0 0 0 0 0 0 0
69 0 0 0 0 0 0 0 0 0 0 0
70 0 0 0 0 0 0 0 0 0 0 0
71 0 0 0 0 0 0 0 0 0 0 0
72 0 0 0 0 0 0 0 0 0 0 0
73 0 0 0 0 0 0 0 0 0 0 0
74 0 0 0 0 0 0 0 0 0 0 0
75 0 0 0 0 0 0 0 0 0 0 0
76 0 0 0 0 0 0 0 0 0 0 0
77 0 0 0 0 0 0 0 0 0 0 0
78 0 0 0 0 0 0 0 0 0 0 0
79 0 0 0 0 0 0 0 0 0 0 0
80 0 0 0 0 0 0 0 0 0 0 0
81 0 0 0 0 0 0 0 0 0 0 0
82 0 0 0 0 0 0 0 0 0 0 0
83 0 0 0 0 0 0 0 0 0 0 0
84 0 0 0 0 0 0 0 0 0 0 0
85 0 0 0 0 0 0 0 0 0 0 0
86 0 0 0 0 0 0 0 0 0 0 0
87 0 0 0 0 0 0 0 0 0 0 0
88 0 0 0 0 0 0 0 0 0 0 0
89 0 0 0 0 0 0 0 0 0 0 0
90 0 0 0 0 0 0 0 0 0 0 0
91 0 0 0 0 0 0 0 0 0 0 0
92 0 0 0 0 0 0 0 0 0 0 0
93 0 0 0 0 0 0 0 0 0 0 0
94 0 0 0 0 0 0 0 0 0 0 0
95 0 0 0 0 0 0 0 0 0 0 0
96 0 0 0 0 0 0 0 0 0 0 0
97 0 0 0 0 0 0 0 0 0 0 0
98 0 0 0 0 0 0 0 0 0 0 0
99 0 0 0 0 0 0 0 0 0 0 0
100 0 0 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 0 0 0

INDIKATOR :
1.    Persalinan ditolong oleh tenaga kesehatan
2.    Memberi bayi ASI ekskusif
3.    Menimbang bayi dan balita setiap bulan
4.    Menggunakan air bersih
5. Cuci tangan pakai sabun
6. Pengelolaan air minum dan makan di rumah tangga
7. Menggunakan jamban sehat (stop BABS)
8. Pengelolaan limbah cair di rumah tangga
9. Membuang sampah pada tempatnya
10.  Memberantas jentik di rumah
11.  Makan sayur dan buah setiap hari
12.  Melakukan aktifitas fisik minimal 30 menit per hari
13.  Tidak merokok di dalam rumah

PETUNJUK PENGISIAN :
0. Jika jawaban" tidak"
1. Jawaban "YA" (artinya perilaku sesuai dengan indikator)
2. Tidak ada sasaran

PHBS : Jika indikator 1 sampai dengan indikator 13 terpenuhi


NGGA TINGKAT RT

SASARAN PS
12 13 1 2 3 11 12 1 2 3 11 12 PHBS
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 100 100 100 100 100 0 0 0 0 0 0
REKAPITULASI HASIL PEMANTAUAN PHBS TATANAN RUMAH TANGGA TINGKAT RT
Tahun : 2022
Semester :
RT :3
Dusun :
Desa :
Kecamatan :

INDIKATOR PHBS
No Nama Kepala Rumah Tangga
1 2 3 4 5 6 7 8 9 10 11 12 13 1 2 3 4 5 6 7 8 9 10 11
1 0 0 0 0 0 0 0 0 0 0 0
2 0 0 0 0 0 0 0 0 0 0 0
3 0 0 0 0 0 0 0 0 0 0 0
4 0 0 0 0 0 0 0 0 0 0 0
5 0 0 0 0 0 0 0 0 0 0 0
6 0 0 0 0 0 0 0 0 0 0 0
7 0 0 0 0 0 0 0 0 0 0 0
8 0 0 0 0 0 0 0 0 0 0 0
9 0 0 0 0 0 0 0 0 0 0 0
10 0 0 0 0 0 0 0 0 0 0 0
11 0 0 0 0 0 0 0 0 0 0 0
12 0 0 0 0 0 0 0 0 0 0 0
13 0 0 0 0 0 0 0 0 0 0 0
14 0 0 0 0 0 0 0 0 0 0 0
15 0 0 0 0 0 0 0 0 0 0 0
16 0 0 0 0 0 0 0 0 0 0 0
17 0 0 0 0 0 0 0 0 0 0 0
18 0 0 0 0 0 0 0 0 0 0 0
19 0 0 0 0 0 0 0 0 0 0 0
20 0 0 0 0 0 0 0 0 0 0 0
21 0 0 0 0 0 0 0 0 0 0 0
22 0 0 0 0 0 0 0 0 0 0 0
23 0 0 0 0 0 0 0 0 0 0 0
24 0 0 0 0 0 0 0 0 0 0 0
25 0 0 0 0 0 0 0 0 0 0 0
26 0 0 0 0 0 0 0 0 0 0 0
27 0 0 0 0 0 0 0 0 0 0 0
28 0 0 0 0 0 0 0 0 0 0 0
29 0 0 0 0 0 0 0 0 0 0 0
30 0 0 0 0 0 0 0 0 0 0 0
31 0 0 0 0 0 0 0 0 0 0 0
32 0 0 0 0 0 0 0 0 0 0 0
33 0 0 0 0 0 0 0 0 0 0 0
34 0 0 0 0 0 0 0 0 0 0 0
35 0 0 0 0 0 0 0 0 0 0 0
36 0 0 0 0 0 0 0 0 0 0 0
37 0 0 0 0 0 0 0 0 0 0 0
38 0 0 0 0 0 0 0 0 0 0 0
39 0 0 0 0 0 0 0 0 0 0 0
40 0 0 0 0 0 0 0 0 0 0 0
41 0 0 0 0 0 0 0 0 0 0 0
42 0 0 0 0 0 0 0 0 0 0 0
43 0 0 0 0 0 0 0 0 0 0 0
44 0 0 0 0 0 0 0 0 0 0 0
45 0 0 0 0 0 0 0 0 0 0 0
46 0 0 0 0 0 0 0 0 0 0 0
47 0 0 0 0 0 0 0 0 0 0 0
48 0 0 0 0 0 0 0 0 0 0 0
49 0 0 0 0 0 0 0 0 0 0 0
50 0 0 0 0 0 0 0 0 0 0 0
51 0 0 0 0 0 0 0 0 0 0 0
52 0 0 0 0 0 0 0 0 0 0 0
53 0 0 0 0 0 0 0 0 0 0 0
54 0 0 0 0 0 0 0 0 0 0 0
55 0 0 0 0 0 0 0 0 0 0 0
56 0 0 0 0 0 0 0 0 0 0 0
57 0 0 0 0 0 0 0 0 0 0 0
58 0 0 0 0 0 0 0 0 0 0 0
59 0 0 0 0 0 0 0 0 0 0 0
60 0 0 0 0 0 0 0 0 0 0 0
61 0 0 0 0 0 0 0 0 0 0 0
62 0 0 0 0 0 0 0 0 0 0 0
63 0 0 0 0 0 0 0 0 0 0 0
64 0 0 0 0 0 0 0 0 0 0 0
65 0 0 0 0 0 0 0 0 0 0 0
66 0 0 0 0 0 0 0 0 0 0 0
67 0 0 0 0 0 0 0 0 0 0 0
68 0 0 0 0 0 0 0 0 0 0 0
69 0 0 0 0 0 0 0 0 0 0 0
70 0 0 0 0 0 0 0 0 0 0 0
71 0 0 0 0 0 0 0 0 0 0 0
72 0 0 0 0 0 0 0 0 0 0 0
73 0 0 0 0 0 0 0 0 0 0 0
74 0 0 0 0 0 0 0 0 0 0 0
75 0 0 0 0 0 0 0 0 0 0 0
76 0 0 0 0 0 0 0 0 0 0 0
77 0 0 0 0 0 0 0 0 0 0 0
78 0 0 0 0 0 0 0 0 0 0 0
79 0 0 0 0 0 0 0 0 0 0 0
80 0 0 0 0 0 0 0 0 0 0 0
81 0 0 0 0 0 0 0 0 0 0 0
82 0 0 0 0 0 0 0 0 0 0 0
83 0 0 0 0 0 0 0 0 0 0 0
84 0 0 0 0 0 0 0 0 0 0 0
85 0 0 0 0 0 0 0 0 0 0 0
86 0 0 0 0 0 0 0 0 0 0 0
87 0 0 0 0 0 0 0 0 0 0 0
88 0 0 0 0 0 0 0 0 0 0 0
89 0 0 0 0 0 0 0 0 0 0 0
90 0 0 0 0 0 0 0 0 0 0 0
91 0 0 0 0 0 0 0 0 0 0 0
92 0 0 0 0 0 0 0 0 0 0 0
93 0 0 0 0 0 0 0 0 0 0 0
94 0 0 0 0 0 0 0 0 0 0 0
95 0 0 0 0 0 0 0 0 0 0 0
96 0 0 0 0 0 0 0 0 0 0 0
97 0 0 0 0 0 0 0 0 0 0 0
98 0 0 0 0 0 0 0 0 0 0 0
99 0 0 0 0 0 0 0 0 0 0 0
100 0 0 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 0 0 0

INDIKATOR :
1.    Persalinan ditolong oleh tenaga kesehatan
2.    Memberi bayi ASI ekskusif
3.    Menimbang bayi dan balita setiap bulan
4.    Menggunakan air bersih
5. Cuci tangan pakai sabun
6. Pengelolaan air minum dan makan di rumah tangga
7. Menggunakan jamban sehat (stop BABS)
8. Pengelolaan limbah cair di rumah tangga
9. Membuang sampah pada tempatnya
10.  Memberantas jentik di rumah
11.  Makan sayur dan buah setiap hari
12.  Melakukan aktifitas fisik minimal 30 menit per hari
13.  Tidak merokok di dalam rumah

PETUNJUK PENGISIAN :
0. Jika jawaban" tidak"
1. Jawaban "YA" (artinya perilaku sesuai dengan indikator)
2. Tidak ada sasaran

PHBS : Jika indikator 1 sampai dengan indikator 13 terpenuhi


NGGA TINGKAT RT

SASARAN PS
12 13 1 2 3 11 12 1 2 3 11 12 PHBS
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 100 100 100 100 100 0 0 0 0 0 0
REKAPITULASI HASIL PEMANTAUAN PHBS TATANAN RUMAH TANGGA TINGKAT RT
Tahun : 2022
Semester :
RT :4
Dusun :
Desa :
Kecamatan :

INDIKATOR PHBS
No Nama Kepala Rumah Tangga
1 2 3 4 5 6 7 8 9 10 11 12 13 1 2 3 4 5 6 7 8 9 10 11
1 0 0 0 0 0 0 0 0 0 0 0
2 0 0 0 0 0 0 0 0 0 0 0
3 0 0 0 0 0 0 0 0 0 0 0
4 0 0 0 0 0 0 0 0 0 0 0
5 0 0 0 0 0 0 0 0 0 0 0
6 0 0 0 0 0 0 0 0 0 0 0
7 0 0 0 0 0 0 0 0 0 0 0
8 0 0 0 0 0 0 0 0 0 0 0
9 0 0 0 0 0 0 0 0 0 0 0
10 0 0 0 0 0 0 0 0 0 0 0
11 0 0 0 0 0 0 0 0 0 0 0
12 0 0 0 0 0 0 0 0 0 0 0
13 0 0 0 0 0 0 0 0 0 0 0
14 0 0 0 0 0 0 0 0 0 0 0
15 0 0 0 0 0 0 0 0 0 0 0
16 0 0 0 0 0 0 0 0 0 0 0
17 0 0 0 0 0 0 0 0 0 0 0
18 0 0 0 0 0 0 0 0 0 0 0
19 0 0 0 0 0 0 0 0 0 0 0
20 0 0 0 0 0 0 0 0 0 0 0
21 0 0 0 0 0 0 0 0 0 0 0
22 0 0 0 0 0 0 0 0 0 0 0
23 0 0 0 0 0 0 0 0 0 0 0
24 0 0 0 0 0 0 0 0 0 0 0
25 0 0 0 0 0 0 0 0 0 0 0
26 0 0 0 0 0 0 0 0 0 0 0
27 0 0 0 0 0 0 0 0 0 0 0
28 0 0 0 0 0 0 0 0 0 0 0
29 0 0 0 0 0 0 0 0 0 0 0
30 0 0 0 0 0 0 0 0 0 0 0
31 0 0 0 0 0 0 0 0 0 0 0
32 0 0 0 0 0 0 0 0 0 0 0
33 0 0 0 0 0 0 0 0 0 0 0
34 0 0 0 0 0 0 0 0 0 0 0
35 0 0 0 0 0 0 0 0 0 0 0
36 0 0 0 0 0 0 0 0 0 0 0
37 0 0 0 0 0 0 0 0 0 0 0
38 0 0 0 0 0 0 0 0 0 0 0
39 0 0 0 0 0 0 0 0 0 0 0
40 0 0 0 0 0 0 0 0 0 0 0
41 0 0 0 0 0 0 0 0 0 0 0
42 0 0 0 0 0 0 0 0 0 0 0
43 0 0 0 0 0 0 0 0 0 0 0
44 0 0 0 0 0 0 0 0 0 0 0
45 0 0 0 0 0 0 0 0 0 0 0
46 0 0 0 0 0 0 0 0 0 0 0
47 0 0 0 0 0 0 0 0 0 0 0
48 0 0 0 0 0 0 0 0 0 0 0
49 0 0 0 0 0 0 0 0 0 0 0
50 0 0 0 0 0 0 0 0 0 0 0
51 0 0 0 0 0 0 0 0 0 0 0
52 0 0 0 0 0 0 0 0 0 0 0
53 0 0 0 0 0 0 0 0 0 0 0
54 0 0 0 0 0 0 0 0 0 0 0
55 0 0 0 0 0 0 0 0 0 0 0
56 0 0 0 0 0 0 0 0 0 0 0
57 0 0 0 0 0 0 0 0 0 0 0
58 0 0 0 0 0 0 0 0 0 0 0
59 0 0 0 0 0 0 0 0 0 0 0
60 0 0 0 0 0 0 0 0 0 0 0
61 0 0 0 0 0 0 0 0 0 0 0
62 0 0 0 0 0 0 0 0 0 0 0
63 0 0 0 0 0 0 0 0 0 0 0
64 0 0 0 0 0 0 0 0 0 0 0
65 0 0 0 0 0 0 0 0 0 0 0
66 0 0 0 0 0 0 0 0 0 0 0
67 0 0 0 0 0 0 0 0 0 0 0
68 0 0 0 0 0 0 0 0 0 0 0
69 0 0 0 0 0 0 0 0 0 0 0
70 0 0 0 0 0 0 0 0 0 0 0
71 0 0 0 0 0 0 0 0 0 0 0
72 0 0 0 0 0 0 0 0 0 0 0
73 0 0 0 0 0 0 0 0 0 0 0
74 0 0 0 0 0 0 0 0 0 0 0
75 0 0 0 0 0 0 0 0 0 0 0
76 0 0 0 0 0 0 0 0 0 0 0
77 0 0 0 0 0 0 0 0 0 0 0
78 0 0 0 0 0 0 0 0 0 0 0
79 0 0 0 0 0 0 0 0 0 0 0
80 0 0 0 0 0 0 0 0 0 0 0
81 0 0 0 0 0 0 0 0 0 0 0
82 0 0 0 0 0 0 0 0 0 0 0
83 0 0 0 0 0 0 0 0 0 0 0
84 0 0 0 0 0 0 0 0 0 0 0
85 0 0 0 0 0 0 0 0 0 0 0
86 0 0 0 0 0 0 0 0 0 0 0
87 0 0 0 0 0 0 0 0 0 0 0
88 0 0 0 0 0 0 0 0 0 0 0
89 0 0 0 0 0 0 0 0 0 0 0
90 0 0 0 0 0 0 0 0 0 0 0
91 0 0 0 0 0 0 0 0 0 0 0
92 0 0 0 0 0 0 0 0 0 0 0
93 0 0 0 0 0 0 0 0 0 0 0
94 0 0 0 0 0 0 0 0 0 0 0
95 0 0 0 0 0 0 0 0 0 0 0
96 0 0 0 0 0 0 0 0 0 0 0
97 0 0 0 0 0 0 0 0 0 0 0
98 0 0 0 0 0 0 0 0 0 0 0
99 0 0 0 0 0 0 0 0 0 0 0
100 0 0 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 0 0 0

INDIKATOR :
1.    Persalinan ditolong oleh tenaga kesehatan
2.    Memberi bayi ASI ekskusif
3.    Menimbang bayi dan balita setiap bulan
4.    Menggunakan air bersih
5. Cuci tangan pakai sabun
6. Pengelolaan air minum dan makan di rumah tangga
7. Menggunakan jamban sehat (stop BABS)
8. Pengelolaan limbah cair di rumah tangga
9. Membuang sampah pada tempatnya
10.  Memberantas jentik di rumah
11.  Makan sayur dan buah setiap hari
12.  Melakukan aktifitas fisik minimal 30 menit per hari
13.  Tidak merokok di dalam rumah

PETUNJUK PENGISIAN :
0. Jika jawaban" tidak"
1. Jawaban "YA" (artinya perilaku sesuai dengan indikator)
2. Tidak ada sasaran

PHBS : Jika indikator 1 sampai dengan indikator 13 terpenuhi


NGGA TINGKAT RT

SASARAN PS
12 13 1 2 3 11 12 1 2 3 11 12 PHBS
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 100 100 100 100 100 0 0 0 0 0 0
REKAPITULASI HASIL PEMANTAUAN PHBS TATANAN RUMAH TANGGA TINGKAT RT
Tahun : 2022
Semester :
RT :5
Dusun :
Desa :
Kecamatan :

INDIKATOR PHBS
No Nama Kepala Rumah Tangga
1 2 3 4 5 6 7 8 9 10 11 12 13 1 2 3 4 5 6 7 8 9 10 11
1 0 0 0 0 0 0 0 0 0 0 0
2 0 0 0 0 0 0 0 0 0 0 0
3 0 0 0 0 0 0 0 0 0 0 0
4 0 0 0 0 0 0 0 0 0 0 0
5 0 0 0 0 0 0 0 0 0 0 0
6 0 0 0 0 0 0 0 0 0 0 0
7 0 0 0 0 0 0 0 0 0 0 0
8 0 0 0 0 0 0 0 0 0 0 0
9 0 0 0 0 0 0 0 0 0 0 0
10 0 0 0 0 0 0 0 0 0 0 0
11 0 0 0 0 0 0 0 0 0 0 0
12 0 0 0 0 0 0 0 0 0 0 0
13 0 0 0 0 0 0 0 0 0 0 0
14 0 0 0 0 0 0 0 0 0 0 0
15 0 0 0 0 0 0 0 0 0 0 0
16 0 0 0 0 0 0 0 0 0 0 0
17 0 0 0 0 0 0 0 0 0 0 0
18 0 0 0 0 0 0 0 0 0 0 0
19 0 0 0 0 0 0 0 0 0 0 0
20 0 0 0 0 0 0 0 0 0 0 0
21 0 0 0 0 0 0 0 0 0 0 0
22 0 0 0 0 0 0 0 0 0 0 0
23 0 0 0 0 0 0 0 0 0 0 0
24 0 0 0 0 0 0 0 0 0 0 0
25 0 0 0 0 0 0 0 0 0 0 0
26 0 0 0 0 0 0 0 0 0 0 0
27 0 0 0 0 0 0 0 0 0 0 0
28 0 0 0 0 0 0 0 0 0 0 0
29 0 0 0 0 0 0 0 0 0 0 0
30 0 0 0 0 0 0 0 0 0 0 0
31 0 0 0 0 0 0 0 0 0 0 0
32 0 0 0 0 0 0 0 0 0 0 0
33 0 0 0 0 0 0 0 0 0 0 0
34 0 0 0 0 0 0 0 0 0 0 0
35 0 0 0 0 0 0 0 0 0 0 0
36 0 0 0 0 0 0 0 0 0 0 0
37 0 0 0 0 0 0 0 0 0 0 0
38 0 0 0 0 0 0 0 0 0 0 0
39 0 0 0 0 0 0 0 0 0 0 0
40 0 0 0 0 0 0 0 0 0 0 0
41 0 0 0 0 0 0 0 0 0 0 0
42 0 0 0 0 0 0 0 0 0 0 0
43 0 0 0 0 0 0 0 0 0 0 0
44 0 0 0 0 0 0 0 0 0 0 0
45 0 0 0 0 0 0 0 0 0 0 0
46 0 0 0 0 0 0 0 0 0 0 0
47 0 0 0 0 0 0 0 0 0 0 0
48 0 0 0 0 0 0 0 0 0 0 0
49 0 0 0 0 0 0 0 0 0 0 0
50 0 0 0 0 0 0 0 0 0 0 0
51 0 0 0 0 0 0 0 0 0 0 0
52 0 0 0 0 0 0 0 0 0 0 0
53 0 0 0 0 0 0 0 0 0 0 0
54 0 0 0 0 0 0 0 0 0 0 0
55 0 0 0 0 0 0 0 0 0 0 0
56 0 0 0 0 0 0 0 0 0 0 0
57 0 0 0 0 0 0 0 0 0 0 0
58 0 0 0 0 0 0 0 0 0 0 0
59 0 0 0 0 0 0 0 0 0 0 0
60 0 0 0 0 0 0 0 0 0 0 0
61 0 0 0 0 0 0 0 0 0 0 0
62 0 0 0 0 0 0 0 0 0 0 0
63 0 0 0 0 0 0 0 0 0 0 0
64 0 0 0 0 0 0 0 0 0 0 0
65 0 0 0 0 0 0 0 0 0 0 0
66 0 0 0 0 0 0 0 0 0 0 0
67 0 0 0 0 0 0 0 0 0 0 0
68 0 0 0 0 0 0 0 0 0 0 0
69 0 0 0 0 0 0 0 0 0 0 0
70 0 0 0 0 0 0 0 0 0 0 0
71 0 0 0 0 0 0 0 0 0 0 0
72 0 0 0 0 0 0 0 0 0 0 0
73 0 0 0 0 0 0 0 0 0 0 0
74 0 0 0 0 0 0 0 0 0 0 0
75 0 0 0 0 0 0 0 0 0 0 0
76 0 0 0 0 0 0 0 0 0 0 0
77 0 0 0 0 0 0 0 0 0 0 0
78 0 0 0 0 0 0 0 0 0 0 0
79 0 0 0 0 0 0 0 0 0 0 0
80 0 0 0 0 0 0 0 0 0 0 0
81 0 0 0 0 0 0 0 0 0 0 0
82 0 0 0 0 0 0 0 0 0 0 0
83 0 0 0 0 0 0 0 0 0 0 0
84 0 0 0 0 0 0 0 0 0 0 0
85 0 0 0 0 0 0 0 0 0 0 0
86 0 0 0 0 0 0 0 0 0 0 0
87 0 0 0 0 0 0 0 0 0 0 0
88 0 0 0 0 0 0 0 0 0 0 0
89 0 0 0 0 0 0 0 0 0 0 0
90 0 0 0 0 0 0 0 0 0 0 0
91 0 0 0 0 0 0 0 0 0 0 0
92 0 0 0 0 0 0 0 0 0 0 0
93 0 0 0 0 0 0 0 0 0 0 0
94 0 0 0 0 0 0 0 0 0 0 0
95 0 0 0 0 0 0 0 0 0 0 0
96 0 0 0 0 0 0 0 0 0 0 0
97 0 0 0 0 0 0 0 0 0 0 0
98 0 0 0 0 0 0 0 0 0 0 0
99 0 0 0 0 0 0 0 0 0 0 0
100 0 0 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 0 0 0

INDIKATOR :
1.    Persalinan ditolong oleh tenaga kesehatan
2.    Memberi bayi ASI ekskusif
3.    Menimbang bayi dan balita setiap bulan
4.    Menggunakan air bersih
5. Cuci tangan pakai sabun
6. Pengelolaan air minum dan makan di rumah tangga
7. Menggunakan jamban sehat (stop BABS)
8. Pengelolaan limbah cair di rumah tangga
9. Membuang sampah pada tempatnya
10.  Memberantas jentik di rumah
11.  Makan sayur dan buah setiap hari
12.  Melakukan aktifitas fisik minimal 30 menit per hari
13.  Tidak merokok di dalam rumah

PETUNJUK PENGISIAN :
0. Jika jawaban" tidak"
1. Jawaban "YA" (artinya perilaku sesuai dengan indikator)
2. Tidak ada sasaran

PHBS : Jika indikator 1 sampai dengan indikator 13 terpenuhi


NGGA TINGKAT RT

SASARAN PS
12 13 1 2 3 11 12 1 2 3 11 12 PHBS
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 100 100 100 100 100 0 0 0 0 0 0
REKAPITULASI HASIL PEMANTAUAN PHBS TATANAN RUMAH TANGGA TINGKAT RT
Tahun : 2022
Semester :
RT :6
Dusun :
Desa :
Kecamatan :

INDIKATOR PHBS
No Nama Kepala Rumah Tangga
1 2 3 4 5 6 7 8 9 10 11 12 13 1 2 3 4 5 6 7 8 9 10 11
1 0 0 0 0 0 0 0 0 0 0 0
2 0 0 0 0 0 0 0 0 0 0 0
3 0 0 0 0 0 0 0 0 0 0 0
4 0 0 0 0 0 0 0 0 0 0 0
5 0 0 0 0 0 0 0 0 0 0 0
6 0 0 0 0 0 0 0 0 0 0 0
7 0 0 0 0 0 0 0 0 0 0 0
8 0 0 0 0 0 0 0 0 0 0 0
9 0 0 0 0 0 0 0 0 0 0 0
10 0 0 0 0 0 0 0 0 0 0 0
11 0 0 0 0 0 0 0 0 0 0 0
12 0 0 0 0 0 0 0 0 0 0 0
13 0 0 0 0 0 0 0 0 0 0 0
14 0 0 0 0 0 0 0 0 0 0 0
15 0 0 0 0 0 0 0 0 0 0 0
16 0 0 0 0 0 0 0 0 0 0 0
17 0 0 0 0 0 0 0 0 0 0 0
18 0 0 0 0 0 0 0 0 0 0 0
19 0 0 0 0 0 0 0 0 0 0 0
20 0 0 0 0 0 0 0 0 0 0 0
21 0 0 0 0 0 0 0 0 0 0 0
22 0 0 0 0 0 0 0 0 0 0 0
23 0 0 0 0 0 0 0 0 0 0 0
24 0 0 0 0 0 0 0 0 0 0 0
25 0 0 0 0 0 0 0 0 0 0 0
26 0 0 0 0 0 0 0 0 0 0 0
27 0 0 0 0 0 0 0 0 0 0 0
28 0 0 0 0 0 0 0 0 0 0 0
29 0 0 0 0 0 0 0 0 0 0 0
30 0 0 0 0 0 0 0 0 0 0 0
31 0 0 0 0 0 0 0 0 0 0 0
32 0 0 0 0 0 0 0 0 0 0 0
33 0 0 0 0 0 0 0 0 0 0 0
34 0 0 0 0 0 0 0 0 0 0 0
35 0 0 0 0 0 0 0 0 0 0 0
36 0 0 0 0 0 0 0 0 0 0 0
37 0 0 0 0 0 0 0 0 0 0 0
38 0 0 0 0 0 0 0 0 0 0 0
39 0 0 0 0 0 0 0 0 0 0 0
40 0 0 0 0 0 0 0 0 0 0 0
41 0 0 0 0 0 0 0 0 0 0 0
42 0 0 0 0 0 0 0 0 0 0 0
43 0 0 0 0 0 0 0 0 0 0 0
44 0 0 0 0 0 0 0 0 0 0 0
45 0 0 0 0 0 0 0 0 0 0 0
46 0 0 0 0 0 0 0 0 0 0 0
47 0 0 0 0 0 0 0 0 0 0 0
48 0 0 0 0 0 0 0 0 0 0 0
49 0 0 0 0 0 0 0 0 0 0 0
50 0 0 0 0 0 0 0 0 0 0 0
51 0 0 0 0 0 0 0 0 0 0 0
52 0 0 0 0 0 0 0 0 0 0 0
53 0 0 0 0 0 0 0 0 0 0 0
54 0 0 0 0 0 0 0 0 0 0 0
55 0 0 0 0 0 0 0 0 0 0 0
56 0 0 0 0 0 0 0 0 0 0 0
57 0 0 0 0 0 0 0 0 0 0 0
58 0 0 0 0 0 0 0 0 0 0 0
59 0 0 0 0 0 0 0 0 0 0 0
60 0 0 0 0 0 0 0 0 0 0 0
61 0 0 0 0 0 0 0 0 0 0 0
62 0 0 0 0 0 0 0 0 0 0 0
63 0 0 0 0 0 0 0 0 0 0 0
64 0 0 0 0 0 0 0 0 0 0 0
65 0 0 0 0 0 0 0 0 0 0 0
66 0 0 0 0 0 0 0 0 0 0 0
67 0 0 0 0 0 0 0 0 0 0 0
68 0 0 0 0 0 0 0 0 0 0 0
69 0 0 0 0 0 0 0 0 0 0 0
70 0 0 0 0 0 0 0 0 0 0 0
71 0 0 0 0 0 0 0 0 0 0 0
72 0 0 0 0 0 0 0 0 0 0 0
73 0 0 0 0 0 0 0 0 0 0 0
74 0 0 0 0 0 0 0 0 0 0 0
75 0 0 0 0 0 0 0 0 0 0 0
76 0 0 0 0 0 0 0 0 0 0 0
77 0 0 0 0 0 0 0 0 0 0 0
78 0 0 0 0 0 0 0 0 0 0 0
79 0 0 0 0 0 0 0 0 0 0 0
80 0 0 0 0 0 0 0 0 0 0 0
81 0 0 0 0 0 0 0 0 0 0 0
82 0 0 0 0 0 0 0 0 0 0 0
83 0 0 0 0 0 0 0 0 0 0 0
84 0 0 0 0 0 0 0 0 0 0 0
85 0 0 0 0 0 0 0 0 0 0 0
86 0 0 0 0 0 0 0 0 0 0 0
87 0 0 0 0 0 0 0 0 0 0 0
88 0 0 0 0 0 0 0 0 0 0 0
89 0 0 0 0 0 0 0 0 0 0 0
90 0 0 0 0 0 0 0 0 0 0 0
91 0 0 0 0 0 0 0 0 0 0 0
92 0 0 0 0 0 0 0 0 0 0 0
93 0 0 0 0 0 0 0 0 0 0 0
94 0 0 0 0 0 0 0 0 0 0 0
95 0 0 0 0 0 0 0 0 0 0 0
96 0 0 0 0 0 0 0 0 0 0 0
97 0 0 0 0 0 0 0 0 0 0 0
98 0 0 0 0 0 0 0 0 0 0 0
99 0 0 0 0 0 0 0 0 0 0 0
100 0 0 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 0 0 0

INDIKATOR :
1.    Persalinan ditolong oleh tenaga kesehatan
2.    Memberi bayi ASI ekskusif
3.    Menimbang bayi dan balita setiap bulan
4.    Menggunakan air bersih
5. Cuci tangan pakai sabun
6. Pengelolaan air minum dan makan di rumah tangga
7. Menggunakan jamban sehat (stop BABS)
8. Pengelolaan limbah cair di rumah tangga
9. Membuang sampah pada tempatnya
10.  Memberantas jentik di rumah
11.  Makan sayur dan buah setiap hari
12.  Melakukan aktifitas fisik minimal 30 menit per hari
13.  Tidak merokok di dalam rumah

PETUNJUK PENGISIAN :
0. Jika jawaban" tidak"
1. Jawaban "YA" (artinya perilaku sesuai dengan indikator)
2. Tidak ada sasaran

PHBS : Jika indikator 1 sampai dengan indikator 13 terpenuhi


NGGA TINGKAT RT

SASARAN PS
12 13 1 2 3 11 12 1 2 3 11 12 PHBS
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 100 100 100 100 100 0 0 0 0 0 0
REKAPITULASI HASIL PEMANTAUAN PHBS TATANAN RUMAH TANGGA TINGKAT RT
Tahun : 2022
Semester :
RT :7
Dusun :
Desa :
Kecamatan :

INDIKATOR PHBS
No Nama Kepala Rumah Tangga
1 2 3 4 5 6 7 8 9 10 11 12 13 1 2 3 4 5 6 7 8 9 10 11
1 0 0 0 0 0 0 0 0 0 0 0
2 0 0 0 0 0 0 0 0 0 0 0
3 0 0 0 0 0 0 0 0 0 0 0
4 0 0 0 0 0 0 0 0 0 0 0
5 0 0 0 0 0 0 0 0 0 0 0
6 0 0 0 0 0 0 0 0 0 0 0
7 0 0 0 0 0 0 0 0 0 0 0
8 0 0 0 0 0 0 0 0 0 0 0
9 0 0 0 0 0 0 0 0 0 0 0
10 0 0 0 0 0 0 0 0 0 0 0
11 0 0 0 0 0 0 0 0 0 0 0
12 0 0 0 0 0 0 0 0 0 0 0
13 0 0 0 0 0 0 0 0 0 0 0
14 0 0 0 0 0 0 0 0 0 0 0
15 0 0 0 0 0 0 0 0 0 0 0
16 0 0 0 0 0 0 0 0 0 0 0
17 0 0 0 0 0 0 0 0 0 0 0
18 0 0 0 0 0 0 0 0 0 0 0
19 0 0 0 0 0 0 0 0 0 0 0
20 0 0 0 0 0 0 0 0 0 0 0
21 0 0 0 0 0 0 0 0 0 0 0
22 0 0 0 0 0 0 0 0 0 0 0
23 0 0 0 0 0 0 0 0 0 0 0
24 0 0 0 0 0 0 0 0 0 0 0
25 0 0 0 0 0 0 0 0 0 0 0
26 0 0 0 0 0 0 0 0 0 0 0
27 0 0 0 0 0 0 0 0 0 0 0
28 0 0 0 0 0 0 0 0 0 0 0
29 0 0 0 0 0 0 0 0 0 0 0
30 0 0 0 0 0 0 0 0 0 0 0
31 0 0 0 0 0 0 0 0 0 0 0
32 0 0 0 0 0 0 0 0 0 0 0
33 0 0 0 0 0 0 0 0 0 0 0
34 0 0 0 0 0 0 0 0 0 0 0
35 0 0 0 0 0 0 0 0 0 0 0
36 0 0 0 0 0 0 0 0 0 0 0
37 0 0 0 0 0 0 0 0 0 0 0
38 0 0 0 0 0 0 0 0 0 0 0
39 0 0 0 0 0 0 0 0 0 0 0
40 0 0 0 0 0 0 0 0 0 0 0
41 0 0 0 0 0 0 0 0 0 0 0
42 0 0 0 0 0 0 0 0 0 0 0
43 0 0 0 0 0 0 0 0 0 0 0
44 0 0 0 0 0 0 0 0 0 0 0
45 0 0 0 0 0 0 0 0 0 0 0
46 0 0 0 0 0 0 0 0 0 0 0
47 0 0 0 0 0 0 0 0 0 0 0
48 0 0 0 0 0 0 0 0 0 0 0
49 0 0 0 0 0 0 0 0 0 0 0
50 0 0 0 0 0 0 0 0 0 0 0
51 0 0 0 0 0 0 0 0 0 0 0
52 0 0 0 0 0 0 0 0 0 0 0
53 0 0 0 0 0 0 0 0 0 0 0
54 0 0 0 0 0 0 0 0 0 0 0
55 0 0 0 0 0 0 0 0 0 0 0
56 0 0 0 0 0 0 0 0 0 0 0
57 0 0 0 0 0 0 0 0 0 0 0
58 0 0 0 0 0 0 0 0 0 0 0
59 0 0 0 0 0 0 0 0 0 0 0
60 0 0 0 0 0 0 0 0 0 0 0
61 0 0 0 0 0 0 0 0 0 0 0
62 0 0 0 0 0 0 0 0 0 0 0
63 0 0 0 0 0 0 0 0 0 0 0
64 0 0 0 0 0 0 0 0 0 0 0
65 0 0 0 0 0 0 0 0 0 0 0
66 0 0 0 0 0 0 0 0 0 0 0
67 0 0 0 0 0 0 0 0 0 0 0
68 0 0 0 0 0 0 0 0 0 0 0
69 0 0 0 0 0 0 0 0 0 0 0
70 0 0 0 0 0 0 0 0 0 0 0
71 0 0 0 0 0 0 0 0 0 0 0
72 0 0 0 0 0 0 0 0 0 0 0
73 0 0 0 0 0 0 0 0 0 0 0
74 0 0 0 0 0 0 0 0 0 0 0
75 0 0 0 0 0 0 0 0 0 0 0
76 0 0 0 0 0 0 0 0 0 0 0
77 0 0 0 0 0 0 0 0 0 0 0
78 0 0 0 0 0 0 0 0 0 0 0
79 0 0 0 0 0 0 0 0 0 0 0
80 0 0 0 0 0 0 0 0 0 0 0
81 0 0 0 0 0 0 0 0 0 0 0
82 0 0 0 0 0 0 0 0 0 0 0
83 0 0 0 0 0 0 0 0 0 0 0
84 0 0 0 0 0 0 0 0 0 0 0
85 0 0 0 0 0 0 0 0 0 0 0
86 0 0 0 0 0 0 0 0 0 0 0
87 0 0 0 0 0 0 0 0 0 0 0
88 0 0 0 0 0 0 0 0 0 0 0
89 0 0 0 0 0 0 0 0 0 0 0
90 0 0 0 0 0 0 0 0 0 0 0
91 0 0 0 0 0 0 0 0 0 0 0
92 0 0 0 0 0 0 0 0 0 0 0
93 0 0 0 0 0 0 0 0 0 0 0
94 0 0 0 0 0 0 0 0 0 0 0
95 0 0 0 0 0 0 0 0 0 0 0
96 0 0 0 0 0 0 0 0 0 0 0
97 0 0 0 0 0 0 0 0 0 0 0
98 0 0 0 0 0 0 0 0 0 0 0
99 0 0 0 0 0 0 0 0 0 0 0
100 0 0 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 0 0 0

INDIKATOR :
1.    Persalinan ditolong oleh tenaga kesehatan
2.    Memberi bayi ASI ekskusif
3.    Menimbang bayi dan balita setiap bulan
4.    Menggunakan air bersih
5. Cuci tangan pakai sabun
6. Pengelolaan air minum dan makan di rumah tangga
7. Menggunakan jamban sehat (stop BABS)
8. Pengelolaan limbah cair di rumah tangga
9. Membuang sampah pada tempatnya
10.  Memberantas jentik di rumah
11.  Makan sayur dan buah setiap hari
12.  Melakukan aktifitas fisik minimal 30 menit per hari
13.  Tidak merokok di dalam rumah

PETUNJUK PENGISIAN :
0. Jika jawaban" tidak"
1. Jawaban "YA" (artinya perilaku sesuai dengan indikator)
2. Tidak ada sasaran

PHBS : Jika indikator 1 sampai dengan indikator 13 terpenuhi


NGGA TINGKAT RT

SASARAN PS
12 13 1 2 3 11 12 1 2 3 11 12 PHBS
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 100 100 100 100 100 0 0 0 0 0 0
REKAPITULASI HASIL PEMANTAUAN PHBS TATANAN RUMAH TANGGA TINGKAT RT
Tahun : 2022
Semester :
RT :8
Dusun :
Desa :
Kecamatan :

INDIKATOR PHBS
No Nama Kepala Rumah Tangga
1 2 3 4 5 6 7 8 9 10 11 12 13 1 2 3 4 5 6 7 8 9 10 11
1 0 0 0 0 0 0 0 0 0 0 0
2 0 0 0 0 0 0 0 0 0 0 0
3 0 0 0 0 0 0 0 0 0 0 0
4 0 0 0 0 0 0 0 0 0 0 0
5 0 0 0 0 0 0 0 0 0 0 0
6 0 0 0 0 0 0 0 0 0 0 0
7 0 0 0 0 0 0 0 0 0 0 0
8 0 0 0 0 0 0 0 0 0 0 0
9 0 0 0 0 0 0 0 0 0 0 0
10 0 0 0 0 0 0 0 0 0 0 0
11 0 0 0 0 0 0 0 0 0 0 0
12 0 0 0 0 0 0 0 0 0 0 0
13 0 0 0 0 0 0 0 0 0 0 0
14 0 0 0 0 0 0 0 0 0 0 0
15 0 0 0 0 0 0 0 0 0 0 0
16 0 0 0 0 0 0 0 0 0 0 0
17 0 0 0 0 0 0 0 0 0 0 0
18 0 0 0 0 0 0 0 0 0 0 0
19 0 0 0 0 0 0 0 0 0 0 0
20 0 0 0 0 0 0 0 0 0 0 0
21 0 0 0 0 0 0 0 0 0 0 0
22 0 0 0 0 0 0 0 0 0 0 0
23 0 0 0 0 0 0 0 0 0 0 0
24 0 0 0 0 0 0 0 0 0 0 0
25 0 0 0 0 0 0 0 0 0 0 0
26 0 0 0 0 0 0 0 0 0 0 0
27 0 0 0 0 0 0 0 0 0 0 0
28 0 0 0 0 0 0 0 0 0 0 0
29 0 0 0 0 0 0 0 0 0 0 0
30 0 0 0 0 0 0 0 0 0 0 0
31 0 0 0 0 0 0 0 0 0 0 0
32 0 0 0 0 0 0 0 0 0 0 0
33 0 0 0 0 0 0 0 0 0 0 0
34 0 0 0 0 0 0 0 0 0 0 0
35 0 0 0 0 0 0 0 0 0 0 0
36 0 0 0 0 0 0 0 0 0 0 0
37 0 0 0 0 0 0 0 0 0 0 0
38 0 0 0 0 0 0 0 0 0 0 0
39 0 0 0 0 0 0 0 0 0 0 0
40 0 0 0 0 0 0 0 0 0 0 0
41 0 0 0 0 0 0 0 0 0 0 0
42 0 0 0 0 0 0 0 0 0 0 0
43 0 0 0 0 0 0 0 0 0 0 0
44 0 0 0 0 0 0 0 0 0 0 0
45 0 0 0 0 0 0 0 0 0 0 0
46 0 0 0 0 0 0 0 0 0 0 0
47 0 0 0 0 0 0 0 0 0 0 0
48 0 0 0 0 0 0 0 0 0 0 0
49 0 0 0 0 0 0 0 0 0 0 0
50 0 0 0 0 0 0 0 0 0 0 0
51 0 0 0 0 0 0 0 0 0 0 0
52 0 0 0 0 0 0 0 0 0 0 0
53 0 0 0 0 0 0 0 0 0 0 0
54 0 0 0 0 0 0 0 0 0 0 0
55 0 0 0 0 0 0 0 0 0 0 0
56 0 0 0 0 0 0 0 0 0 0 0
57 0 0 0 0 0 0 0 0 0 0 0
58 0 0 0 0 0 0 0 0 0 0 0
59 0 0 0 0 0 0 0 0 0 0 0
60 0 0 0 0 0 0 0 0 0 0 0
61 0 0 0 0 0 0 0 0 0 0 0
62 0 0 0 0 0 0 0 0 0 0 0
63 0 0 0 0 0 0 0 0 0 0 0
64 0 0 0 0 0 0 0 0 0 0 0
65 0 0 0 0 0 0 0 0 0 0 0
66 0 0 0 0 0 0 0 0 0 0 0
67 0 0 0 0 0 0 0 0 0 0 0
68 0 0 0 0 0 0 0 0 0 0 0
69 0 0 0 0 0 0 0 0 0 0 0
70 0 0 0 0 0 0 0 0 0 0 0
71 0 0 0 0 0 0 0 0 0 0 0
72 0 0 0 0 0 0 0 0 0 0 0
73 0 0 0 0 0 0 0 0 0 0 0
74 0 0 0 0 0 0 0 0 0 0 0
75 0 0 0 0 0 0 0 0 0 0 0
76 0 0 0 0 0 0 0 0 0 0 0
77 0 0 0 0 0 0 0 0 0 0 0
78 0 0 0 0 0 0 0 0 0 0 0
79 0 0 0 0 0 0 0 0 0 0 0
80 0 0 0 0 0 0 0 0 0 0 0
81 0 0 0 0 0 0 0 0 0 0 0
82 0 0 0 0 0 0 0 0 0 0 0
83 0 0 0 0 0 0 0 0 0 0 0
84 0 0 0 0 0 0 0 0 0 0 0
85 0 0 0 0 0 0 0 0 0 0 0
86 0 0 0 0 0 0 0 0 0 0 0
87 0 0 0 0 0 0 0 0 0 0 0
88 0 0 0 0 0 0 0 0 0 0 0
89 0 0 0 0 0 0 0 0 0 0 0
90 0 0 0 0 0 0 0 0 0 0 0
91 0 0 0 0 0 0 0 0 0 0 0
92 0 0 0 0 0 0 0 0 0 0 0
93 0 0 0 0 0 0 0 0 0 0 0
94 0 0 0 0 0 0 0 0 0 0 0
95 0 0 0 0 0 0 0 0 0 0 0
96 0 0 0 0 0 0 0 0 0 0 0
97 0 0 0 0 0 0 0 0 0 0 0
98 0 0 0 0 0 0 0 0 0 0 0
99 0 0 0 0 0 0 0 0 0 0 0
100 0 0 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 0 0 0

INDIKATOR :
1.    Persalinan ditolong oleh tenaga kesehatan
2.    Memberi bayi ASI ekskusif
3.    Menimbang bayi dan balita setiap bulan
4.    Menggunakan air bersih
5. Cuci tangan pakai sabun
6. Pengelolaan air minum dan makan di rumah tangga
7. Menggunakan jamban sehat (stop BABS)
8. Pengelolaan limbah cair di rumah tangga
9. Membuang sampah pada tempatnya
10.  Memberantas jentik di rumah
11.  Makan sayur dan buah setiap hari
12.  Melakukan aktifitas fisik minimal 30 menit per hari
13.  Tidak merokok di dalam rumah

PETUNJUK PENGISIAN :
0. Jika jawaban" tidak"
1. Jawaban "YA" (artinya perilaku sesuai dengan indikator)
2. Tidak ada sasaran

PHBS : Jika indikator 1 sampai dengan indikator 13 terpenuhi


NGGA TINGKAT RT

SASARAN PS
12 13 1 2 3 11 12 1 2 3 11 12 PHBS
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 100 100 100 100 100 0 0 0 0 0 0
REKAPITULASI HASIL PEMANTAUAN PHBS TATANAN RUMAH TANGGA TINGKAT RT
Tahun : 2022
Semester :
RT :9
Dusun :
Desa :
Kecamatan :

INDIKATOR PHBS
No Nama Kepala Rumah Tangga
1 2 3 4 5 6 7 8 9 10 11 12 13 1 2 3 4 5 6 7 8 9 10 11
1 0 0 0 0 0 0 0 0 0 0 0
2 0 0 0 0 0 0 0 0 0 0 0
3 0 0 0 0 0 0 0 0 0 0 0
4 0 0 0 0 0 0 0 0 0 0 0
5 0 0 0 0 0 0 0 0 0 0 0
6 0 0 0 0 0 0 0 0 0 0 0
7 0 0 0 0 0 0 0 0 0 0 0
8 0 0 0 0 0 0 0 0 0 0 0
9 0 0 0 0 0 0 0 0 0 0 0
10 0 0 0 0 0 0 0 0 0 0 0
11 0 0 0 0 0 0 0 0 0 0 0
12 0 0 0 0 0 0 0 0 0 0 0
13 0 0 0 0 0 0 0 0 0 0 0
14 0 0 0 0 0 0 0 0 0 0 0
15 0 0 0 0 0 0 0 0 0 0 0
16 0 0 0 0 0 0 0 0 0 0 0
17 0 0 0 0 0 0 0 0 0 0 0
18 0 0 0 0 0 0 0 0 0 0 0
19 0 0 0 0 0 0 0 0 0 0 0
20 0 0 0 0 0 0 0 0 0 0 0
21 0 0 0 0 0 0 0 0 0 0 0
22 0 0 0 0 0 0 0 0 0 0 0
23 0 0 0 0 0 0 0 0 0 0 0
24 0 0 0 0 0 0 0 0 0 0 0
25 0 0 0 0 0 0 0 0 0 0 0
26 0 0 0 0 0 0 0 0 0 0 0
27 0 0 0 0 0 0 0 0 0 0 0
28 0 0 0 0 0 0 0 0 0 0 0
29 0 0 0 0 0 0 0 0 0 0 0
30 0 0 0 0 0 0 0 0 0 0 0
31 0 0 0 0 0 0 0 0 0 0 0
32 0 0 0 0 0 0 0 0 0 0 0
33 0 0 0 0 0 0 0 0 0 0 0
34 0 0 0 0 0 0 0 0 0 0 0
35 0 0 0 0 0 0 0 0 0 0 0
36 0 0 0 0 0 0 0 0 0 0 0
37 0 0 0 0 0 0 0 0 0 0 0
38 0 0 0 0 0 0 0 0 0 0 0
39 0 0 0 0 0 0 0 0 0 0 0
40 0 0 0 0 0 0 0 0 0 0 0
41 0 0 0 0 0 0 0 0 0 0 0
42 0 0 0 0 0 0 0 0 0 0 0
43 0 0 0 0 0 0 0 0 0 0 0
44 0 0 0 0 0 0 0 0 0 0 0
45 0 0 0 0 0 0 0 0 0 0 0
46 0 0 0 0 0 0 0 0 0 0 0
47 0 0 0 0 0 0 0 0 0 0 0
48 0 0 0 0 0 0 0 0 0 0 0
49 0 0 0 0 0 0 0 0 0 0 0
50 0 0 0 0 0 0 0 0 0 0 0
51 0 0 0 0 0 0 0 0 0 0 0
52 0 0 0 0 0 0 0 0 0 0 0
53 0 0 0 0 0 0 0 0 0 0 0
54 0 0 0 0 0 0 0 0 0 0 0
55 0 0 0 0 0 0 0 0 0 0 0
56 0 0 0 0 0 0 0 0 0 0 0
57 0 0 0 0 0 0 0 0 0 0 0
58 0 0 0 0 0 0 0 0 0 0 0
59 0 0 0 0 0 0 0 0 0 0 0
60 0 0 0 0 0 0 0 0 0 0 0
61 0 0 0 0 0 0 0 0 0 0 0
62 0 0 0 0 0 0 0 0 0 0 0
63 0 0 0 0 0 0 0 0 0 0 0
64 0 0 0 0 0 0 0 0 0 0 0
65 0 0 0 0 0 0 0 0 0 0 0
66 0 0 0 0 0 0 0 0 0 0 0
67 0 0 0 0 0 0 0 0 0 0 0
68 0 0 0 0 0 0 0 0 0 0 0
69 0 0 0 0 0 0 0 0 0 0 0
70 0 0 0 0 0 0 0 0 0 0 0
71 0 0 0 0 0 0 0 0 0 0 0
72 0 0 0 0 0 0 0 0 0 0 0
73 0 0 0 0 0 0 0 0 0 0 0
74 0 0 0 0 0 0 0 0 0 0 0
75 0 0 0 0 0 0 0 0 0 0 0
76 0 0 0 0 0 0 0 0 0 0 0
77 0 0 0 0 0 0 0 0 0 0 0
78 0 0 0 0 0 0 0 0 0 0 0
79 0 0 0 0 0 0 0 0 0 0 0
80 0 0 0 0 0 0 0 0 0 0 0
81 0 0 0 0 0 0 0 0 0 0 0
82 0 0 0 0 0 0 0 0 0 0 0
83 0 0 0 0 0 0 0 0 0 0 0
84 0 0 0 0 0 0 0 0 0 0 0
85 0 0 0 0 0 0 0 0 0 0 0
86 0 0 0 0 0 0 0 0 0 0 0
87 0 0 0 0 0 0 0 0 0 0 0
88 0 0 0 0 0 0 0 0 0 0 0
89 0 0 0 0 0 0 0 0 0 0 0
90 0 0 0 0 0 0 0 0 0 0 0
91 0 0 0 0 0 0 0 0 0 0 0
92 0 0 0 0 0 0 0 0 0 0 0
93 0 0 0 0 0 0 0 0 0 0 0
94 0 0 0 0 0 0 0 0 0 0 0
95 0 0 0 0 0 0 0 0 0 0 0
96 0 0 0 0 0 0 0 0 0 0 0
97 0 0 0 0 0 0 0 0 0 0 0
98 0 0 0 0 0 0 0 0 0 0 0
99 0 0 0 0 0 0 0 0 0 0 0
100 0 0 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 0 0 0

INDIKATOR :
1.    Persalinan ditolong oleh tenaga kesehatan
2.    Memberi bayi ASI ekskusif
3.    Menimbang bayi dan balita setiap bulan
4.    Menggunakan air bersih
5. Cuci tangan pakai sabun
6. Pengelolaan air minum dan makan di rumah tangga
7. Menggunakan jamban sehat (stop BABS)
8. Pengelolaan limbah cair di rumah tangga
9. Membuang sampah pada tempatnya
10.  Memberantas jentik di rumah
11.  Makan sayur dan buah setiap hari
12.  Melakukan aktifitas fisik minimal 30 menit per hari
13.  Tidak merokok di dalam rumah

PETUNJUK PENGISIAN :
0. Jika jawaban" tidak"
1. Jawaban "YA" (artinya perilaku sesuai dengan indikator)
2. Tidak ada sasaran

PHBS : Jika indikator 1 sampai dengan indikator 13 terpenuhi


NGGA TINGKAT RT

SASARAN PS
12 13 1 2 3 11 12 1 2 3 11 12 PHBS
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 100 100 100 100 100 0 0 0 0 0 0
REKAPITULASI HASIL PEMANTAUAN PHBS TATANAN RUMAH TANGGA TINGKAT RT
Tahun : 2022
Semester :
RT : 10
Dusun :
Desa :
Kecamatan :

INDIKATOR PHBS
No Nama Kepala Rumah Tangga
1 2 3 4 5 6 7 8 9 10 11 12 13 1 2 3 4 5 6 7 8 9 10 11
1 0 0 0 0 0 0 0 0 0 0 0
2 0 0 0 0 0 0 0 0 0 0 0
3 0 0 0 0 0 0 0 0 0 0 0
4 0 0 0 0 0 0 0 0 0 0 0
5 0 0 0 0 0 0 0 0 0 0 0
6 0 0 0 0 0 0 0 0 0 0 0
7 0 0 0 0 0 0 0 0 0 0 0
8 0 0 0 0 0 0 0 0 0 0 0
9 0 0 0 0 0 0 0 0 0 0 0
10 0 0 0 0 0 0 0 0 0 0 0
11 0 0 0 0 0 0 0 0 0 0 0
12 0 0 0 0 0 0 0 0 0 0 0
13 0 0 0 0 0 0 0 0 0 0 0
14 0 0 0 0 0 0 0 0 0 0 0
15 0 0 0 0 0 0 0 0 0 0 0
16 0 0 0 0 0 0 0 0 0 0 0
17 0 0 0 0 0 0 0 0 0 0 0
18 0 0 0 0 0 0 0 0 0 0 0
19 0 0 0 0 0 0 0 0 0 0 0
20 0 0 0 0 0 0 0 0 0 0 0
21 0 0 0 0 0 0 0 0 0 0 0
22 0 0 0 0 0 0 0 0 0 0 0
23 0 0 0 0 0 0 0 0 0 0 0
24 0 0 0 0 0 0 0 0 0 0 0
25 0 0 0 0 0 0 0 0 0 0 0
26 0 0 0 0 0 0 0 0 0 0 0
27 0 0 0 0 0 0 0 0 0 0 0
28 0 0 0 0 0 0 0 0 0 0 0
29 0 0 0 0 0 0 0 0 0 0 0
30 0 0 0 0 0 0 0 0 0 0 0
31 0 0 0 0 0 0 0 0 0 0 0
32 0 0 0 0 0 0 0 0 0 0 0
33 0 0 0 0 0 0 0 0 0 0 0
34 0 0 0 0 0 0 0 0 0 0 0
35 0 0 0 0 0 0 0 0 0 0 0
36 0 0 0 0 0 0 0 0 0 0 0
37 0 0 0 0 0 0 0 0 0 0 0
38 0 0 0 0 0 0 0 0 0 0 0
39 0 0 0 0 0 0 0 0 0 0 0
40 0 0 0 0 0 0 0 0 0 0 0
41 0 0 0 0 0 0 0 0 0 0 0
42 0 0 0 0 0 0 0 0 0 0 0
43 0 0 0 0 0 0 0 0 0 0 0
44 0 0 0 0 0 0 0 0 0 0 0
45 0 0 0 0 0 0 0 0 0 0 0
46 0 0 0 0 0 0 0 0 0 0 0
47 0 0 0 0 0 0 0 0 0 0 0
48 0 0 0 0 0 0 0 0 0 0 0
49 0 0 0 0 0 0 0 0 0 0 0
50 0 0 0 0 0 0 0 0 0 0 0
51 0 0 0 0 0 0 0 0 0 0 0
52 0 0 0 0 0 0 0 0 0 0 0
53 0 0 0 0 0 0 0 0 0 0 0
54 0 0 0 0 0 0 0 0 0 0 0
55 0 0 0 0 0 0 0 0 0 0 0
56 0 0 0 0 0 0 0 0 0 0 0
57 0 0 0 0 0 0 0 0 0 0 0
58 0 0 0 0 0 0 0 0 0 0 0
59 0 0 0 0 0 0 0 0 0 0 0
60 0 0 0 0 0 0 0 0 0 0 0
61 0 0 0 0 0 0 0 0 0 0 0
62 0 0 0 0 0 0 0 0 0 0 0
63 0 0 0 0 0 0 0 0 0 0 0
64 0 0 0 0 0 0 0 0 0 0 0
65 0 0 0 0 0 0 0 0 0 0 0
66 0 0 0 0 0 0 0 0 0 0 0
67 0 0 0 0 0 0 0 0 0 0 0
68 0 0 0 0 0 0 0 0 0 0 0
69 0 0 0 0 0 0 0 0 0 0 0
70 0 0 0 0 0 0 0 0 0 0 0
71 0 0 0 0 0 0 0 0 0 0 0
72 0 0 0 0 0 0 0 0 0 0 0
73 0 0 0 0 0 0 0 0 0 0 0
74 0 0 0 0 0 0 0 0 0 0 0
75 0 0 0 0 0 0 0 0 0 0 0
76 0 0 0 0 0 0 0 0 0 0 0
77 0 0 0 0 0 0 0 0 0 0 0
78 0 0 0 0 0 0 0 0 0 0 0
79 0 0 0 0 0 0 0 0 0 0 0
80 0 0 0 0 0 0 0 0 0 0 0
81 0 0 0 0 0 0 0 0 0 0 0
82 0 0 0 0 0 0 0 0 0 0 0
83 0 0 0 0 0 0 0 0 0 0 0
84 0 0 0 0 0 0 0 0 0 0 0
85 0 0 0 0 0 0 0 0 0 0 0
86 0 0 0 0 0 0 0 0 0 0 0
87 0 0 0 0 0 0 0 0 0 0 0
88 0 0 0 0 0 0 0 0 0 0 0
89 0 0 0 0 0 0 0 0 0 0 0
90 0 0 0 0 0 0 0 0 0 0 0
91 0 0 0 0 0 0 0 0 0 0 0
92 0 0 0 0 0 0 0 0 0 0 0
93 0 0 0 0 0 0 0 0 0 0 0
94 0 0 0 0 0 0 0 0 0 0 0
95 0 0 0 0 0 0 0 0 0 0 0
96 0 0 0 0 0 0 0 0 0 0 0
97 0 0 0 0 0 0 0 0 0 0 0
98 0 0 0 0 0 0 0 0 0 0 0
99 0 0 0 0 0 0 0 0 0 0 0
100 0 0 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 0 0 0

INDIKATOR :
1.    Persalinan ditolong oleh tenaga kesehatan
2.    Memberi bayi ASI ekskusif
3.    Menimbang bayi dan balita setiap bulan
4.    Menggunakan air bersih
5. Cuci tangan pakai sabun
6. Pengelolaan air minum dan makan di rumah tangga
7. Menggunakan jamban sehat (stop BABS)
8. Pengelolaan limbah cair di rumah tangga
9. Membuang sampah pada tempatnya
10.  Memberantas jentik di rumah
11.  Makan sayur dan buah setiap hari
12.  Melakukan aktifitas fisik minimal 30 menit per hari
13.  Tidak merokok di dalam rumah

PETUNJUK PENGISIAN :
0. Jika jawaban" tidak"
1. Jawaban "YA" (artinya perilaku sesuai dengan indikator)
2. Tidak ada sasaran

PHBS : Jika indikator 1 sampai dengan indikator 13 terpenuhi


NGGA TINGKAT RT

SASARAN PS
12 13 1 2 3 11 12 1 2 3 11 12 PHBS
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 100 100 100 100 100 0 0 0 0 0 0
REKAPITULASI HASIL PEMANTAUAN PHBS TATANAN RUMAH TANGGA TINGKAT RT
Tahun : 2022
Semester :
RT : 11
Dusun :
Desa :
Kecamatan :

INDIKATOR PHBS
No Nama Kepala Rumah Tangga
1 2 3 4 5 6 7 8 9 10 11 12 13 1 2 3 4 5 6 7 8 9 10 11
1 0 0 0 0 0 0 0 0 0 0 0
2 0 0 0 0 0 0 0 0 0 0 0
3 0 0 0 0 0 0 0 0 0 0 0
4 0 0 0 0 0 0 0 0 0 0 0
5 0 0 0 0 0 0 0 0 0 0 0
6 0 0 0 0 0 0 0 0 0 0 0
7 0 0 0 0 0 0 0 0 0 0 0
8 0 0 0 0 0 0 0 0 0 0 0
9 0 0 0 0 0 0 0 0 0 0 0
10 0 0 0 0 0 0 0 0 0 0 0
11 0 0 0 0 0 0 0 0 0 0 0
12 0 0 0 0 0 0 0 0 0 0 0
13 0 0 0 0 0 0 0 0 0 0 0
14 0 0 0 0 0 0 0 0 0 0 0
15 0 0 0 0 0 0 0 0 0 0 0
16 0 0 0 0 0 0 0 0 0 0 0
17 0 0 0 0 0 0 0 0 0 0 0
18 0 0 0 0 0 0 0 0 0 0 0
19 0 0 0 0 0 0 0 0 0 0 0
20 0 0 0 0 0 0 0 0 0 0 0
21 0 0 0 0 0 0 0 0 0 0 0
22 0 0 0 0 0 0 0 0 0 0 0
23 0 0 0 0 0 0 0 0 0 0 0
24 0 0 0 0 0 0 0 0 0 0 0
25 0 0 0 0 0 0 0 0 0 0 0
26 0 0 0 0 0 0 0 0 0 0 0
27 0 0 0 0 0 0 0 0 0 0 0
28 0 0 0 0 0 0 0 0 0 0 0
29 0 0 0 0 0 0 0 0 0 0 0
30 0 0 0 0 0 0 0 0 0 0 0
31 0 0 0 0 0 0 0 0 0 0 0
32 0 0 0 0 0 0 0 0 0 0 0
33 0 0 0 0 0 0 0 0 0 0 0
34 0 0 0 0 0 0 0 0 0 0 0
35 0 0 0 0 0 0 0 0 0 0 0
36 0 0 0 0 0 0 0 0 0 0 0
37 0 0 0 0 0 0 0 0 0 0 0
38 0 0 0 0 0 0 0 0 0 0 0
39 0 0 0 0 0 0 0 0 0 0 0
40 0 0 0 0 0 0 0 0 0 0 0
41 0 0 0 0 0 0 0 0 0 0 0
42 0 0 0 0 0 0 0 0 0 0 0
43 0 0 0 0 0 0 0 0 0 0 0
44 0 0 0 0 0 0 0 0 0 0 0
45 0 0 0 0 0 0 0 0 0 0 0
46 0 0 0 0 0 0 0 0 0 0 0
47 0 0 0 0 0 0 0 0 0 0 0
48 0 0 0 0 0 0 0 0 0 0 0
49 0 0 0 0 0 0 0 0 0 0 0
50 0 0 0 0 0 0 0 0 0 0 0
51 0 0 0 0 0 0 0 0 0 0 0
52 0 0 0 0 0 0 0 0 0 0 0
53 0 0 0 0 0 0 0 0 0 0 0
54 0 0 0 0 0 0 0 0 0 0 0
55 0 0 0 0 0 0 0 0 0 0 0
56 0 0 0 0 0 0 0 0 0 0 0
57 0 0 0 0 0 0 0 0 0 0 0
58 0 0 0 0 0 0 0 0 0 0 0
59 0 0 0 0 0 0 0 0 0 0 0
60 0 0 0 0 0 0 0 0 0 0 0
61 0 0 0 0 0 0 0 0 0 0 0
62 0 0 0 0 0 0 0 0 0 0 0
63 0 0 0 0 0 0 0 0 0 0 0
64 0 0 0 0 0 0 0 0 0 0 0
65 0 0 0 0 0 0 0 0 0 0 0
66 0 0 0 0 0 0 0 0 0 0 0
67 0 0 0 0 0 0 0 0 0 0 0
68 0 0 0 0 0 0 0 0 0 0 0
69 0 0 0 0 0 0 0 0 0 0 0
70 0 0 0 0 0 0 0 0 0 0 0
71 0 0 0 0 0 0 0 0 0 0 0
72 0 0 0 0 0 0 0 0 0 0 0
73 0 0 0 0 0 0 0 0 0 0 0
74 0 0 0 0 0 0 0 0 0 0 0
75 0 0 0 0 0 0 0 0 0 0 0
76 0 0 0 0 0 0 0 0 0 0 0
77 0 0 0 0 0 0 0 0 0 0 0
78 0 0 0 0 0 0 0 0 0 0 0
79 0 0 0 0 0 0 0 0 0 0 0
80 0 0 0 0 0 0 0 0 0 0 0
81 0 0 0 0 0 0 0 0 0 0 0
82 0 0 0 0 0 0 0 0 0 0 0
83 0 0 0 0 0 0 0 0 0 0 0
84 0 0 0 0 0 0 0 0 0 0 0
85 0 0 0 0 0 0 0 0 0 0 0
86 0 0 0 0 0 0 0 0 0 0 0
87 0 0 0 0 0 0 0 0 0 0 0
88 0 0 0 0 0 0 0 0 0 0 0
89 0 0 0 0 0 0 0 0 0 0 0
90 0 0 0 0 0 0 0 0 0 0 0
91 0 0 0 0 0 0 0 0 0 0 0
92 0 0 0 0 0 0 0 0 0 0 0
93 0 0 0 0 0 0 0 0 0 0 0
94 0 0 0 0 0 0 0 0 0 0 0
95 0 0 0 0 0 0 0 0 0 0 0
96 0 0 0 0 0 0 0 0 0 0 0
97 0 0 0 0 0 0 0 0 0 0 0
98 0 0 0 0 0 0 0 0 0 0 0
99 0 0 0 0 0 0 0 0 0 0 0
100 0 0 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 0 0 0

INDIKATOR :
1.    Persalinan ditolong oleh tenaga kesehatan
2.    Memberi bayi ASI ekskusif
3.    Menimbang bayi dan balita setiap bulan
4.    Menggunakan air bersih
5. Cuci tangan pakai sabun
6. Pengelolaan air minum dan makan di rumah tangga
7. Menggunakan jamban sehat (stop BABS)
8. Pengelolaan limbah cair di rumah tangga
9. Membuang sampah pada tempatnya
10.  Memberantas jentik di rumah
11.  Makan sayur dan buah setiap hari
12.  Melakukan aktifitas fisik minimal 30 menit per hari
13.  Tidak merokok di dalam rumah

PETUNJUK PENGISIAN :
0. Jika jawaban" tidak"
1. Jawaban "YA" (artinya perilaku sesuai dengan indikator)
2. Tidak ada sasaran

PHBS : Jika indikator 1 sampai dengan indikator 13 terpenuhi


NGGA TINGKAT RT

SASARAN PS
12 13 1 2 3 11 12 1 2 3 11 12 PHBS
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 100 100 100 100 100 0 0 0 0 0 0
REKAPITULASI HASIL PEMANTAUAN PHBS TATANAN RUMAH TANGGA TINGKAT RT
Tahun : 2022
Semester :
RT : 12
Dusun :
Desa :
Kecamatan :

INDIKATOR PHBS
No Nama Kepala Rumah Tangga
1 2 3 4 5 6 7 8 9 10 11 12 13 1 2 3 4 5 6 7 8 9 10 11
1 0 0 0 0 0 0 0 0 0 0 0
2 0 0 0 0 0 0 0 0 0 0 0
3 0 0 0 0 0 0 0 0 0 0 0
4 0 0 0 0 0 0 0 0 0 0 0
5 0 0 0 0 0 0 0 0 0 0 0
6 0 0 0 0 0 0 0 0 0 0 0
7 0 0 0 0 0 0 0 0 0 0 0
8 0 0 0 0 0 0 0 0 0 0 0
9 0 0 0 0 0 0 0 0 0 0 0
10 0 0 0 0 0 0 0 0 0 0 0
11 0 0 0 0 0 0 0 0 0 0 0
12 0 0 0 0 0 0 0 0 0 0 0
13 0 0 0 0 0 0 0 0 0 0 0
14 0 0 0 0 0 0 0 0 0 0 0
15 0 0 0 0 0 0 0 0 0 0 0
16 0 0 0 0 0 0 0 0 0 0 0
17 0 0 0 0 0 0 0 0 0 0 0
18 0 0 0 0 0 0 0 0 0 0 0
19 0 0 0 0 0 0 0 0 0 0 0
20 0 0 0 0 0 0 0 0 0 0 0
21 0 0 0 0 0 0 0 0 0 0 0
22 0 0 0 0 0 0 0 0 0 0 0
23 0 0 0 0 0 0 0 0 0 0 0
24 0 0 0 0 0 0 0 0 0 0 0
25 0 0 0 0 0 0 0 0 0 0 0
26 0 0 0 0 0 0 0 0 0 0 0
27 0 0 0 0 0 0 0 0 0 0 0
28 0 0 0 0 0 0 0 0 0 0 0
29 0 0 0 0 0 0 0 0 0 0 0
30 0 0 0 0 0 0 0 0 0 0 0
31 0 0 0 0 0 0 0 0 0 0 0
32 0 0 0 0 0 0 0 0 0 0 0
33 0 0 0 0 0 0 0 0 0 0 0
34 0 0 0 0 0 0 0 0 0 0 0
35 0 0 0 0 0 0 0 0 0 0 0
36 0 0 0 0 0 0 0 0 0 0 0
37 0 0 0 0 0 0 0 0 0 0 0
38 0 0 0 0 0 0 0 0 0 0 0
39 0 0 0 0 0 0 0 0 0 0 0
40 0 0 0 0 0 0 0 0 0 0 0
41 0 0 0 0 0 0 0 0 0 0 0
42 0 0 0 0 0 0 0 0 0 0 0
43 0 0 0 0 0 0 0 0 0 0 0
44 0 0 0 0 0 0 0 0 0 0 0
45 0 0 0 0 0 0 0 0 0 0 0
46 0 0 0 0 0 0 0 0 0 0 0
47 0 0 0 0 0 0 0 0 0 0 0
48 0 0 0 0 0 0 0 0 0 0 0
49 0 0 0 0 0 0 0 0 0 0 0
50 0 0 0 0 0 0 0 0 0 0 0
51 0 0 0 0 0 0 0 0 0 0 0
52 0 0 0 0 0 0 0 0 0 0 0
53 0 0 0 0 0 0 0 0 0 0 0
54 0 0 0 0 0 0 0 0 0 0 0
55 0 0 0 0 0 0 0 0 0 0 0
56 0 0 0 0 0 0 0 0 0 0 0
57 0 0 0 0 0 0 0 0 0 0 0
58 0 0 0 0 0 0 0 0 0 0 0
59 0 0 0 0 0 0 0 0 0 0 0
60 0 0 0 0 0 0 0 0 0 0 0
61 0 0 0 0 0 0 0 0 0 0 0
62 0 0 0 0 0 0 0 0 0 0 0
63 0 0 0 0 0 0 0 0 0 0 0
64 0 0 0 0 0 0 0 0 0 0 0
65 0 0 0 0 0 0 0 0 0 0 0
66 0 0 0 0 0 0 0 0 0 0 0
67 0 0 0 0 0 0 0 0 0 0 0
68 0 0 0 0 0 0 0 0 0 0 0
69 0 0 0 0 0 0 0 0 0 0 0
70 0 0 0 0 0 0 0 0 0 0 0
71 0 0 0 0 0 0 0 0 0 0 0
72 0 0 0 0 0 0 0 0 0 0 0
73 0 0 0 0 0 0 0 0 0 0 0
74 0 0 0 0 0 0 0 0 0 0 0
75 0 0 0 0 0 0 0 0 0 0 0
76 0 0 0 0 0 0 0 0 0 0 0
77 0 0 0 0 0 0 0 0 0 0 0
78 0 0 0 0 0 0 0 0 0 0 0
79 0 0 0 0 0 0 0 0 0 0 0
80 0 0 0 0 0 0 0 0 0 0 0
81 0 0 0 0 0 0 0 0 0 0 0
82 0 0 0 0 0 0 0 0 0 0 0
83 0 0 0 0 0 0 0 0 0 0 0
84 0 0 0 0 0 0 0 0 0 0 0
85 0 0 0 0 0 0 0 0 0 0 0
86 0 0 0 0 0 0 0 0 0 0 0
87 0 0 0 0 0 0 0 0 0 0 0
88 0 0 0 0 0 0 0 0 0 0 0
89 0 0 0 0 0 0 0 0 0 0 0
90 0 0 0 0 0 0 0 0 0 0 0
91 0 0 0 0 0 0 0 0 0 0 0
92 0 0 0 0 0 0 0 0 0 0 0
93 0 0 0 0 0 0 0 0 0 0 0
94 0 0 0 0 0 0 0 0 0 0 0
95 0 0 0 0 0 0 0 0 0 0 0
96 0 0 0 0 0 0 0 0 0 0 0
97 0 0 0 0 0 0 0 0 0 0 0
98 0 0 0 0 0 0 0 0 0 0 0
99 0 0 0 0 0 0 0 0 0 0 0
100 0 0 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 0 0 0

INDIKATOR :
1.    Persalinan ditolong oleh tenaga kesehatan
2.    Memberi bayi ASI ekskusif
3.    Menimbang bayi dan balita setiap bulan
4.    Menggunakan air bersih
5. Cuci tangan pakai sabun
6. Pengelolaan air minum dan makan di rumah tangga
7. Menggunakan jamban sehat (stop BABS)
8. Pengelolaan limbah cair di rumah tangga
9. Membuang sampah pada tempatnya
10.  Memberantas jentik di rumah
11.  Makan sayur dan buah setiap hari
12.  Melakukan aktifitas fisik minimal 30 menit per hari
13.  Tidak merokok di dalam rumah

PETUNJUK PENGISIAN :
0. Jika jawaban" tidak"
1. Jawaban "YA" (artinya perilaku sesuai dengan indikator)
2. Tidak ada sasaran

PHBS : Jika indikator 1 sampai dengan indikator 13 terpenuhi


NGGA TINGKAT RT

SASARAN PS
12 13 1 2 3 11 12 1 2 3 11 12 PHBS
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 100 100 100 100 100 0 0 0 0 0 0
REKAPITULASI HASIL PEMANTAUAN PHBS TATANAN RUMAH TANGGA TINGKAT RT
Tahun : 2022
Semester :
RT : 13
Dusun :
Desa :
Kecamatan :

INDIKATOR PHBS
No Nama Kepala Rumah Tangga
1 2 3 4 5 6 7 8 9 10 11 12 13 1 2 3 4 5 6 7 8 9 10 11
1 0 0 0 0 0 0 0 0 0 0 0
2 0 0 0 0 0 0 0 0 0 0 0
3 0 0 0 0 0 0 0 0 0 0 0
4 0 0 0 0 0 0 0 0 0 0 0
5 0 0 0 0 0 0 0 0 0 0 0
6 0 0 0 0 0 0 0 0 0 0 0
7 0 0 0 0 0 0 0 0 0 0 0
8 0 0 0 0 0 0 0 0 0 0 0
9 0 0 0 0 0 0 0 0 0 0 0
10 0 0 0 0 0 0 0 0 0 0 0
11 0 0 0 0 0 0 0 0 0 0 0
12 0 0 0 0 0 0 0 0 0 0 0
13 0 0 0 0 0 0 0 0 0 0 0
14 0 0 0 0 0 0 0 0 0 0 0
15 0 0 0 0 0 0 0 0 0 0 0
16 0 0 0 0 0 0 0 0 0 0 0
17 0 0 0 0 0 0 0 0 0 0 0
18 0 0 0 0 0 0 0 0 0 0 0
19 0 0 0 0 0 0 0 0 0 0 0
20 0 0 0 0 0 0 0 0 0 0 0
21 0 0 0 0 0 0 0 0 0 0 0
22 0 0 0 0 0 0 0 0 0 0 0
23 0 0 0 0 0 0 0 0 0 0 0
24 0 0 0 0 0 0 0 0 0 0 0
25 0 0 0 0 0 0 0 0 0 0 0
26 0 0 0 0 0 0 0 0 0 0 0
27 0 0 0 0 0 0 0 0 0 0 0
28 0 0 0 0 0 0 0 0 0 0 0
29 0 0 0 0 0 0 0 0 0 0 0
30 0 0 0 0 0 0 0 0 0 0 0
31 0 0 0 0 0 0 0 0 0 0 0
32 0 0 0 0 0 0 0 0 0 0 0
33 0 0 0 0 0 0 0 0 0 0 0
34 0 0 0 0 0 0 0 0 0 0 0
35 0 0 0 0 0 0 0 0 0 0 0
36 0 0 0 0 0 0 0 0 0 0 0
37 0 0 0 0 0 0 0 0 0 0 0
38 0 0 0 0 0 0 0 0 0 0 0
39 0 0 0 0 0 0 0 0 0 0 0
40 0 0 0 0 0 0 0 0 0 0 0
41 0 0 0 0 0 0 0 0 0 0 0
42 0 0 0 0 0 0 0 0 0 0 0
43 0 0 0 0 0 0 0 0 0 0 0
44 0 0 0 0 0 0 0 0 0 0 0
45 0 0 0 0 0 0 0 0 0 0 0
46 0 0 0 0 0 0 0 0 0 0 0
47 0 0 0 0 0 0 0 0 0 0 0
48 0 0 0 0 0 0 0 0 0 0 0
49 0 0 0 0 0 0 0 0 0 0 0
50 0 0 0 0 0 0 0 0 0 0 0
51 0 0 0 0 0 0 0 0 0 0 0
52 0 0 0 0 0 0 0 0 0 0 0
53 0 0 0 0 0 0 0 0 0 0 0
54 0 0 0 0 0 0 0 0 0 0 0
55 0 0 0 0 0 0 0 0 0 0 0
56 0 0 0 0 0 0 0 0 0 0 0
57 0 0 0 0 0 0 0 0 0 0 0
58 0 0 0 0 0 0 0 0 0 0 0
59 0 0 0 0 0 0 0 0 0 0 0
60 0 0 0 0 0 0 0 0 0 0 0
61 0 0 0 0 0 0 0 0 0 0 0
62 0 0 0 0 0 0 0 0 0 0 0
63 0 0 0 0 0 0 0 0 0 0 0
64 0 0 0 0 0 0 0 0 0 0 0
65 0 0 0 0 0 0 0 0 0 0 0
66 0 0 0 0 0 0 0 0 0 0 0
67 0 0 0 0 0 0 0 0 0 0 0
68 0 0 0 0 0 0 0 0 0 0 0
69 0 0 0 0 0 0 0 0 0 0 0
70 0 0 0 0 0 0 0 0 0 0 0
71 0 0 0 0 0 0 0 0 0 0 0
72 0 0 0 0 0 0 0 0 0 0 0
73 0 0 0 0 0 0 0 0 0 0 0
74 0 0 0 0 0 0 0 0 0 0 0
75 0 0 0 0 0 0 0 0 0 0 0
76 0 0 0 0 0 0 0 0 0 0 0
77 0 0 0 0 0 0 0 0 0 0 0
78 0 0 0 0 0 0 0 0 0 0 0
79 0 0 0 0 0 0 0 0 0 0 0
80 0 0 0 0 0 0 0 0 0 0 0
81 0 0 0 0 0 0 0 0 0 0 0
82 0 0 0 0 0 0 0 0 0 0 0
83 0 0 0 0 0 0 0 0 0 0 0
84 0 0 0 0 0 0 0 0 0 0 0
85 0 0 0 0 0 0 0 0 0 0 0
86 0 0 0 0 0 0 0 0 0 0 0
87 0 0 0 0 0 0 0 0 0 0 0
88 0 0 0 0 0 0 0 0 0 0 0
89 0 0 0 0 0 0 0 0 0 0 0
90 0 0 0 0 0 0 0 0 0 0 0
91 0 0 0 0 0 0 0 0 0 0 0
92 0 0 0 0 0 0 0 0 0 0 0
93 0 0 0 0 0 0 0 0 0 0 0
94 0 0 0 0 0 0 0 0 0 0 0
95 0 0 0 0 0 0 0 0 0 0 0
96 0 0 0 0 0 0 0 0 0 0 0
97 0 0 0 0 0 0 0 0 0 0 0
98 0 0 0 0 0 0 0 0 0 0 0
99 0 0 0 0 0 0 0 0 0 0 0
100 0 0 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 0 0 0

INDIKATOR :
1.    Persalinan ditolong oleh tenaga kesehatan
2.    Memberi bayi ASI ekskusif
3.    Menimbang bayi dan balita setiap bulan
4.    Menggunakan air bersih
5. Cuci tangan pakai sabun
6. Pengelolaan air minum dan makan di rumah tangga
7. Menggunakan jamban sehat (stop BABS)
8. Pengelolaan limbah cair di rumah tangga
9. Membuang sampah pada tempatnya
10.  Memberantas jentik di rumah
11.  Makan sayur dan buah setiap hari
12.  Melakukan aktifitas fisik minimal 30 menit per hari
13.  Tidak merokok di dalam rumah

PETUNJUK PENGISIAN :
0. Jika jawaban" tidak"
1. Jawaban "YA" (artinya perilaku sesuai dengan indikator)
2. Tidak ada sasaran

PHBS : Jika indikator 1 sampai dengan indikator 13 terpenuhi


NGGA TINGKAT RT

SASARAN PS
12 13 1 2 3 11 12 1 2 3 11 12 PHBS
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 100 100 100 100 100 0 0 0 0 0 0
REKAPITULASI HASIL PEMANTAUAN PHBS TATANAN RUMAH TANGGA TINGKAT RT
Tahun : 2022
Semester :
RT : 14
Dusun :
Desa :
Kecamatan :

INDIKATOR PHBS
No Nama Kepala Rumah Tangga
1 2 3 4 5 6 7 8 9 10 11 12 13 1 2 3 4 5 6 7 8 9 10 11
1 0 0 0 0 0 0 0 0 0 0 0
2 0 0 0 0 0 0 0 0 0 0 0
3 0 0 0 0 0 0 0 0 0 0 0
4 0 0 0 0 0 0 0 0 0 0 0
5 0 0 0 0 0 0 0 0 0 0 0
6 0 0 0 0 0 0 0 0 0 0 0
7 0 0 0 0 0 0 0 0 0 0 0
8 0 0 0 0 0 0 0 0 0 0 0
9 0 0 0 0 0 0 0 0 0 0 0
10 0 0 0 0 0 0 0 0 0 0 0
11 0 0 0 0 0 0 0 0 0 0 0
12 0 0 0 0 0 0 0 0 0 0 0
13 0 0 0 0 0 0 0 0 0 0 0
14 0 0 0 0 0 0 0 0 0 0 0
15 0 0 0 0 0 0 0 0 0 0 0
16 0 0 0 0 0 0 0 0 0 0 0
17 0 0 0 0 0 0 0 0 0 0 0
18 0 0 0 0 0 0 0 0 0 0 0
19 0 0 0 0 0 0 0 0 0 0 0
20 0 0 0 0 0 0 0 0 0 0 0
21 0 0 0 0 0 0 0 0 0 0 0
22 0 0 0 0 0 0 0 0 0 0 0
23 0 0 0 0 0 0 0 0 0 0 0
24 0 0 0 0 0 0 0 0 0 0 0
25 0 0 0 0 0 0 0 0 0 0 0
26 0 0 0 0 0 0 0 0 0 0 0
27 0 0 0 0 0 0 0 0 0 0 0
28 0 0 0 0 0 0 0 0 0 0 0
29 0 0 0 0 0 0 0 0 0 0 0
30 0 0 0 0 0 0 0 0 0 0 0
31 0 0 0 0 0 0 0 0 0 0 0
32 0 0 0 0 0 0 0 0 0 0 0
33 0 0 0 0 0 0 0 0 0 0 0
34 0 0 0 0 0 0 0 0 0 0 0
35 0 0 0 0 0 0 0 0 0 0 0
36 0 0 0 0 0 0 0 0 0 0 0
37 0 0 0 0 0 0 0 0 0 0 0
38 0 0 0 0 0 0 0 0 0 0 0
39 0 0 0 0 0 0 0 0 0 0 0
40 0 0 0 0 0 0 0 0 0 0 0
41 0 0 0 0 0 0 0 0 0 0 0
42 0 0 0 0 0 0 0 0 0 0 0
43 0 0 0 0 0 0 0 0 0 0 0
44 0 0 0 0 0 0 0 0 0 0 0
45 0 0 0 0 0 0 0 0 0 0 0
46 0 0 0 0 0 0 0 0 0 0 0
47 0 0 0 0 0 0 0 0 0 0 0
48 0 0 0 0 0 0 0 0 0 0 0
49 0 0 0 0 0 0 0 0 0 0 0
50 0 0 0 0 0 0 0 0 0 0 0
51 0 0 0 0 0 0 0 0 0 0 0
52 0 0 0 0 0 0 0 0 0 0 0
53 0 0 0 0 0 0 0 0 0 0 0
54 0 0 0 0 0 0 0 0 0 0 0
55 0 0 0 0 0 0 0 0 0 0 0
56 0 0 0 0 0 0 0 0 0 0 0
57 0 0 0 0 0 0 0 0 0 0 0
58 0 0 0 0 0 0 0 0 0 0 0
59 0 0 0 0 0 0 0 0 0 0 0
60 0 0 0 0 0 0 0 0 0 0 0
61 0 0 0 0 0 0 0 0 0 0 0
62 0 0 0 0 0 0 0 0 0 0 0
63 0 0 0 0 0 0 0 0 0 0 0
64 0 0 0 0 0 0 0 0 0 0 0
65 0 0 0 0 0 0 0 0 0 0 0
66 0 0 0 0 0 0 0 0 0 0 0
67 0 0 0 0 0 0 0 0 0 0 0
68 0 0 0 0 0 0 0 0 0 0 0
69 0 0 0 0 0 0 0 0 0 0 0
70 0 0 0 0 0 0 0 0 0 0 0
71 0 0 0 0 0 0 0 0 0 0 0
72 0 0 0 0 0 0 0 0 0 0 0
73 0 0 0 0 0 0 0 0 0 0 0
74 0 0 0 0 0 0 0 0 0 0 0
75 0 0 0 0 0 0 0 0 0 0 0
76 0 0 0 0 0 0 0 0 0 0 0
77 0 0 0 0 0 0 0 0 0 0 0
78 0 0 0 0 0 0 0 0 0 0 0
79 0 0 0 0 0 0 0 0 0 0 0
80 0 0 0 0 0 0 0 0 0 0 0
81 0 0 0 0 0 0 0 0 0 0 0
82 0 0 0 0 0 0 0 0 0 0 0
83 0 0 0 0 0 0 0 0 0 0 0
84 0 0 0 0 0 0 0 0 0 0 0
85 0 0 0 0 0 0 0 0 0 0 0
86 0 0 0 0 0 0 0 0 0 0 0
87 0 0 0 0 0 0 0 0 0 0 0
88 0 0 0 0 0 0 0 0 0 0 0
89 0 0 0 0 0 0 0 0 0 0 0
90 0 0 0 0 0 0 0 0 0 0 0
91 0 0 0 0 0 0 0 0 0 0 0
92 0 0 0 0 0 0 0 0 0 0 0
93 0 0 0 0 0 0 0 0 0 0 0
94 0 0 0 0 0 0 0 0 0 0 0
95 0 0 0 0 0 0 0 0 0 0 0
96 0 0 0 0 0 0 0 0 0 0 0
97 0 0 0 0 0 0 0 0 0 0 0
98 0 0 0 0 0 0 0 0 0 0 0
99 0 0 0 0 0 0 0 0 0 0 0
100 0 0 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 0 0 0

INDIKATOR :
1.    Persalinan ditolong oleh tenaga kesehatan
2.    Memberi bayi ASI ekskusif
3.    Menimbang bayi dan balita setiap bulan
4.    Menggunakan air bersih
5. Cuci tangan pakai sabun
6. Pengelolaan air minum dan makan di rumah tangga
7. Menggunakan jamban sehat (stop BABS)
8. Pengelolaan limbah cair di rumah tangga
9. Membuang sampah pada tempatnya
10.  Memberantas jentik di rumah
11.  Makan sayur dan buah setiap hari
12.  Melakukan aktifitas fisik minimal 30 menit per hari
13.  Tidak merokok di dalam rumah

PETUNJUK PENGISIAN :
0. Jika jawaban" tidak"
1. Jawaban "YA" (artinya perilaku sesuai dengan indikator)
2. Tidak ada sasaran

PHBS : Jika indikator 1 sampai dengan indikator 13 terpenuhi


NGGA TINGKAT RT

SASARAN PS
12 13 1 2 3 11 12 1 2 3 11 12 PHBS
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 100 100 100 100 100 0 0 0 0 0 0
REKAPITULASI HASIL PEMANTAUAN PHBS TATANAN RUMAH TANGGA TINGKAT RT
Tahun : 2022
Semester :
RT : 15
Dusun :
Desa :
Kecamatan :

INDIKATOR PHBS
No Nama Kepala Rumah Tangga
1 2 3 4 5 6 7 8 9 10 11 12 13 1 2 3 4 5 6 7 8 9 10 11
1 0 0 0 0 0 0 0 0 0 0 0
2 0 0 0 0 0 0 0 0 0 0 0
3 0 0 0 0 0 0 0 0 0 0 0
4 0 0 0 0 0 0 0 0 0 0 0
5 0 0 0 0 0 0 0 0 0 0 0
6 0 0 0 0 0 0 0 0 0 0 0
7 0 0 0 0 0 0 0 0 0 0 0
8 0 0 0 0 0 0 0 0 0 0 0
9 0 0 0 0 0 0 0 0 0 0 0
10 0 0 0 0 0 0 0 0 0 0 0
11 0 0 0 0 0 0 0 0 0 0 0
12 0 0 0 0 0 0 0 0 0 0 0
13 0 0 0 0 0 0 0 0 0 0 0
14 0 0 0 0 0 0 0 0 0 0 0
15 0 0 0 0 0 0 0 0 0 0 0
16 0 0 0 0 0 0 0 0 0 0 0
17 0 0 0 0 0 0 0 0 0 0 0
18 0 0 0 0 0 0 0 0 0 0 0
19 0 0 0 0 0 0 0 0 0 0 0
20 0 0 0 0 0 0 0 0 0 0 0
21 0 0 0 0 0 0 0 0 0 0 0
22 0 0 0 0 0 0 0 0 0 0 0
23 0 0 0 0 0 0 0 0 0 0 0
24 0 0 0 0 0 0 0 0 0 0 0
25 0 0 0 0 0 0 0 0 0 0 0
26 0 0 0 0 0 0 0 0 0 0 0
27 0 0 0 0 0 0 0 0 0 0 0
28 0 0 0 0 0 0 0 0 0 0 0
29 0 0 0 0 0 0 0 0 0 0 0
30 0 0 0 0 0 0 0 0 0 0 0
31 0 0 0 0 0 0 0 0 0 0 0
32 0 0 0 0 0 0 0 0 0 0 0
33 0 0 0 0 0 0 0 0 0 0 0
34 0 0 0 0 0 0 0 0 0 0 0
35 0 0 0 0 0 0 0 0 0 0 0
36 0 0 0 0 0 0 0 0 0 0 0
37 0 0 0 0 0 0 0 0 0 0 0
38 0 0 0 0 0 0 0 0 0 0 0
39 0 0 0 0 0 0 0 0 0 0 0
40 0 0 0 0 0 0 0 0 0 0 0
41 0 0 0 0 0 0 0 0 0 0 0
42 0 0 0 0 0 0 0 0 0 0 0
43 0 0 0 0 0 0 0 0 0 0 0
44 0 0 0 0 0 0 0 0 0 0 0
45 0 0 0 0 0 0 0 0 0 0 0
46 0 0 0 0 0 0 0 0 0 0 0
47 0 0 0 0 0 0 0 0 0 0 0
48 0 0 0 0 0 0 0 0 0 0 0
49 0 0 0 0 0 0 0 0 0 0 0
50 0 0 0 0 0 0 0 0 0 0 0
51 0 0 0 0 0 0 0 0 0 0 0
52 0 0 0 0 0 0 0 0 0 0 0
53 0 0 0 0 0 0 0 0 0 0 0
54 0 0 0 0 0 0 0 0 0 0 0
55 0 0 0 0 0 0 0 0 0 0 0
56 0 0 0 0 0 0 0 0 0 0 0
57 0 0 0 0 0 0 0 0 0 0 0
58 0 0 0 0 0 0 0 0 0 0 0
59 0 0 0 0 0 0 0 0 0 0 0
60 0 0 0 0 0 0 0 0 0 0 0
61 0 0 0 0 0 0 0 0 0 0 0
62 0 0 0 0 0 0 0 0 0 0 0
63 0 0 0 0 0 0 0 0 0 0 0
64 0 0 0 0 0 0 0 0 0 0 0
65 0 0 0 0 0 0 0 0 0 0 0
66 0 0 0 0 0 0 0 0 0 0 0
67 0 0 0 0 0 0 0 0 0 0 0
68 0 0 0 0 0 0 0 0 0 0 0
69 0 0 0 0 0 0 0 0 0 0 0
70 0 0 0 0 0 0 0 0 0 0 0
71 0 0 0 0 0 0 0 0 0 0 0
72 0 0 0 0 0 0 0 0 0 0 0
73 0 0 0 0 0 0 0 0 0 0 0
74 0 0 0 0 0 0 0 0 0 0 0
75 0 0 0 0 0 0 0 0 0 0 0
76 0 0 0 0 0 0 0 0 0 0 0
77 0 0 0 0 0 0 0 0 0 0 0
78 0 0 0 0 0 0 0 0 0 0 0
79 0 0 0 0 0 0 0 0 0 0 0
80 0 0 0 0 0 0 0 0 0 0 0
81 0 0 0 0 0 0 0 0 0 0 0
82 0 0 0 0 0 0 0 0 0 0 0
83 0 0 0 0 0 0 0 0 0 0 0
84 0 0 0 0 0 0 0 0 0 0 0
85 0 0 0 0 0 0 0 0 0 0 0
86 0 0 0 0 0 0 0 0 0 0 0
87 0 0 0 0 0 0 0 0 0 0 0
88 0 0 0 0 0 0 0 0 0 0 0
89 0 0 0 0 0 0 0 0 0 0 0
90 0 0 0 0 0 0 0 0 0 0 0
91 0 0 0 0 0 0 0 0 0 0 0
92 0 0 0 0 0 0 0 0 0 0 0
93 0 0 0 0 0 0 0 0 0 0 0
94 0 0 0 0 0 0 0 0 0 0 0
95 0 0 0 0 0 0 0 0 0 0 0
96 0 0 0 0 0 0 0 0 0 0 0
97 0 0 0 0 0 0 0 0 0 0 0
98 0 0 0 0 0 0 0 0 0 0 0
99 0 0 0 0 0 0 0 0 0 0 0
100 0 0 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 0 0 0

INDIKATOR :
1.    Persalinan ditolong oleh tenaga kesehatan
2.    Memberi bayi ASI ekskusif
3.    Menimbang bayi dan balita setiap bulan
4.    Menggunakan air bersih
5. Cuci tangan pakai sabun
6. Pengelolaan air minum dan makan di rumah tangga
7. Menggunakan jamban sehat (stop BABS)
8. Pengelolaan limbah cair di rumah tangga
9. Membuang sampah pada tempatnya
10.  Memberantas jentik di rumah
11.  Makan sayur dan buah setiap hari
12.  Melakukan aktifitas fisik minimal 30 menit per hari
13.  Tidak merokok di dalam rumah

PETUNJUK PENGISIAN :
0. Jika jawaban" tidak"
1. Jawaban "YA" (artinya perilaku sesuai dengan indikator)
2. Tidak ada sasaran

PHBS : Jika indikator 1 sampai dengan indikator 13 terpenuhi


NGGA TINGKAT RT

SASARAN PS
12 13 1 2 3 11 12 1 2 3 11 12 PHBS
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 100 100 100 100 100 0 0 0 0 0 0
REKAPITULASI HASIL PEMANTAUAN PHBS TATANAN RUMAH TANGGA TINGKAT RT
Tahun : 2022
Semester :
RT : 16
Dusun :
Desa :
Kecamatan :

INDIKATOR PHBS
No Nama Kepala Rumah Tangga
1 2 3 4 5 6 7 8 9 10 11 12 13 1 2 3 4 5 6 7 8 9 10 11
1 0 0 0 0 0 0 0 0 0 0 0
2 0 0 0 0 0 0 0 0 0 0 0
3 0 0 0 0 0 0 0 0 0 0 0
4 0 0 0 0 0 0 0 0 0 0 0
5 0 0 0 0 0 0 0 0 0 0 0
6 0 0 0 0 0 0 0 0 0 0 0
7 0 0 0 0 0 0 0 0 0 0 0
8 0 0 0 0 0 0 0 0 0 0 0
9 0 0 0 0 0 0 0 0 0 0 0
10 0 0 0 0 0 0 0 0 0 0 0
11 0 0 0 0 0 0 0 0 0 0 0
12 0 0 0 0 0 0 0 0 0 0 0
13 0 0 0 0 0 0 0 0 0 0 0
14 0 0 0 0 0 0 0 0 0 0 0
15 0 0 0 0 0 0 0 0 0 0 0
16 0 0 0 0 0 0 0 0 0 0 0
17 0 0 0 0 0 0 0 0 0 0 0
18 0 0 0 0 0 0 0 0 0 0 0
19 0 0 0 0 0 0 0 0 0 0 0
20 0 0 0 0 0 0 0 0 0 0 0
21 0 0 0 0 0 0 0 0 0 0 0
22 0 0 0 0 0 0 0 0 0 0 0
23 0 0 0 0 0 0 0 0 0 0 0
24 0 0 0 0 0 0 0 0 0 0 0
25 0 0 0 0 0 0 0 0 0 0 0
26 0 0 0 0 0 0 0 0 0 0 0
27 0 0 0 0 0 0 0 0 0 0 0
28 0 0 0 0 0 0 0 0 0 0 0
29 0 0 0 0 0 0 0 0 0 0 0
30 0 0 0 0 0 0 0 0 0 0 0
31 0 0 0 0 0 0 0 0 0 0 0
32 0 0 0 0 0 0 0 0 0 0 0
33 0 0 0 0 0 0 0 0 0 0 0
34 0 0 0 0 0 0 0 0 0 0 0
35 0 0 0 0 0 0 0 0 0 0 0
36 0 0 0 0 0 0 0 0 0 0 0
37 0 0 0 0 0 0 0 0 0 0 0
38 0 0 0 0 0 0 0 0 0 0 0
39 0 0 0 0 0 0 0 0 0 0 0
40 0 0 0 0 0 0 0 0 0 0 0
41 0 0 0 0 0 0 0 0 0 0 0
42 0 0 0 0 0 0 0 0 0 0 0
43 0 0 0 0 0 0 0 0 0 0 0
44 0 0 0 0 0 0 0 0 0 0 0
45 0 0 0 0 0 0 0 0 0 0 0
46 0 0 0 0 0 0 0 0 0 0 0
47 0 0 0 0 0 0 0 0 0 0 0
48 0 0 0 0 0 0 0 0 0 0 0
49 0 0 0 0 0 0 0 0 0 0 0
50 0 0 0 0 0 0 0 0 0 0 0
51 0 0 0 0 0 0 0 0 0 0 0
52 0 0 0 0 0 0 0 0 0 0 0
53 0 0 0 0 0 0 0 0 0 0 0
54 0 0 0 0 0 0 0 0 0 0 0
55 0 0 0 0 0 0 0 0 0 0 0
56 0 0 0 0 0 0 0 0 0 0 0
57 0 0 0 0 0 0 0 0 0 0 0
58 0 0 0 0 0 0 0 0 0 0 0
59 0 0 0 0 0 0 0 0 0 0 0
60 0 0 0 0 0 0 0 0 0 0 0
61 0 0 0 0 0 0 0 0 0 0 0
62 0 0 0 0 0 0 0 0 0 0 0
63 0 0 0 0 0 0 0 0 0 0 0
64 0 0 0 0 0 0 0 0 0 0 0
65 0 0 0 0 0 0 0 0 0 0 0
66 0 0 0 0 0 0 0 0 0 0 0
67 0 0 0 0 0 0 0 0 0 0 0
68 0 0 0 0 0 0 0 0 0 0 0
69 0 0 0 0 0 0 0 0 0 0 0
70 0 0 0 0 0 0 0 0 0 0 0
71 0 0 0 0 0 0 0 0 0 0 0
72 0 0 0 0 0 0 0 0 0 0 0
73 0 0 0 0 0 0 0 0 0 0 0
74 0 0 0 0 0 0 0 0 0 0 0
75 0 0 0 0 0 0 0 0 0 0 0
76 0 0 0 0 0 0 0 0 0 0 0
77 0 0 0 0 0 0 0 0 0 0 0
78 0 0 0 0 0 0 0 0 0 0 0
79 0 0 0 0 0 0 0 0 0 0 0
80 0 0 0 0 0 0 0 0 0 0 0
81 0 0 0 0 0 0 0 0 0 0 0
82 0 0 0 0 0 0 0 0 0 0 0
83 0 0 0 0 0 0 0 0 0 0 0
84 0 0 0 0 0 0 0 0 0 0 0
85 0 0 0 0 0 0 0 0 0 0 0
86 0 0 0 0 0 0 0 0 0 0 0
87 0 0 0 0 0 0 0 0 0 0 0
88 0 0 0 0 0 0 0 0 0 0 0
89 0 0 0 0 0 0 0 0 0 0 0
90 0 0 0 0 0 0 0 0 0 0 0
91 0 0 0 0 0 0 0 0 0 0 0
92 0 0 0 0 0 0 0 0 0 0 0
93 0 0 0 0 0 0 0 0 0 0 0
94 0 0 0 0 0 0 0 0 0 0 0
95 0 0 0 0 0 0 0 0 0 0 0
96 0 0 0 0 0 0 0 0 0 0 0
97 0 0 0 0 0 0 0 0 0 0 0
98 0 0 0 0 0 0 0 0 0 0 0
99 0 0 0 0 0 0 0 0 0 0 0
100 0 0 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 0 0 0

INDIKATOR :
1.    Persalinan ditolong oleh tenaga kesehatan
2.    Memberi bayi ASI ekskusif
3.    Menimbang bayi dan balita setiap bulan
4.    Menggunakan air bersih
5. Cuci tangan pakai sabun
6. Pengelolaan air minum dan makan di rumah tangga
7. Menggunakan jamban sehat (stop BABS)
8. Pengelolaan limbah cair di rumah tangga
9. Membuang sampah pada tempatnya
10.  Memberantas jentik di rumah
11.  Makan sayur dan buah setiap hari
12.  Melakukan aktifitas fisik minimal 30 menit per hari
13.  Tidak merokok di dalam rumah

PETUNJUK PENGISIAN :
0. Jika jawaban" tidak"
1. Jawaban "YA" (artinya perilaku sesuai dengan indikator)
2. Tidak ada sasaran

PHBS : Jika indikator 1 sampai dengan indikator 13 terpenuhi


NGGA TINGKAT RT

SASARAN PS
12 13 1 2 3 11 12 1 2 3 11 12 PHBS
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 100 100 100 100 100 0 0 0 0 0 0
REKAPITULASI HASIL PEMANTAUAN PHBS TATANAN RUMAH TANGGA TINGKAT RT
Tahun : 2022
Semester :
RT : 17
Dusun :
Desa :
Kecamatan :

INDIKATOR PHBS
No Nama Kepala Rumah Tangga
1 2 3 4 5 6 7 8 9 10 11 12 13 1 2 3 4 5 6 7 8 9 10 11
1 0 0 0 0 0 0 0 0 0 0 0
2 0 0 0 0 0 0 0 0 0 0 0
3 0 0 0 0 0 0 0 0 0 0 0
4 0 0 0 0 0 0 0 0 0 0 0
5 0 0 0 0 0 0 0 0 0 0 0
6 0 0 0 0 0 0 0 0 0 0 0
7 0 0 0 0 0 0 0 0 0 0 0
8 0 0 0 0 0 0 0 0 0 0 0
9 0 0 0 0 0 0 0 0 0 0 0
10 0 0 0 0 0 0 0 0 0 0 0
11 0 0 0 0 0 0 0 0 0 0 0
12 0 0 0 0 0 0 0 0 0 0 0
13 0 0 0 0 0 0 0 0 0 0 0
14 0 0 0 0 0 0 0 0 0 0 0
15 0 0 0 0 0 0 0 0 0 0 0
16 0 0 0 0 0 0 0 0 0 0 0
17 0 0 0 0 0 0 0 0 0 0 0
18 0 0 0 0 0 0 0 0 0 0 0
19 0 0 0 0 0 0 0 0 0 0 0
20 0 0 0 0 0 0 0 0 0 0 0
21 0 0 0 0 0 0 0 0 0 0 0
22 0 0 0 0 0 0 0 0 0 0 0
23 0 0 0 0 0 0 0 0 0 0 0
24 0 0 0 0 0 0 0 0 0 0 0
25 0 0 0 0 0 0 0 0 0 0 0
26 0 0 0 0 0 0 0 0 0 0 0
27 0 0 0 0 0 0 0 0 0 0 0
28 0 0 0 0 0 0 0 0 0 0 0
29 0 0 0 0 0 0 0 0 0 0 0
30 0 0 0 0 0 0 0 0 0 0 0
31 0 0 0 0 0 0 0 0 0 0 0
32 0 0 0 0 0 0 0 0 0 0 0
33 0 0 0 0 0 0 0 0 0 0 0
34 0 0 0 0 0 0 0 0 0 0 0
35 0 0 0 0 0 0 0 0 0 0 0
36 0 0 0 0 0 0 0 0 0 0 0
37 0 0 0 0 0 0 0 0 0 0 0
38 0 0 0 0 0 0 0 0 0 0 0
39 0 0 0 0 0 0 0 0 0 0 0
40 0 0 0 0 0 0 0 0 0 0 0
41 0 0 0 0 0 0 0 0 0 0 0
42 0 0 0 0 0 0 0 0 0 0 0
43 0 0 0 0 0 0 0 0 0 0 0
44 0 0 0 0 0 0 0 0 0 0 0
45 0 0 0 0 0 0 0 0 0 0 0
46 0 0 0 0 0 0 0 0 0 0 0
47 0 0 0 0 0 0 0 0 0 0 0
48 0 0 0 0 0 0 0 0 0 0 0
49 0 0 0 0 0 0 0 0 0 0 0
50 0 0 0 0 0 0 0 0 0 0 0
51 0 0 0 0 0 0 0 0 0 0 0
52 0 0 0 0 0 0 0 0 0 0 0
53 0 0 0 0 0 0 0 0 0 0 0
54 0 0 0 0 0 0 0 0 0 0 0
55 0 0 0 0 0 0 0 0 0 0 0
56 0 0 0 0 0 0 0 0 0 0 0
57 0 0 0 0 0 0 0 0 0 0 0
58 0 0 0 0 0 0 0 0 0 0 0
59 0 0 0 0 0 0 0 0 0 0 0
60 0 0 0 0 0 0 0 0 0 0 0
61 0 0 0 0 0 0 0 0 0 0 0
62 0 0 0 0 0 0 0 0 0 0 0
63 0 0 0 0 0 0 0 0 0 0 0
64 0 0 0 0 0 0 0 0 0 0 0
65 0 0 0 0 0 0 0 0 0 0 0
66 0 0 0 0 0 0 0 0 0 0 0
67 0 0 0 0 0 0 0 0 0 0 0
68 0 0 0 0 0 0 0 0 0 0 0
69 0 0 0 0 0 0 0 0 0 0 0
70 0 0 0 0 0 0 0 0 0 0 0
71 0 0 0 0 0 0 0 0 0 0 0
72 0 0 0 0 0 0 0 0 0 0 0
73 0 0 0 0 0 0 0 0 0 0 0
74 0 0 0 0 0 0 0 0 0 0 0
75 0 0 0 0 0 0 0 0 0 0 0
76 0 0 0 0 0 0 0 0 0 0 0
77 0 0 0 0 0 0 0 0 0 0 0
78 0 0 0 0 0 0 0 0 0 0 0
79 0 0 0 0 0 0 0 0 0 0 0
80 0 0 0 0 0 0 0 0 0 0 0
81 0 0 0 0 0 0 0 0 0 0 0
82 0 0 0 0 0 0 0 0 0 0 0
83 0 0 0 0 0 0 0 0 0 0 0
84 0 0 0 0 0 0 0 0 0 0 0
85 0 0 0 0 0 0 0 0 0 0 0
86 0 0 0 0 0 0 0 0 0 0 0
87 0 0 0 0 0 0 0 0 0 0 0
88 0 0 0 0 0 0 0 0 0 0 0
89 0 0 0 0 0 0 0 0 0 0 0
90 0 0 0 0 0 0 0 0 0 0 0
91 0 0 0 0 0 0 0 0 0 0 0
92 0 0 0 0 0 0 0 0 0 0 0
93 0 0 0 0 0 0 0 0 0 0 0
94 0 0 0 0 0 0 0 0 0 0 0
95 0 0 0 0 0 0 0 0 0 0 0
96 0 0 0 0 0 0 0 0 0 0 0
97 0 0 0 0 0 0 0 0 0 0 0
98 0 0 0 0 0 0 0 0 0 0 0
99 0 0 0 0 0 0 0 0 0 0 0
100 0 0 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 0 0 0

INDIKATOR :
1.    Persalinan ditolong oleh tenaga kesehatan
2.    Memberi bayi ASI ekskusif
3.    Menimbang bayi dan balita setiap bulan
4.    Menggunakan air bersih
5. Cuci tangan pakai sabun
6. Pengelolaan air minum dan makan di rumah tangga
7. Menggunakan jamban sehat (stop BABS)
8. Pengelolaan limbah cair di rumah tangga
9. Membuang sampah pada tempatnya
10.  Memberantas jentik di rumah
11.  Makan sayur dan buah setiap hari
12.  Melakukan aktifitas fisik minimal 30 menit per hari
13.  Tidak merokok di dalam rumah

PETUNJUK PENGISIAN :
0. Jika jawaban" tidak"
1. Jawaban "YA" (artinya perilaku sesuai dengan indikator)
2. Tidak ada sasaran

PHBS : Jika indikator 1 sampai dengan indikator 13 terpenuhi


NGGA TINGKAT RT

SASARAN PS
12 13 1 2 3 11 12 1 2 3 11 12 PHBS
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 100 100 100 100 100 0 0 0 0 0 0
REKAPITULASI HASIL PEMANTAUAN PHBS TATANAN RUMAH TANGGA TINGKAT RT
Tahun : 2022
Semester :
RT : 18
Dusun :
Desa :
Kecamatan :

INDIKATOR PHBS
No Nama Kepala Rumah Tangga
1 2 3 4 5 6 7 8 9 10 11 12 13 1 2 3 4 5 6 7 8 9 10 11
1 0 0 0 0 0 0 0 0 0 0 0
2 0 0 0 0 0 0 0 0 0 0 0
3 0 0 0 0 0 0 0 0 0 0 0
4 0 0 0 0 0 0 0 0 0 0 0
5 0 0 0 0 0 0 0 0 0 0 0
6 0 0 0 0 0 0 0 0 0 0 0
7 0 0 0 0 0 0 0 0 0 0 0
8 0 0 0 0 0 0 0 0 0 0 0
9 0 0 0 0 0 0 0 0 0 0 0
10 0 0 0 0 0 0 0 0 0 0 0
11 0 0 0 0 0 0 0 0 0 0 0
12 0 0 0 0 0 0 0 0 0 0 0
13 0 0 0 0 0 0 0 0 0 0 0
14 0 0 0 0 0 0 0 0 0 0 0
15 0 0 0 0 0 0 0 0 0 0 0
16 0 0 0 0 0 0 0 0 0 0 0
17 0 0 0 0 0 0 0 0 0 0 0
18 0 0 0 0 0 0 0 0 0 0 0
19 0 0 0 0 0 0 0 0 0 0 0
20 0 0 0 0 0 0 0 0 0 0 0
21 0 0 0 0 0 0 0 0 0 0 0
22 0 0 0 0 0 0 0 0 0 0 0
23 0 0 0 0 0 0 0 0 0 0 0
24 0 0 0 0 0 0 0 0 0 0 0
25 0 0 0 0 0 0 0 0 0 0 0
26 0 0 0 0 0 0 0 0 0 0 0
27 0 0 0 0 0 0 0 0 0 0 0
28 0 0 0 0 0 0 0 0 0 0 0
29 0 0 0 0 0 0 0 0 0 0 0
30 0 0 0 0 0 0 0 0 0 0 0
31 0 0 0 0 0 0 0 0 0 0 0
32 0 0 0 0 0 0 0 0 0 0 0
33 0 0 0 0 0 0 0 0 0 0 0
34 0 0 0 0 0 0 0 0 0 0 0
35 0 0 0 0 0 0 0 0 0 0 0
36 0 0 0 0 0 0 0 0 0 0 0
37 0 0 0 0 0 0 0 0 0 0 0
38 0 0 0 0 0 0 0 0 0 0 0
39 0 0 0 0 0 0 0 0 0 0 0
40 0 0 0 0 0 0 0 0 0 0 0
41 0 0 0 0 0 0 0 0 0 0 0
42 0 0 0 0 0 0 0 0 0 0 0
43 0 0 0 0 0 0 0 0 0 0 0
44 0 0 0 0 0 0 0 0 0 0 0
45 0 0 0 0 0 0 0 0 0 0 0
46 0 0 0 0 0 0 0 0 0 0 0
47 0 0 0 0 0 0 0 0 0 0 0
48 0 0 0 0 0 0 0 0 0 0 0
49 0 0 0 0 0 0 0 0 0 0 0
50 0 0 0 0 0 0 0 0 0 0 0
51 0 0 0 0 0 0 0 0 0 0 0
52 0 0 0 0 0 0 0 0 0 0 0
53 0 0 0 0 0 0 0 0 0 0 0
54 0 0 0 0 0 0 0 0 0 0 0
55 0 0 0 0 0 0 0 0 0 0 0
56 0 0 0 0 0 0 0 0 0 0 0
57 0 0 0 0 0 0 0 0 0 0 0
58 0 0 0 0 0 0 0 0 0 0 0
59 0 0 0 0 0 0 0 0 0 0 0
60 0 0 0 0 0 0 0 0 0 0 0
61 0 0 0 0 0 0 0 0 0 0 0
62 0 0 0 0 0 0 0 0 0 0 0
63 0 0 0 0 0 0 0 0 0 0 0
64 0 0 0 0 0 0 0 0 0 0 0
65 0 0 0 0 0 0 0 0 0 0 0
66 0 0 0 0 0 0 0 0 0 0 0
67 0 0 0 0 0 0 0 0 0 0 0
68 0 0 0 0 0 0 0 0 0 0 0
69 0 0 0 0 0 0 0 0 0 0 0
70 0 0 0 0 0 0 0 0 0 0 0
71 0 0 0 0 0 0 0 0 0 0 0
72 0 0 0 0 0 0 0 0 0 0 0
73 0 0 0 0 0 0 0 0 0 0 0
74 0 0 0 0 0 0 0 0 0 0 0
75 0 0 0 0 0 0 0 0 0 0 0
76 0 0 0 0 0 0 0 0 0 0 0
77 0 0 0 0 0 0 0 0 0 0 0
78 0 0 0 0 0 0 0 0 0 0 0
79 0 0 0 0 0 0 0 0 0 0 0
80 0 0 0 0 0 0 0 0 0 0 0
81 0 0 0 0 0 0 0 0 0 0 0
82 0 0 0 0 0 0 0 0 0 0 0
83 0 0 0 0 0 0 0 0 0 0 0
84 0 0 0 0 0 0 0 0 0 0 0
85 0 0 0 0 0 0 0 0 0 0 0
86 0 0 0 0 0 0 0 0 0 0 0
87 0 0 0 0 0 0 0 0 0 0 0
88 0 0 0 0 0 0 0 0 0 0 0
89 0 0 0 0 0 0 0 0 0 0 0
90 0 0 0 0 0 0 0 0 0 0 0
91 0 0 0 0 0 0 0 0 0 0 0
92 0 0 0 0 0 0 0 0 0 0 0
93 0 0 0 0 0 0 0 0 0 0 0
94 0 0 0 0 0 0 0 0 0 0 0
95 0 0 0 0 0 0 0 0 0 0 0
96 0 0 0 0 0 0 0 0 0 0 0
97 0 0 0 0 0 0 0 0 0 0 0
98 0 0 0 0 0 0 0 0 0 0 0
99 0 0 0 0 0 0 0 0 0 0 0
100 0 0 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 0 0 0

INDIKATOR :
1.    Persalinan ditolong oleh tenaga kesehatan
2.    Memberi bayi ASI ekskusif
3.    Menimbang bayi dan balita setiap bulan
4.    Menggunakan air bersih
5. Cuci tangan pakai sabun
6. Pengelolaan air minum dan makan di rumah tangga
7. Menggunakan jamban sehat (stop BABS)
8. Pengelolaan limbah cair di rumah tangga
9. Membuang sampah pada tempatnya
10.  Memberantas jentik di rumah
11.  Makan sayur dan buah setiap hari
12.  Melakukan aktifitas fisik minimal 30 menit per hari
13.  Tidak merokok di dalam rumah

PETUNJUK PENGISIAN :
0. Jika jawaban" tidak"
1. Jawaban "YA" (artinya perilaku sesuai dengan indikator)
2. Tidak ada sasaran

PHBS : Jika indikator 1 sampai dengan indikator 13 terpenuhi


NGGA TINGKAT RT

SASARAN PS
12 13 1 2 3 11 12 1 2 3 11 12 PHBS
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 100 100 100 100 100 0 0 0 0 0 0
REKAPITULASI HASIL PEMANTAUAN PHBS TATANAN RUMAH TANGGA TINGKAT RT
Tahun : 2022
Semester :
RT : 19
Dusun :
Desa :
Kecamatan :

INDIKATOR PHBS
No Nama Kepala Rumah Tangga
1 2 3 4 5 6 7 8 9 10 11 12 13 1 2 3 4 5 6 7 8 9 10 11
1 0 0 0 0 0 0 0 0 0 0 0
2 0 0 0 0 0 0 0 0 0 0 0
3 0 0 0 0 0 0 0 0 0 0 0
4 0 0 0 0 0 0 0 0 0 0 0
5 0 0 0 0 0 0 0 0 0 0 0
6 0 0 0 0 0 0 0 0 0 0 0
7 0 0 0 0 0 0 0 0 0 0 0
8 0 0 0 0 0 0 0 0 0 0 0
9 0 0 0 0 0 0 0 0 0 0 0
10 0 0 0 0 0 0 0 0 0 0 0
11 0 0 0 0 0 0 0 0 0 0 0
12 0 0 0 0 0 0 0 0 0 0 0
13 0 0 0 0 0 0 0 0 0 0 0
14 0 0 0 0 0 0 0 0 0 0 0
15 0 0 0 0 0 0 0 0 0 0 0
16 0 0 0 0 0 0 0 0 0 0 0
17 0 0 0 0 0 0 0 0 0 0 0
18 0 0 0 0 0 0 0 0 0 0 0
19 0 0 0 0 0 0 0 0 0 0 0
20 0 0 0 0 0 0 0 0 0 0 0
21 0 0 0 0 0 0 0 0 0 0 0
22 0 0 0 0 0 0 0 0 0 0 0
23 0 0 0 0 0 0 0 0 0 0 0
24 0 0 0 0 0 0 0 0 0 0 0
25 0 0 0 0 0 0 0 0 0 0 0
26 0 0 0 0 0 0 0 0 0 0 0
27 0 0 0 0 0 0 0 0 0 0 0
28 0 0 0 0 0 0 0 0 0 0 0
29 0 0 0 0 0 0 0 0 0 0 0
30 0 0 0 0 0 0 0 0 0 0 0
31 0 0 0 0 0 0 0 0 0 0 0
32 0 0 0 0 0 0 0 0 0 0 0
33 0 0 0 0 0 0 0 0 0 0 0
34 0 0 0 0 0 0 0 0 0 0 0
35 0 0 0 0 0 0 0 0 0 0 0
36 0 0 0 0 0 0 0 0 0 0 0
37 0 0 0 0 0 0 0 0 0 0 0
38 0 0 0 0 0 0 0 0 0 0 0
39 0 0 0 0 0 0 0 0 0 0 0
40 0 0 0 0 0 0 0 0 0 0 0
41 0 0 0 0 0 0 0 0 0 0 0
42 0 0 0 0 0 0 0 0 0 0 0
43 0 0 0 0 0 0 0 0 0 0 0
44 0 0 0 0 0 0 0 0 0 0 0
45 0 0 0 0 0 0 0 0 0 0 0
46 0 0 0 0 0 0 0 0 0 0 0
47 0 0 0 0 0 0 0 0 0 0 0
48 0 0 0 0 0 0 0 0 0 0 0
49 0 0 0 0 0 0 0 0 0 0 0
50 0 0 0 0 0 0 0 0 0 0 0
51 0 0 0 0 0 0 0 0 0 0 0
52 0 0 0 0 0 0 0 0 0 0 0
53 0 0 0 0 0 0 0 0 0 0 0
54 0 0 0 0 0 0 0 0 0 0 0
55 0 0 0 0 0 0 0 0 0 0 0
56 0 0 0 0 0 0 0 0 0 0 0
57 0 0 0 0 0 0 0 0 0 0 0
58 0 0 0 0 0 0 0 0 0 0 0
59 0 0 0 0 0 0 0 0 0 0 0
60 0 0 0 0 0 0 0 0 0 0 0
61 0 0 0 0 0 0 0 0 0 0 0
62 0 0 0 0 0 0 0 0 0 0 0
63 0 0 0 0 0 0 0 0 0 0 0
64 0 0 0 0 0 0 0 0 0 0 0
65 0 0 0 0 0 0 0 0 0 0 0
66 0 0 0 0 0 0 0 0 0 0 0
67 0 0 0 0 0 0 0 0 0 0 0
68 0 0 0 0 0 0 0 0 0 0 0
69 0 0 0 0 0 0 0 0 0 0 0
70 0 0 0 0 0 0 0 0 0 0 0
71 0 0 0 0 0 0 0 0 0 0 0
72 0 0 0 0 0 0 0 0 0 0 0
73 0 0 0 0 0 0 0 0 0 0 0
74 0 0 0 0 0 0 0 0 0 0 0
75 0 0 0 0 0 0 0 0 0 0 0
76 0 0 0 0 0 0 0 0 0 0 0
77 0 0 0 0 0 0 0 0 0 0 0
78 0 0 0 0 0 0 0 0 0 0 0
79 0 0 0 0 0 0 0 0 0 0 0
80 0 0 0 0 0 0 0 0 0 0 0
81 0 0 0 0 0 0 0 0 0 0 0
82 0 0 0 0 0 0 0 0 0 0 0
83 0 0 0 0 0 0 0 0 0 0 0
84 0 0 0 0 0 0 0 0 0 0 0
85 0 0 0 0 0 0 0 0 0 0 0
86 0 0 0 0 0 0 0 0 0 0 0
87 0 0 0 0 0 0 0 0 0 0 0
88 0 0 0 0 0 0 0 0 0 0 0
89 0 0 0 0 0 0 0 0 0 0 0
90 0 0 0 0 0 0 0 0 0 0 0
91 0 0 0 0 0 0 0 0 0 0 0
92 0 0 0 0 0 0 0 0 0 0 0
93 0 0 0 0 0 0 0 0 0 0 0
94 0 0 0 0 0 0 0 0 0 0 0
95 0 0 0 0 0 0 0 0 0 0 0
96 0 0 0 0 0 0 0 0 0 0 0
97 0 0 0 0 0 0 0 0 0 0 0
98 0 0 0 0 0 0 0 0 0 0 0
99 0 0 0 0 0 0 0 0 0 0 0
100 0 0 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 0 0 0

INDIKATOR :
1.    Persalinan ditolong oleh tenaga kesehatan
2.    Memberi bayi ASI ekskusif
3.    Menimbang bayi dan balita setiap bulan
4.    Menggunakan air bersih
5. Cuci tangan pakai sabun
6. Pengelolaan air minum dan makan di rumah tangga
7. Menggunakan jamban sehat (stop BABS)
8. Pengelolaan limbah cair di rumah tangga
9. Membuang sampah pada tempatnya
10.  Memberantas jentik di rumah
11.  Makan sayur dan buah setiap hari
12.  Melakukan aktifitas fisik minimal 30 menit per hari
13.  Tidak merokok di dalam rumah

PETUNJUK PENGISIAN :
0. Jika jawaban" tidak"
1. Jawaban "YA" (artinya perilaku sesuai dengan indikator)
2. Tidak ada sasaran

PHBS : Jika indikator 1 sampai dengan indikator 13 terpenuhi


NGGA TINGKAT RT

SASARAN PS
12 13 1 2 3 11 12 1 2 3 11 12 PHBS
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 100 100 100 100 100 0 0 0 0 0 0
REKAPITULASI HASIL PEMANTAUAN PHBS TATANAN RUMAH TANGGA TINGKAT RT
Tahun : 2022
Semester :
RT : 20
Dusun :
Desa :
Kecamatan :

INDIKATOR PHBS
No Nama Kepala Rumah Tangga
1 2 3 4 5 6 7 8 9 10 11 12 13 1 2 3 4 5 6 7 8 9 10 11
1 0 0 0 0 0 0 0 0 0 0 0
2 0 0 0 0 0 0 0 0 0 0 0
3 0 0 0 0 0 0 0 0 0 0 0
4 0 0 0 0 0 0 0 0 0 0 0
5 0 0 0 0 0 0 0 0 0 0 0
6 0 0 0 0 0 0 0 0 0 0 0
7 0 0 0 0 0 0 0 0 0 0 0
8 0 0 0 0 0 0 0 0 0 0 0
9 0 0 0 0 0 0 0 0 0 0 0
10 0 0 0 0 0 0 0 0 0 0 0
11 0 0 0 0 0 0 0 0 0 0 0
12 0 0 0 0 0 0 0 0 0 0 0
13 0 0 0 0 0 0 0 0 0 0 0
14 0 0 0 0 0 0 0 0 0 0 0
15 0 0 0 0 0 0 0 0 0 0 0
16 0 0 0 0 0 0 0 0 0 0 0
17 0 0 0 0 0 0 0 0 0 0 0
18 0 0 0 0 0 0 0 0 0 0 0
19 0 0 0 0 0 0 0 0 0 0 0
20 0 0 0 0 0 0 0 0 0 0 0
21 0 0 0 0 0 0 0 0 0 0 0
22 0 0 0 0 0 0 0 0 0 0 0
23 0 0 0 0 0 0 0 0 0 0 0
24 0 0 0 0 0 0 0 0 0 0 0
25 0 0 0 0 0 0 0 0 0 0 0
26 0 0 0 0 0 0 0 0 0 0 0
27 0 0 0 0 0 0 0 0 0 0 0
28 0 0 0 0 0 0 0 0 0 0 0
29 0 0 0 0 0 0 0 0 0 0 0
30 0 0 0 0 0 0 0 0 0 0 0
31 0 0 0 0 0 0 0 0 0 0 0
32 0 0 0 0 0 0 0 0 0 0 0
33 0 0 0 0 0 0 0 0 0 0 0
34 0 0 0 0 0 0 0 0 0 0 0
35 0 0 0 0 0 0 0 0 0 0 0
36 0 0 0 0 0 0 0 0 0 0 0
37 0 0 0 0 0 0 0 0 0 0 0
38 0 0 0 0 0 0 0 0 0 0 0
39 0 0 0 0 0 0 0 0 0 0 0
40 0 0 0 0 0 0 0 0 0 0 0
41 0 0 0 0 0 0 0 0 0 0 0
42 0 0 0 0 0 0 0 0 0 0 0
43 0 0 0 0 0 0 0 0 0 0 0
44 0 0 0 0 0 0 0 0 0 0 0
45 0 0 0 0 0 0 0 0 0 0 0
46 0 0 0 0 0 0 0 0 0 0 0
47 0 0 0 0 0 0 0 0 0 0 0
48 0 0 0 0 0 0 0 0 0 0 0
49 0 0 0 0 0 0 0 0 0 0 0
50 0 0 0 0 0 0 0 0 0 0 0
51 0 0 0 0 0 0 0 0 0 0 0
52 0 0 0 0 0 0 0 0 0 0 0
53 0 0 0 0 0 0 0 0 0 0 0
54 0 0 0 0 0 0 0 0 0 0 0
55 0 0 0 0 0 0 0 0 0 0 0
56 0 0 0 0 0 0 0 0 0 0 0
57 0 0 0 0 0 0 0 0 0 0 0
58 0 0 0 0 0 0 0 0 0 0 0
59 0 0 0 0 0 0 0 0 0 0 0
60 0 0 0 0 0 0 0 0 0 0 0
61 0 0 0 0 0 0 0 0 0 0 0
62 0 0 0 0 0 0 0 0 0 0 0
63 0 0 0 0 0 0 0 0 0 0 0
64 0 0 0 0 0 0 0 0 0 0 0
65 0 0 0 0 0 0 0 0 0 0 0
66 0 0 0 0 0 0 0 0 0 0 0
67 0 0 0 0 0 0 0 0 0 0 0
68 0 0 0 0 0 0 0 0 0 0 0
69 0 0 0 0 0 0 0 0 0 0 0
70 0 0 0 0 0 0 0 0 0 0 0
71 0 0 0 0 0 0 0 0 0 0 0
72 0 0 0 0 0 0 0 0 0 0 0
73 0 0 0 0 0 0 0 0 0 0 0
74 0 0 0 0 0 0 0 0 0 0 0
75 0 0 0 0 0 0 0 0 0 0 0
76 0 0 0 0 0 0 0 0 0 0 0
77 0 0 0 0 0 0 0 0 0 0 0
78 0 0 0 0 0 0 0 0 0 0 0
79 0 0 0 0 0 0 0 0 0 0 0
80 0 0 0 0 0 0 0 0 0 0 0
81 0 0 0 0 0 0 0 0 0 0 0
82 0 0 0 0 0 0 0 0 0 0 0
83 0 0 0 0 0 0 0 0 0 0 0
84 0 0 0 0 0 0 0 0 0 0 0
85 0 0 0 0 0 0 0 0 0 0 0
86 0 0 0 0 0 0 0 0 0 0 0
87 0 0 0 0 0 0 0 0 0 0 0
88 0 0 0 0 0 0 0 0 0 0 0
89 0 0 0 0 0 0 0 0 0 0 0
90 0 0 0 0 0 0 0 0 0 0 0
91 0 0 0 0 0 0 0 0 0 0 0
92 0 0 0 0 0 0 0 0 0 0 0
93 0 0 0 0 0 0 0 0 0 0 0
94 0 0 0 0 0 0 0 0 0 0 0
95 0 0 0 0 0 0 0 0 0 0 0
96 0 0 0 0 0 0 0 0 0 0 0
97 0 0 0 0 0 0 0 0 0 0 0
98 0 0 0 0 0 0 0 0 0 0 0
99 0 0 0 0 0 0 0 0 0 0 0
100 0 0 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 0 0 0

INDIKATOR :
1.    Persalinan ditolong oleh tenaga kesehatan
2.    Memberi bayi ASI ekskusif
3.    Menimbang bayi dan balita setiap bulan
4.    Menggunakan air bersih
5. Cuci tangan pakai sabun
6. Pengelolaan air minum dan makan di rumah tangga
7. Menggunakan jamban sehat (stop BABS)
8. Pengelolaan limbah cair di rumah tangga
9. Membuang sampah pada tempatnya
10.  Memberantas jentik di rumah
11.  Makan sayur dan buah setiap hari
12.  Melakukan aktifitas fisik minimal 30 menit per hari
13.  Tidak merokok di dalam rumah

PETUNJUK PENGISIAN :
0. Jika jawaban" tidak"
1. Jawaban "YA" (artinya perilaku sesuai dengan indikator)
2. Tidak ada sasaran

PHBS : Jika indikator 1 sampai dengan indikator 13 terpenuhi


NGGA TINGKAT RT

SASARAN PS
12 13 1 2 3 11 12 1 2 3 11 12 PHBS
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 1 1 1 1 1 0 0 0 0 0 0
0 0 0 100 100 100 100 100 0 0 0 0 0 0
REKAPITULASI HASIL PEMANTAUAN PHBS TATANAN RUMAH
Tahun : 2022
Semester :
Dusun :
Desa :
Kecamatan :
Jumlah rumah Tangga :

INDIKATOR
JML RUMAH
No RT
TANGGA 1 2 3 4 5
P S PS P S PS P S PS P P
1 RT 1 0 0 100 0 0 100 0 0 100 0 0 0
2 RT 2 0 0 100 0 0 100 0 0 100 0 0 0
3 RT 3 0 0 100 0 0 100 0 0 100 0 0 0
4 RT 4 0 0 100 0 0 100 0 0 100 0 0 0
5 RT 5 0 0 100 0 0 100 0 0 100 0 0 0
6 RT 6 0 0 100 0 0 100 0 0 100 0 0 0
7 RT 7 0 0 100 0 0 100 0 0 100 0 0 0
8 RT 8 0 0 100 0 0 100 0 0 100 0 0 0
9 RT 9 0 0 100 0 0 100 0 0 100 0 0 0
10 RT 10 0 0 100 0 0 100 0 0 100 0 0 0
11 RT 11 0 0 100 0 0 100 0 0 100 0 0 0
12 RT 12 0 0 100 0 0 100 0 0 100 0 0 0
13 RT 13 0 0 100 0 0 100 0 0 100 0 0 0
14 RT 14 0 0 100 0 0 100 0 0 100 0 0 0
15 RT 15 0 0 100 0 0 100 0 0 100 0 0 0
16 RT 16 0 0 100 0 0 100 0 0 100 0 0 0
17 RT 17 0 0 100 0 0 100 0 0 100 0 0 0
18 RT 18 0 0 100 0 0 100 0 0 100 0 0 0
19 RT 19 0 0 100 0 0 100 0 0 100 0 0 0
20 RT 20 0 0 100 0 0 100 0 0 100 0 0 0
Jumlah 0 0 2000 0 0 2000 0 0 2000 0 0 0
Persentase 0.00% 0.00% 0.00% #DIV/0! #DIV/0!
INDIKATOR :
1.    Persalinan ditolong oleh tenaga kesehatan
2.    Memberi bayi ASI ekskusif
3.    Menimbang bayi dan balita setiap bulan
4.    Menggunakan air bersih
5.    Cuci Tangan Pakai Sabun
6. Pengelolaan air minum dan makan di rumah tangga
7.    Menggunakan jamban sehat STOP BABS
8. Pengelolaan Limbah cair rumah tangga
9. Membuang sampah di tempat sampah
10.    Memberantas jentik nyamuk
11.    Makan sayur dan buah setiap hari
12.    Melakukan aktifitas fisik setiap hari
13.  Tidak merokok di dalam rumah
HBS TATANAN RUMAH TANGGA TINGKAT RT

INDIKATOR

6 7 8 9 10 11 12 13 PHBS
P P P P P P S PS P S PS P (23)
0 0 0 0 0 0 100 0 0 100 0 0 0
0 0 0 0 0 0 100 0 0 100 0 0 0
0 0 0 0 0 0 100 0 0 100 0 0 0
0 0 0 0 0 0 100 0 0 100 0 0 0
0 0 0 0 0 0 100 0 0 100 0 0 0
0 0 0 0 0 0 100 0 0 100 0 0 0
0 0 0 0 0 0 100 0 0 100 0 0 0
0 0 0 0 0 0 100 0 0 100 0 0 0
0 0 0 0 0 0 100 0 0 100 0 0 0
0 0 0 0 0 0 100 0 0 100 0 0 0
0 0 0 0 0 0 100 0 0 100 0 0 0
0 0 0 0 0 0 100 0 0 100 0 0 0
0 0 0 0 0 0 100 0 0 100 0 0 0
0 0 0 0 0 0 100 0 0 100 0 0 0
0 0 0 0 0 0 100 0 0 100 0 0 0
0 0 0 0 0 0 100 0 0 100 0 0 0
0 0 0 0 0 0 100 0 0 100 0 0 0
0 0 0 0 0 0 100 0 0 100 0 0 0
0 0 0 0 0 0 100 0 0 100 0 0 0
0 0 0 0 0 0 100 0 0 100 0 0 0
0 0 0 0 0 0 2000 0 0 2000 0 0 0
#DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! 0.00% 0.00% #DIV/0! #DIV/0!
Capaian
1 0.00%
2 0.00% Persentase Rumah Tangga ber-PHBS
3 0.00%
4 #DIV/0! Dusun ........ Tahun 2022
5 #DIV/0! 1 2
6 #DIV/0! 3 4
7 #DIV/0! 100.00% 5 6
8 #DIV/0! 7 8
9 #DIV/0! 80.00%
9 10
10 #DIV/0! 60.00% 11 12
11 0.00%
12 0.00% 40.00% 13
13 #DIV/0!
20.00%
0.00%
1 2 3 4 5 6 7 8 9 10 11 12 13

PHBS #DIV/0!
Tidak ber-PHBS #DIV/0!
Persentase Rumah Tangga ber-
PHBS Tahun 2022

PHBS
Tidak ber-PHBS
PHBS
1 2
3 4
5 6
7 8
9 10
11 12
13

12 13

er-

HBS
dak ber-PHBS

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