HKN

FORMAT PENILAIAN RUANGAN No Item Penilaian Hasil Penilaian Baik Sedang Tidak I Kebersihan Ruangan a Kebersihan Lantai b Kebersihan dinding c Kebersihan Kamar mandi d Kondisi Plafon e Kaca Jendela f Kaca Pintu g lantai Kamar Mandi h Closet i BAK Kamar Mandi j Dinding Kamar mandi K Plafon Kamar mandi l Wastafel m Tangga n Teras o Halaman p Pembuangan Sampah q Pemilahan Sampah Medis r SPAL/GOT s Lemari t Tempat Tidur II Petugas a Kerapian Pakaian Petugas b Kecakapan Melakukan Tindakan c Kepedulian Terhadap Pasien d Melakukan Hubungan Teurapetik dengan pasien e Prosedur pemberian asuhan keperawatan - Pengkajian - Diagnosa Keperawatan - Implementasi - Evaluasi Jumlah Hasil Penilaian Kurang Katagori Penilaian 1. Nilai 63 S/D 84 : Baik 2. Nilai 42 S/D 62 : Sedang 3. Nilai < 42 : Kurang

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R.SarafFORMAT PENILAIAN RUANGANNoItem PenilaianHasil PenilaianNilaiBaikSedangTidakIKebersihan RuanganaKebersihan Lantai0bKebersihan dinding0cKebersihan Kamar mandi0dKondisi Plafon0eKaca Jendela0fKaca Pintu0glantai Kamar Mandi0hCloset0iBAK Kamar Mandi0jDinding Kamar mandi0KPlafon Kamar mandi0lWastafel0mTangga0nTeras0oHalaman0pPembuangan Sampah0qPemilahan Sampah Medis0rSPAL/GOT0sLemari0tTempat Tidur0IIPetugasaKerapian Pakaian Petugas0bKecakapan Melakukan Tindakan0cKepedulian Terhadap Pasien075dMelakukan Hubungan Teurapetik50dengan pasien0eProsedur pemberian asuhan keperawatan- Pengkajian0- Diagnosa Keperawatan0- Implementasi0- Evaluasi0Jumlah0Hasil PenilaianKurangKatagori Penilaian1.Nilai 63 S/D 84 : Baik2.Nilai 42 S/D 62 : Sedang3.Nilai < 42 : Kurang

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Format rinaFORMAT PENILAIAN RUANGANRuangan :Tanggal :NoItem PenilaianHasil PenilaianNilaiBaikKurangTidakIKebersihan RuanganaKebersihan LantaibKebersihan dindingcKebersihan Kamar mandidKondisi PlafoneKaca JendelafKaca Pintuglantai Kamar MandihClosetiBAK Kamar MandijDinding Kamar mandiKPlafon Kamar mandilWastafelmTangganTerasoHalamanpPembuangan SampahqPemilahan Sampah MedisrSPAL/GOTsLemaritTempat TidurIIPetugasaKerapian Pakaian PetugasbKecakapan Melakukan TindakancKepedulian Terhadap Pasien75dMelakukan Hubungan Teurapetik50dengan pasieneProsedur pemberian asuhan keperawatan- Pengkajian- Diagnosa Keperawatan- Implementasi- EvaluasiJumlahHasil PenilaianKatagori Penilaian1.Nilai 63 S/D 84 : Baik2.Nilai 42 S/D 62 : Sedang3.Nilai < 42 : Kurang

Format pOLIFORMAT PENILAIAN RUANGANNoItem PenilaianHasil PenilaianNilaiBaikKurangTidakIKebersihan RuanganaKebersihan LantaibKebersihan dindingcKebersihan Kamar mandidKondisi PlafoneKaca JendelafKaca Pintuglantai Kamar MandihClosetiBAK Kamar MandijDinding Kamar MandiKPlafon Kamar MandilWastafelmTangganTerasoHalamanpPembuangan SampahqPemilahan Sampah MedisrSPAL/GOTsLemaritTempat TidurIIPetugasaKerapian Pakaian PetugasbKecakapan Melakukan TindakancKepedulian Terhadap Pasien75dMelakukan Hubungan Teurapetik50dengan pasieneTersedianya dokter pada saat jam KerjaJumlahHasil PenilaianKatagori Penilaian1.Nilai 63 S/D 84 : Baik2.Nilai 42 S/D 62 : Sedang3.Nilai < 42 : Kurang

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CV HKN August 16!

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