7/25/2019 KUESIONER PENELITIAN SAMPAH

1/3

KUESIONER PENELITIAN

PENGETAHUAN SIKAP DAN PERILAKU PEMBUANGAN DAN PENGOLAHAN SAMPAHRUMAHTANGGA DI WILAYAH KERJA PUSKESMAS TELING ATAS, MANADO

PERIODE 22 OKTOBER 2014 22 FEBRUARI 2015

Nomo K!"#$o%"&

Semua data yang tercantum di bawah ini akan dirahasiakan !!!

DATA UMUM

1' N(m( "#)o%*"% &2' U#$( + #"#!($ KTP &-' A.(m(/ &4' P"%*$*$(% /"($ & 3 SD#"*"((/

3 SMP#"*"((/

3 SMA#"*"((/ 3 P"6!!(% T$%66$#"*"((/ m!($ D- 3 T$*( S"o.(

+ T(%*($ + 7 (8(9(% :(%6 #"#!($

5' P""((% & 3 B""( 3 T$*( B""(

+ T(%*($ + 7 (8(9(% :(%6 #"#!($

;' P"%6(#$.(% K".!(6( & R)

7/25/2019 KUESIONER PENELITIAN SAMPAH

2/3

9' M"%6!9( )"$.(! #"#"o(%6 !%/! /")"%6(! )(*( )"%:!.!(% /"%/(%6 #(m)(C' T$*( A*(

5' A)(( :(%6 *$m(#!* /"%/(%6 m"%*(! !.(%6 #(m)(?(' M"%6!9( #(m)( m"%(*$ 9((%6 9(! :(%6 #$() *$ )(($

9' M"%66!%((% "m9(.$ 9((%6 .(m( :(%6 m(#$ 9$#( *$)(($C' M"%6!9( 9"%/! #(m)(

;' A)(( :(%6 /"m(#! *(.(m #(m)( o6(%$?(' S$#( #(:!#(:!(% *(% 9!(, *(!% "$%6, *(% #$#( m((%(%

9' S$#( #(:!#(:!(% *(% 9!(, ).(#/$ *(% #$#( m((%(%C' K"/(#, 9o/o. m$%!m(%, (."%6(."%6(%

=' A)(( :(%6 *$m(#!* *"%6(% m"%66!%((% "m9(.$ #(m)(?(' M"%6!9( #(m)( m"%(*$ 9((%6 9(! :(%6 #$() *$)(($

9' M"%66!%((% "m9(.$ 9((%6 .(m( :(%6 m(#$ 9$#( *$)(($C' M"%6!9( 9"%/! #(m)(

' A)( :(%6 *$m(#!* *"%6(% 8(*( #(m)( :(%6 9($ *$6!%((% *$ !m(?(' T"m)(/ m"%(m)!%6 #(m)( :(%6 "*() ($, m!*( *$o#o%6(% *$)$%*((%,

"o%om$#, m!*( *$)"o.", *(% *$9!(/ o." m(#:(((/'

9' T"m)(/ m"%(m)!%6 #(m)( :(%6 m!*( *$)"o." *(% *$9!(/ m(#:(((/'C' T"m)(/ !%/! m"%(m)!%6 #(m)( )"m(%"%, 9"!!(% 9"#(,*(% /$*( *()(/

*$)$%*((%

B. Sikap

Beriah tanda pada saahsatu k"tak #SS$S$%%$TS$TSS& yang paing sesuai dengan

Anda.

Keterangan '

SS ( Sangat Setu)u S ( Setu)u %% (%agu*%agu TS ( Tidak Setu)u

STS ( Sangat Tidak Setu)u

+" Pernyataan SS S %% TS STS, M"m9!(%6 #(m)( #"m9((%6(%

*$9"$(% #(%#$'- M"%6!(%6$ #(m)( *"%6(% C((

m"m9(( #(m)( #"%*$$' M"m)"(/$(% /(%*(/(%*( (/(!

.(m9(%6 )(*( 8(*( #(m)(

/ M"%6$!/$ )"%:!.!(% /"%/(%6 #(m)('0 M"%66!%((% #(m)( (."%6 #"9(6($

$(#(% *$ *$%*$%6 (/(! (# 9!%6(1 M"m$#((% #(m)( m!*( m"m9!#!

*(% :(%6 /$*( m"m9!#!2 M"m9(8( /(# 9"(# #((/ 9"9".(%( *$

)(#( #"9(6($ )"%66(%/$ (%/o%6 ).(#/$'3 M"%66!%((% (*!# 9"(# #"9(6($

/"m)(/ )"%(m)!%6(% #(m)('

4. Periaku

7/25/2019 KUESIONER PENELITIAN SAMPAH

3/3