KEMENTRIAN KESEHATAN REPUBLIK INDONESIA / MINISTRY OF HEALTH REPUBLIC OF INDONESIA

DIREKTORAT JENDERAL PP & PL / DIRECTORATE GENERAL OF DISEASE CONTROL AND ENVIRONMENTAL SANITATION
KANTOR KESEHATAN PELABUHAN KELAS II CILACAP / PORT HEALTH OFFICE OF CILACAP

PENGAMATAN VEKTOR & RESERVOIR PENYAKIT

Form of Vector Observation and Reservoir Disease

NAMA KAPAL / Name of Ship

JENIS KAPAL / ship types

PELABUHAN TERAKHIR/Last Port

BENDERA/Flag

TANGGAL, WAKTU / Hour, Date

IMO

LABUH-SANDAR/Anchorage-Berthing

ABK/ Crew

TONASE / Tonnage

VARIABEL

RUANGAN

NO

TIKUS / Rats*)

Compartment
A
1

NYAMUK / Mosquito
species

species

KECOAK / Cocroach
A

species

LALAT / Fly
A

species

DAPUR
Galley

RUANG SAJI
Pantry

GUDANG
Stores

Gudang makanan
dry provision store

KAMAR/
Cabin

GELADAK/
Deck

RUANG KONTROL
Control Room

RUANG MESIN
Engine room
Terpasang

Tidak Terpasang

Baik

Rusak

installed

not installed

properly

damaged

9 RAT GUARD

*) Keberadaan tikus termasuk adanya bau tikus, bekas urine dan kotoran tikus, suara, bangkai tikus (WHO, 1972).
presence of rodents, including the smell of rat, mouse droppings and urine marks, sounds, dead rats (WHO, 1972)

KETERANGAN

(abbreviation)

INTERPRETASI
(Interpretation )

KESIMPULAN

(Conclusion )

SARAN
(recommendation )

A : Adult (dewasa)
G : Gnawing (bekas gigitan)
D : Dropping (kotoran tikus)
R : Runways (jalan tikus)
F : Foot print (bekas telapak kaki)
L : Larva (Jentik)
O : Ootheca (kantung telur kecoak)

Nahkoda / Master's

Pemeriksa / Inspector