00 PROSEDUR PENGURUSAN PENYELIDIKAN MS ISO 9001

Transcription

00 PROSEDUR PENGURUSAN PENYELIDIKAN MS ISO 9001
Prosedur Pengurusan
Penyelidikan
MS ISO 9001:2008
Prosedur Pengurusan Penyelidikan MS ISO 9001:2008
INSTITUT PENYELIDIKAN PERUBATAN
KUALA LUMPUR
PROSEDUR PENGURUSAN
PENYELIDIKAN
SISTEM PENGURUSAN KUALITI
MS ISO 9001:2008
PPP/IMR
Tarikh Kuatkuasa
5 Nov 2008
Institut Penyelidikan Perubatan
Jalan Pahang,
50588 Kuala Lumpur
Diluluskan Oleh
Dr Shahnaz bt Murad
Pengarah Institut Penyelidikan Perubatan
Dikeluarkan Kepada:
No Salinan Terkawal:
‐Prosedur Pengurusan Penyelidikan‐ Institut Penyelidikan Perubatan Kuala Lumpur SENARAI KANDUNGAN
Bhgn
Perkara
Mukasurat
Rekod Pindaan
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Objektif
Skop
Rujukan
Definisi dan Singkatan
Definisi
Singkatan
Tanggungjawab dan Tindakan
Penerimaan dan Penyemakan Proposal Melalui Kaedah Manual
Penerimaan dan Penyemakan Proposal Melalui Kaedah
Pendaftaran Penyelidikan NMRR
Mesyuarat JPP-IMR Untuk Penilaian Keseluruhan Proposal
Melalui Penyerahan Secara Manual Atau Kaedah Pendaftaran
NMRR
Pemantauan Kemajuan Penyelidikan
Pemantauan Penamatan Penyelidikan
Pemantauan Selepas Tamat Projek
Pemantauan Hasil Penyelidikan (Penerbitan/ Pembentangan/
Paten)
Penutupan Fail Projek
Rekod Pelaksanaan
Senarai Lampiran
Borang JTP/KKM-3ver1.1
Borang Semakan Proposal Baru Penyelidikan
Ministry Of Health Grant Technical Evaluation Form
Quarterly Financial Report
Project Activity Report
Milestone Achievement Report
End of Project Report
Laporan Pemantauan Hasil Penyelidikan
Permohonan Menghadiri Seminar dan Membentangkan Kertas
Saintifik serta Pembiayaan
Permohonan Kelulusan Menerbitkan Hasil Penyelidikan
Borang Soal Selidik Kepuasan Pelanggan
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‐Prosedur Pengurusan Penyelidikan‐ Institut Penyelidikan Perubatan Kuala Lumpur REKOD PINDAAN
Keluaran
/Pindaan
1.1
Tarikh
Keterangan Ringkas
Pindaan
07/06/10 Pindaan ke atas keseluruhan
Prosedur Pengurusan
Penyelidikan hasil daripada
semakan dan penambahbaikan
dokumentasi ISO 9001:2008
Seksyen/
Mukasurat
Terlibat
Diluluskan
Oleh
Semua
Pengarah
IMR
‐Prosedur Pengurusan Penyelidikan‐ Institut Penyelidikan Perubatan Kuala Lumpur 1. OBJEKTIF
a) Untuk memastikan projek penyelidikan dijalankan mengikut peraturan yang ditetapkan
oleh JPP-IMR berasaskan kehendak pelanggan (agensi peruntukan).
b) Untuk memastikan proses pengurusan sesebuah projek penyelidikan dilakukan
secara teliti dan teratur.
2. SKOP
Prosedur ini digunakan sebagai panduan oleh semua penyelidik bermula dari proses
penyediaan proposal sehingga penutupan projek. Ia juga digunakan oleh Urusetia JPPIMR untuk menguruskan projek penyelidikan di IMR.
3. RUJUKAN
i. MS ISO 9001:2008
ii. Manual Kualiti
iii. NIH Guidelines and Forms
iv.
MOSTI Guidelines and Forms
v. Garis Panduan Penilaian dan Pemantauan Pengurusan Penyelidikan
4. DEFINISI DAN SINGKATAN
DEFINISI
Agensi Peruntukan
: Agensi yang akan membiayai projek penyelidikan seperti
NIH, MOSTI dan agensi lain.
Ketua Penyelidik
: Pegawai yang mengetuai Pasukan Penyelidik
Pasukan Penyelidik
: Terdiri daripada pegawai perubatan, pegawai penyelidik,
kolaborator dan kumpulan sokongan yang dikenalpasti
dalam cadangan projek penyelidikan
Kolaborator
: Institusi yang bekerjasama dengan ketua penyelidik
JPP-IMR
: Jawatankuasa yang dipengerusikan oleh Pengarah IMR
dan ahli-ahlinya terdiri daripada beberapa orang pakar
dalam disiplin tertentu yang dilantik oleh Pengarah
Jawatankuasa Etika dan
Penyelidikan Perubatan
(MREC)
: Jawatankuasa yang dipengerusikan oleh Timbalan Ketua
Pengarah Kesihatan (Penyelidikan dan Sokongan
Teknikal), KKM. Ahli-ahlinya terdiri daripada PengarahPengarah Institut di bawah NIH, pakar perubatan dan
penyelidik dalam disiplin tertentu daripada KKM dan
universiti, wakil Akademi Perubatan Malaysia, ahli
farmasi,
pegawai
undang-undang,
jururawat,
juruteknologi makmal perubatan dan lain-lain lagi.
1-7
‐Prosedur Pengurusan Penyelidikan‐ Institut Penyelidikan Perubatan Kuala Lumpur Jawatankuasa
Penjagaan dan
Penggunaan Haiwan
Makmal (ACUC)
: Jawatankuasa yang terdiri daripada pegawai veterinar,
pegawai perubatan dan pegawai penyelidik daripada
Institut Penyelidikan Perubatan, universiti-universiti
tempatan dan Jabatan Perkhidmatan Haiwan.
SINGKATAN
JPP-IMR
: Jawatankuasa Penilaian Penyelidikan IMR
Urusetia
: Urusetia Jawatankuasa Penilaian Penyelidikan IMR
NMRR
: National Medical Research Register
MREC
: Medical Research and Ethics Committee (Jawatankuasa
Etika dan Penyelidikan Perubatan)
ACUC
: Animal Care and Use Committee (Jawatankuasa
Penjagaan dan Penggunaan Haiwan Makmal)
NIH
: National Institutes of Health (Institut Kesihatan
Kebangsaan)
KKM
: Kementerian Kesihatan Malaysia
MOSTI
: Ministry of Science, Technology and Innovations
2-7
‐Prosedur Pengurusan Penyelidikan‐ Institut Penyelidikan Perubatan Kuala Lumpur 5. TANGGUNGJAWAB DAN TINDAKAN
TANGGUNGJAWAB
TINDAKAN
Penerimaan dan Penyemakan Proposal Melalui Kaedah
Manual
Urusetia
1.
Mengedar Borang Proposal melalui laman web IMR, e-mel
atau hard copy untuk diisi oleh Ketua Penyelidik.
2.
Menerima borang proposal daripada Ketua Penyelidik yang
telah diluluskan oleh Ketua Pusat / Ketua Unit. Salinan
secukupnya perlu disediakan oleh Ketua Penyelidik untuk
diedarkan kepada anggota panel JPP-IMR.
3.
Memberi nombor kod JPP-IMR kepada setiap proposal yang
diterima.
4.
Menyemak proposal mengikut Borang Semakan Proposal
Baru Penyelidikan yang mengandungi perkara-perkara
berikut:
- Gantt Chart
- Budget: Direct Project Funding
- Budget: Disbursement Schedule
- Funding Sources
- Contractual Matters
- CV of All Key Researchers
5.
Mengedarkan salinan proposal lengkap kepada anggota
panel JPP-IMR untuk dinilai sebelum mesyuarat JPP-IMR.
Penerimaan dan Penyemakan Proposal Melalui Kaedah
Pendaftaran Penyelidikan NMRR
Ketua Penyelidik
6.
Mendaftar sebagai penyelidik melalui laman web
‘www.nmrr.gov.my’ untuk mendapatkan ‘ID penyelidik’.
Ketua Penyelidik
7.
Menyediakan proposal penyelidikan mengikut format yang di
tetapkan di dalam laman web tersebut.
8.
Menghantar proposal bagi penilaian oleh panel JPP-IMR
(Reviewer) secara on-line.
9.
Menghantar e-mel ‘alert’ kepada Urusetia JPP-IMR untuk
memulakan proses penilaian.
Urusetia NMRR
Urusetia
10. Memberi tugas kepada panel JPP-IMR (Reviewer) yang
berkaitan bagi penilaian proposal penyelidikan.
JPP-IMR
11. Menilai proposal melalui laman web NMRR sebelum
mesyuarat JPP-IMR.
3-7
‐Prosedur Pengurusan Penyelidikan‐ Institut Penyelidikan Perubatan Kuala Lumpur TANGGUNGJAWAB
TINDAKAN
Mesyuarat JPP-IMR Untuk Penilaian Keseluruhan Proposal
Melalui Penyerahan Secara Manual Atau Kaedah Pendaftaran
NMRR
Urusetia
12. Mencadangkan kepada Pengerusi JPP-IMR supaya penilaian
proposal penyelidikan dimasukkan ke dalam agenda
Mesyuarat JPP-IMR.
13. Menetapkan tarikh mesyuarat JPP-IMR untuk penilaian
proposal.
14. Memaklumkan tarikh mesyuarat beserta jadual penilaian
proposal kepada Ketua Penyelidik yang berkenaan dan
semua ahli panel JPP-IMR.
JPP-IMR
15. Menilai dan membuat keputusan mengenai proposal
penyelidikan.
Urusetia
16. Memaklumkan keputusan penilaian proposal kepada Ketua
Penyelidik dengan keputusan seperti di bawah:

Lulus: tiada pindaan

Lulus dengan pindaan: pindaan perlu dibuat dalam
tempoh masa yang ditetapkan

Lulus bersyarat: perlu memenuhi syarat yang ditetapkan
oleh JPP-IMR/NIH/KKM (contoh: kelulusan dari MREC)

Tidak diluluskan
17. Memaklumkan tindakan pembetulan yang perlu diambil oleh
Ketua Penyelidik.
18. Menerima proposal yang telah dipinda beserta maklumat
pindaan / pembetulan dari Ketua Penyelidik.
19. Mengemukakan proposal yang telah dipinda beserta Ministry
Of Health Grant Technical Evaluation Form yang telah
dinilai oleh Pengerusi Panel JPP-IMR kepada Agensi
Peruntukan untuk mendapatkan kelulusan melalui Pengarah
IMR.
Pengarah
20. Menerima keputusan daripada Agensi Peruntukan dan
serahkan kepada Urusetia.
Urusetia
21. Memaklumkan keputusan Agensi Peruntukan beserta
dengan pecahan peruntukan kepada Ketua Penyelidik dan
satu salinan dikemukakan kepada Unit Kewangan.
Ketua Penyelidik
22. Semua urusan kewangan boleh dijalankan setelah surat
pecahan peruntukan diedarkan kepada Ketua Penyelidik dan
Unit Kewangan IMR.
4-7
‐Prosedur Pengurusan Penyelidikan‐ Institut Penyelidikan Perubatan Kuala Lumpur TANGGUNGJAWAB
TINDAKAN
Pemantauan Kemajuan Penyelidikan
Urusetia
23. Memaklumkan kepada Ketua Penyelidik untuk menyediakan
laporan Suku Tahunan dan Setengah Tahunan selewatlewatnya seminggu sebelum tarikh yang ditetapkan.
Urusetia
24. Memantau kemajuan projek mengikut garispanduan yang
ditetapkan oleh NIH (rujuk Quarterly Financial Report,
Project Activity Report dan Milestone Achievement
Report Guidelines and Form) atau Agensi Peruntukan
melalui laporan-laporan berikut:
(i) Laporan Suku Tahunan mengandungi:

Quarterly Financial Report
Tarikh Laporan: 31 Mac, 30 Jun, 30 Sep, 31 Dis
(ii) Laporan Setengah Tahunan mengandungi:

Project Activity Report

Milestone Achievement Report
Tarikh Laporan: 15 Jul, 15 Jan (tahun berikutnya)
Ketua Penyelidik
25. Menyediakan laporan kemajuan penyelidikan dengan
melengkapkan borang suku tahunan dan setengah tahunan
dan serahkan kepada Urusetia.
Urusetia
26. Menyemak laporan dan menganalisis data kemajuan projek
dengan menggunakan kaedah yang bersesuaian.
27. Menyerahkan satu salinan laporan suku tahunan dan
setengah tahunan kepada Agensi Peruntukan.
Pemantauan Penamatan Penyelidikan
28. Memantau projek yang telah tamat melalui borang End of
Project Report (rujuk End of Project Report Guidelines
and Form).
29. Memaklumkan kepada Ketua Penyelidik sebaik sahaja projek
tamat mengikut jadual untuk menyerahkan laporan tamat
projek dalam tempoh 3 bulan selepas tamat projek.
Ketua Penyelidik
30. Menyediakan laporan tamat projek dengan melengkapkan
borang End of Project Report dan serahkan kepada
Urusetia.
Urusetia
31. Menyemak dan menganalisis data laporan tamat projek
dengan menggunakan kaedah yang bersesuaian.
32. Menyerahkan satu salinan laporan tamat projek kepada
Agensi Peruntukan.
5-7
‐Prosedur Pengurusan Penyelidikan‐ Institut Penyelidikan Perubatan Kuala Lumpur TANGGUNGJAWAB
TINDAKAN
Pemantauan Selepas Tamat Projek
Urusetia
33. Memantau projek yang telah tamat (rujuk Garis Panduan
Penilaian dan Pemantauan Pengurusan Penyelidikan)
sehingga penutupan projek.
Ketua Penyelidik
34. Menyedia laporan pemantauan selepas tamat projek dengan
melengkapkan Laporan Pemantauan Hasil Penyelidikan
dan serahkan kepada Urusetia bagi setiap setengah
tahunan.
Urusetia
Tarikh Laporan: 15 Jul, 15 Jan (tahun berikutnya).
Pemantauan Hasil Penyelidikan (Penerbitan/ Pembentangan/
Paten)
35. Menerima dan menyimpan satu salinan permohonan
penerbitan yang telah diluluskan oleh Pengarah beserta
manuskrip, pengesahan penerimaan daripada Editor Jurnal
dan salinan artikel yang telah diterbitkan (Permohonan
Kelulusan Menerbitkan Hasil Penyelidikan).
36. Menerima dan menyimpan salinan permohonan
pembentangan yang telah diluluskan oleh Pengarah beserta
abstrak, pengesahan penerimaan daripada pihak penganjur
dan bukti kehadiran pembentang (Permohonan Menghadiri
Seminar dan Membentangkan Kertas Saintifik serta
Pembiayaan).
37. Menerima dan menyimpan salinan permohonan paten yang
telah diluluskan oleh Pengarah dan pengesahan penerimaan
paten.
Penutupan Fail Projek
Urusetia
38. Menutup fail projek setelah JPP-IMR berpuashati dengan
hasil penyelidikan seperti penerbitan, pembentangan
dan/atau permohonan paten.
39. Penutupan fail projek dilakukan setelah mendapat kelulusan
dari panel JPP-IMR
40. Menghantar Borang Soal Selidik Kepuasan Pelanggan
setelah penutupan projek kepada Agensi Peruntukan untuk
penilaian.
41. Merekod dan membuat analisis kepuasan pelanggan setelah
mendapat maklumbalas dari Agensi Peruntukan.
6-7
‐Prosedur Pengurusan Penyelidikan‐ Institut Penyelidikan Perubatan Kuala Lumpur 6.
REKOD PELAKSANAAN
BIL.
NAMA REKOD
i.
Proposal
ii.
Salinan proposal yang telah dipinda
iii.
Semakan Proposal Projek Baru
iv.
Keputusan Agensi Peruntukan
v.
Surat-menyurat berkenaan dengan
keputusan Jawatankuasajawatankuasa penyelidikan
vi.
Quarterly Financial Report
vii.
Project Activity Report
viii.
Milestone Achievement Report
ix.
End of Project Report
LOKASI
TEMPOH
SIMPANAN
Bilik Ketua Penyelidik /
Urusetia
Bilik Ketua Penyelidik /
Urusetia
Bilik Urusetia
5 tahun selepas
projek ditutup
5 tahun selepas
projek ditutup
Bilik Ketua Penyelidik /
Urusetia
Bilik Ketua Penyelidik /
Urusetia
Bilik Ketua Penyelidik /
Urusetia
Bilik Ketua Penyelidik /
Urusetia
Bilik Ketua Penyelidik /
Urusetia
Bilik Ketua Penyelidik /
Urusetia
5 tahun selepas
projek ditutup
5 tahun selepas
projek ditutup
5 tahun selepas
projek ditutup
5 tahun selepas
projek ditutup
5 tahun selepas
projek ditutup
5 tahun selepas
projek ditutup
5 tahun selepas
projek ditutup
7-7
Form JTP/KKM-3ver1.1
I.
A.
Project Identification
NMRR Project ID :
---------------------------------------------------------------------------------------------------------------------B.
Type of Grant (Please tick one only. Small research grants are for amounts not exceeding RM
10,000 each)
Major Research Grant
Small Research Grant
----------------------------------------------------------------------------------------------------------------------C.
Project Title
----------------------------------------------------------------------------------------------------------------------D.
Principal Investigator (Please indicate the name and identification card number of the principal
investigator)
-----------------------------------------------------------------------------------------------------------------------E.
Department (Please indicate the name, address, telephone number and fax number of the
Department in which the principal investigator is based. Where available, indicate the e-mail address
of the principal investigator too)
-----------------------------------------------------------------------------------------------------------------------F.
Key words (Please provide a maximum of 5 key words that describes the research project. These
key words shall be used in a database on research in the Ministry of Health)
Page 1 of 12
Form JTP/KKM-3ver1.1
II.
A.
Objectives of the Project
Objectives of the project (Please describe the measurable general and specific objectives of
the project and define the expected results. Use results-oriented wording with verbs such as ‘to
define …’, ‘to determine …’, ‘to develop …..’ )
-----------------------------------------------------------------------------------------------------------------------B.
Research background of the project (Please indicate if the project is new, modification, or
extension. Give a summary of your literature review and related research to indicate originality and feasibility
of proposed research. If modification, indicate why modification is required. If extension, indicate findings of
previous research project and why extension is required).

Project Status (Please tick one)
New
Modification
of previous
project
Extension
of previous
project
-----------------------------------------------------------------------------------------------------------------------C.
Type of Research (Please tick one only)
o
Scientific (basic) research
o
o
o
Technology development (applied research)
Prototype development (design and engineering)
Social / policy research
-----------------------------------------------------------------------------------------------------------------------D.
Field of Research (Please tick one only)
o
Biomedical
o
o
o
o
o
o
o
Clinical
Public health
Epidemiological
Health systems
Health economics
Behavioural
Others, please specify ………………………………………
-----------------------------------------------------------------------------------------------------------------------E.
Ministry of Health 9MP Health Research Priority Areas being addressed (Please
refer to the Ministry of Health Research Priorities for the 9th Malaysia Plan as in www.nih.gov.my)

CAM Disease / Cross Cutting Group :

Research Scope :

Relative Rank :
-------------------------------------------------------------------------------------------------------------
Page 2 of 12
Form JTP/KKM-3ver1.1
III.
Benefits of the Project
A.
Direct customers / beneficiaries of the project (Please identify clearly, the potential
customers / beneficiaries of the research findings and provide details of their relevance to the health
services. If this is a directed / requested research, please name the health service provider involved)
-----------------------------------------------------------------------------------------------------------------------B.
Outputs expected from the project (Please refer to the outputs in the Guidelines and give
further details. Your actual outputs at the completion of the project shall be compared with the
outputs listed here. Any unjustified shortfall may be detrimental to your future application)
-----------------------------------------------------------------------------------------------------------------------IV. Project Structure (Optional for Small Research Grants)
A.
Departments and research organizations involved in the project (Please identify all
MOH Departments and other research organizations collaborating in the project and describe briefly the role
/ contribution to the project)
Page 3 of 12
Form JTP/KKM-3ver1.1
B.
Project team
Name
Department/ Organization
Principal Investigator :
Co-investigators :
Support staff :
Contract staff : (Indicate numbers)
Total :
Page 4 of 12
Estimated days on
project
Form JTP/KKM-3ver1.1
V.
A.
Research Approach
Project Activities (Please list and describe the main project activities. The timing and duration
of these activities are to be shown in the Gantt chart in Section VI)
-----------------------------------------------------------------------------------------------------------------------B.
Key milestones (Please list and describe the principal milestones of the project. The timing of
milestones is to be shown in the Gantt chart in Section VI. A key milestone is reached when a
significant phase in the project is completed.)
-----------------------------------------------------------------------------------------------------------------------C.
Risks of the project (Please describe the factors that may cause delays in, or prevent
implementation, of the project as proposed above; estimate the degree of risk)

Factors:
Low

Technical risk:

Timing risk:

Budget risk:
Medium
High
------------------------------------------------------------------------------------------------------------D. Duration (Indicate the planned starting date of the project and the elapsed time, in months, to
complete the project. Do not include time for preparation of publication)

Starting date:

Duration (in months):
-----------------------------------------------------------------------------------------------------------------------
Page 5 of 12
Form JTP/KKM-3ver1.1
VI.
Project Schedule
(Please prepare additional pages if necessary)
Project Activities
J
200_
F M A M J J A S O N D J
Use () to indicate planned milestones.
Page 6 of 12
200_
F M A M J J A S O N D
Form JTP/KKM-3ver1.1
VII.
A.
Project Funding
Direct project expenses (Please indicate the yearly costs for the project. The amounts should
only include costs, which are to be requested from the MOH Allocation on Research Development.
Use additional pages if necessary. Details and justification for each cost category should be
prepared in the form shown in Appendix B.*Please refer to your Department’s Financial Unit in
stating the allocation as OS-Objek Sebagai)
Cost category
OS21000 :Travel &
Transportation
(In Country)
OS22000 : Travel &
Transportation
(Overseas)
OS24000 : Rentals
Total RM
200_ RM
200_ RM
200_RM
OS25000 : Raw Materials
OS27000 : Research materials
and Supplies
OS29000 : Special services
OS29000 : Temporary &
contract personnel
OS35000 : Special equipment
and accessories
OTHERS (Please list as OS*)
TOTAL
B.
Disbursement Schedule (Please indicate how the fund requested above in Section VII. A, will
be allocated)
Department/
Organization
Total RM
200_ RM
Page 7 of 12
200_ RM
200_ RM
Form JTP/KKM-3ver1.1
C.
Funding Sources (Please indicate all sources of funding for the project)
Funding Sorces
MOH Allocation on Research
Development (this is the total
RM
amount requested for in Section
VII.A above)
Operating budget
Other sources (please specify)
Page 8 of 12
% of Total Funding
Form JTP/KKM-3ver1.1
VIII. Contractual Matters
(For Small Research Grant application, submit only information for the Principal Investigator and not collaborators)
-----------------------------------------------------------------------------------------------------------------------Principal Investigator
Name:
Signature:
Date:
Head of Department of Principal Investigator
Name:
Signature and Official Stamp:
Date:
-----------------------------------------------------------------------------------------------------------------------Co-Investigator
Name:
Signature:
Date:
Head of Department of Co-Investigator
Name:
Signature and Official Stamp:
Date:
-----------------------------------------------------------------------------------------------------------------------Co-Investigator
Name:
Signature:
Date:
Head of Department of Co-Investigator
Name:
Signature and Official Stamp:
Date:
Page 9 of 12
Form JTP/KKM-3ver1.1
-----------------------------------------------------------------------------------------------------------------------Repeat for Co-Investigators, if necessary
IX.
CURRICULUM VITAE
(Please prepare and submit a curriculum vitae of all key researchers for major research grant application. For small
research grant application submit only the curriculum vitae of the principal investigator. The curriculum vitae should
contain the following information below)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Name:
I/C No.
Age:
Nationality:
Name and address of Department / Institution:
Title of Position currently held:
Official telephone number:
Official fax number:
Official e- mail:
Academic and professional qualifications: (List all qualifications in the following format:
title,field, year, name and place of institution)
Number of years of experience in the field related to this project.
List all major research projects completed or involved in which are in the field related to this
project (List the projects in the following format: title, year started, year completed, position
held in project, major findings and outputs)
Page 10 of 12
Form JTP/KKM-3ver1.1
APPENDIX A
Summary of literature review and related research
Page 11 of 12
Form JTP/KKM-3ver1.1
APPENDIX B
(Please provide detailed breakdown and justifications for all project costs requested in Section VII. A. Use
additional pages if necessary)
Cost Category
Total RM
200_ RM
Page 12 of 12
200_ RM
200_ RM
versi 2
URUSETIA JAWATANKUASA PENILAIAN PENYELIDIKAN
INSTITUT PENYELIDIKAN PERUBATAN
Jalan Pahang, 50588 Kuala Lumpur
Tel : 03-2616 2492 Faks : 03-2616 2721
BORANG SEMAKAN PROPOSAL BARU PENYELIDIKAN MAKLUMAT PROJEK:
Tahun :
LOI/RP
Kod JPP-IMR :
Ketua Penyelidik:
Unit / Pusat :
Tarikh Mula :
Tajuk Penyelidikan :
SENARAI SEMAK:
1. Gantt Chart
2. Budget – Direct Project Funding
3. Budget – Disbursement Schedule
4. Funding Sources
5. Contractual Matters (signatures)
a.
Principle Investigators
b.
Head Department of PI
6. CV of all key researchers
KOMEN DAN CADANGAN:
Disemak dan disahkan;
.......................................
(Nama & Cop Rasmi)
Tarikh:
Tarikh Tamat :
RIP
MINISTRY OF HEALTH RESEARCH GRANT TECHNICAL EVALUATION FORM
A.
NMRR ID :
Project title:
Project leader:
Tel:
B.
Fax:
Name of evaluator:
Date of this evaluation:
First
Follow-up
C. Summary of assessment (Please tick appropriate box.
Also, provide additional comments in Section G. Numbers in
parentheses refer to the corresponding section in the Application Form)
Inadequate
1
1.
Scientific merit of research objectives
2.
Credibility of benefits assessment
3.
Appropriateness of the project structure
4.
Robustness of the technical methodology
5.
Appropriateness of the risk assessment
6.
Cost effectiveness of the approach
7.
Overall assessment
2
Acceptable
3
4
Very Good
5
Note: A proposal should be rejected if either item 1 (scientific merit of research objectives) or
item 4 score is less than 3
D.
Decision (Please tick appropriate box)
Recommended for funding
Rejection of application recommended (Please list reasons for rejection and suggestions in Section F)
MOH GRANT TECHNICAL EVALUATION FORM
1
E.
Recommended Funding (Please provide below the recommended funding for the project)
Cost Categories
Recommended Funding (RM)
20__
20__
20__
20__
20__
Total
 OS21000 Travel and transportation
 OS24000 Rentals
 OS25000 Raw material
 OS27000 Research materials & supplies
 OS29000 Special services
 OSTemporary and contract personnel
 OS35000 Special equipment and
accessories
Others (Please list as OS)
Total Funding
F.
Comments regarding assessment (Please provide below an explanation for any assessment made in Section C showing
a rating below “acceptable”). Also provide reasons for proposal rejected and suggestions for improvement.
________________________________________
Signature & Chop of Director / Evaluator
Date:
MOH GRANT TECHNICAL EVALUATION FORM
2
G. MREC Decision
Funding supported
Funding rejected
Total : RM___________
Reason/s :
……………………………………….
MREC Chairman
F.
Funding duration : ____________
Date : ………………………..
Funding Approval
Funding approved
Total : RM___________
Funding rejected
Reason/s :
Funding duration : ____________
Date : ………………………..
……………………………………….
Deputy Director General of Health
(Research & Technical Support)
MOH GRANT TECHNICAL EVALUATION FORM
3
QUARTERLY FINANCIAL REPORT
GUIDELINES AND FORM
A.
Purpose
The purpose of the quarterly financial report is to allow the NIH Secretariat to monitor the
actual/committed expenditures incurred by each approved project.
B.
Information required
The project leader is required to indicate the cumulative actual/committed expenditure
incurred up to the end of the quarter. Project leaders are reminded that deviation from the
approved budget breakdown is not permitted unless with permission from the Deputy
Director-General of Health (R&TS). Request for additional budget should be indicated
with appropriate justifications.
C.
Responsibility
It is the responsibility of the project leader to complete the quarterly financial report.
D.
Date of submission
The quarterly financial report is to be submitted by 31 March; 30 June; 30 September; 31
December
E.
Submission procedure
One copy of the report is to be submitted to the Head of Department. The Head of
Department should compile reports of all approved projects in the Department and submit
to the :
NIH Secretariat,
Ministry of Health Malaysia
c/o Institute for Health Management
Jalan Rumah Sakit, Bangsar
59000 Kuala Lumpur
QUARTERLY FINANCIAL REPORT
_______________________________________________________________________
A.
Project Code:
……………………………………
Project Title: ………………………………………………………………………
………………………………………………………………………………………
……………………………………………………………………………………….
Name of Project Leader: ……………………………………………………….
Telephone No.: ………………………… Fax no.: ……………………………...
E-mail: ………………………………….
Date: ……………………….
Signature: ……………………………
_______________________________________________________________________
_
B.
Cumulative project expenditure up to end of quarter
Year: …………………
Quarter (tick where appropriate):
January April March
June
Category
OS21000 : Travel and
transportation (in country)
OS22000 : Travel and
transportation (overseas)
OS24000 : Rentals
OS25000 : Raw Materials
OS27000 : Research
materials and supplies
0S29000 : Special services
OS29000 : Temporary and
contract personnel
OS35000 : Special
equipment and accessories
Others (Please list as OS)
TOTAL
July September
Allocation (RM)
October December
Cumulative
expenditure (RM)
_______________________________________________________________________
C.
Request for additional budget (Complete only if additional budget is required. State
clearly the amount requested, breakdown into the above categories, and justification why
additional budget required)
PROJECT ACTIVITY REPORT
GUIDELINES AND FORM
A.
Purpose
The purpose of this project activity report is to allow both the project leader and the NIH
Secretariat to monitor the progress of approved projects.
B.
Information required
The project leader is required to report the progress of each activity scheduled for the
reporting period. As far as possible, progress should be reported in measurable terms
such as number of samples collected, number of analysis done, etc. In the event that any
activity is behind schedule, the project leader is required to :
 provide reasons for any delays; and
 suggest adjustments to the original project schedule.
C.
Responsibility
Each project leader is to complete this Project Activity Report and submit it together with
the Milestone Achievement Report. The Head of Department is responsible to collect all
reports for approved projects of the Department and submit them to the NIH Secretariat
D.
Frequency
The Project Activity Report is to be submitted not later than 15 July (report for the period
January - June) and 15 January (report for the period July - December of the previous
year).
E.
Submission procedure
One copy of the Project Activity Report is to be submitted to the Head of Department. The
Head of Department will compile all reports from the Department. The compilation is then
submitted to:
NIH Secretariat
Ministry of Health
c/o Institute for Health Management
Jalan Rumah Sakit Bangsar
59000 Kuala Lumpur
PROJECT ACTIVITY REPORT
_____________________________________________________________________
Project code: ………………………………..
Project Title: …………………………………………………………………………..
…………………………………………………………………………………………..
…………………………………………………………………………………………..
Name of Project Leader: ………………………………………………………………
Telephone no.: ……………………….. Fax no.: ……………………………
E-mail: ……………………………….
Date: ……………………….
Signature: ………………………….
_____________________________________________________________________
State actual progress for each research activity (refer to original project schedule).
As far as possible, progress should be reported in measurable terms such as
number of samples collected, number of analysis done, etc.
Year:
Period:
Indicate current status of project:
Abandoned
Jan-Jun
On-going
Suspended
Jul-Dec
Terminated
Completed
If project is terminated/abandoned/suspended, state reasons:
_____________________________________________________________________
Title of activity:
Progress (state reasons for any delays):
Note: Repeat this section for each activity scheduled for the period.
Attach copy of original project schedule. Where necessary, include revised
project schedule.
MILESTONE ACHIEVEMENT REPORT
GUIDELINES AND FORM
A.
Purpose
The purpose of this project activity report is to allow both the project leader and the NIH
Secretariat to monitor the overall progress of approved projects.
B.
Information required
The project leader is required to indicate whether the milestones proposed in the original
project plan are achieved. If any milestone is not achieved according to schedule, the
project leader is required to:
 provide reasons for the non-achievement; and
 suggest adjustments to the project approach and schedule.
C.
Responsibility
Each project leader is to complete this Milestone Achievement Report and submit it
together with the Project Activity Report. The Head of Department is responsible to collect
all reports for approved projects of the Department and submit them to the NIH
Secretariat.
D.
Frequency
The Milestone Achievement Report is to be submitted not later than 15 July (report for
the period January - June) and 15 January (report for the period July - December of the
previous year).
E.
Submission procedure
One copy of the report is to be submitted to the Head of Department. The Head of
Department should compile reports of all approved projects in the Department and submit
to the :
NIH Secretariat
Ministry of Health
c/o The Institute for Health Management
Jalan Rumah Sakit Bangsar
59000 Kuala Lumpur
MILESTONE ACHIEVEMENT REPORT
(Repeat Sections B and C for each milestone that is due. Other Sections need to be completed once only)
____________________________________________________________________
A.
Project number: …………………………………………………………….
Project title: ………………………………………………………………….
…………………………………………………………………………………
…………………………………………………………………………………
Name of Project Leader: …………………………………………………….
Tel. no.: ………………………
Fax. no.: ………………………………
E-mail: ………………………
_____________________________________________________________________
B.
Milestone achievement (Please attach a copy of the original project schedule)
Name of milestone: ……………………………………………………………
…………………………………………………………………………………
Planned milestone date: ………………………………………………………
Status:
Achieved
Not achieved (please
sections C, D, E and F)
complete
Milestone description:
____________________________________________________________________
C.
Reasons for non-achievement (Please give reasons for non-achievement of the
milestone)
____________________________________________________________________
D.
Suggested adjustments to the project approach (Please state the changes that
are proposed)
_____________________________________________________________________
E.
Impact on project schedule (Please attach revised project schedule, if
applicable)
Revised date for this milestone: …………………….
New date of project completion:………………. Original date: ……………….
____________________________________________________________________
F.
Impact on project budget (Please attach revised budget if necessary)
Original approved budget: RM …………………………..
Revised budget:
RM …………………………..
____________________________________________________________________
Date:
Signature:
END OF PROJECT REPORT
GUIDELINES AND FORM
A.
Purpose
The purpose of the End of Project Report is to allow the NIH Secretariat and other MOH
Departments to assess the findings of research project, their utilization (or potential
utilization) and where possible, their impact.
B.
Information required
The project leader is required to provide the following information:
 Project summary for compilation and dissemination;
 Extend of achievement of original objectives;
 Project outputs; and
 Utilization of findings and potential commercialization.
C.
Responsibility
The project leader is to complete the End of Project Report and submit to the Head of
Department.
D.
Date of submission
The End of Project Report is to be submitted not later than 3 months after scheduled
compilation of the research project.
E.
Submission procedure
The Head of Department is to submit all End of Project Reports of the Department, to:
NIH Secretariat
Ministry of Health Malaysia
c/o Institute for Health Management
Jalan Rumah Sakit Bangsar
59000 Kuala Lumpur.
END OF PROJECT REPORT
_____________________________________________________________________
A.
Project code: ………………………..
Project title: ……………………………………………………………………
…………………………………………………………………………………..
…………………………………………………………………………………..
Name of Project Leader: ……………………………………………………….
Tel. no: ………………………………
Fax no: ………………………….
E-mail: ………………………………
Date: ………………….
Signature of project leader: …………………….
_____________________________________________________________________
B.
Summary for the Research Activity Annual Report (Please summarize the
project objectives, significant results or findings achieved, and utilization/impact of results
or findings)
C.
Funding Received (Please list all funds and source of funding used for the
project)
FUNDING SOURCE
D.
AMOUNT (RM)
Achievement of objectives

Original project objectives (Please state the general and specific objectives as
described in the original project proposal)

Objectives achieved (Please state the extent to which the project objectives have
been achieved. Just like the objectives, the achievement must be stated in
measurable terms)

Objectives not achieved (Please state the objectives that were not achieved and
give reasons for non-achievement)
E.
Utilization and impact of research findings (Where applicable, please describe
the utilization (how, where, when, whom, etc.) of research results or findings. State the
measurable impact arising from utilization of the research results or findings.)
F.
Indirect outputs
1. Number of publications: ……………………
(Please list the publications using the format below.)
You CH, Lee KY, Chev RY, Menguy R (1980). Electrogastrographic study of
patients with unexplained masses, bloating and vomiting. Gastroenterology
79(2):311-314.
NO.
1.
TITLE
2.
3.
2. Number of unpublished reports: …………..
(Please list the reports using the format below.)
Public Health Institute, Ministry of Health. National Health and Morbidity Survey
(1986-1987): Purpose, scope and methodology. Malaysia, Kuala Lumpur, 1987.
NO.
1.
2.
3.
TITLE
3. Number of oral presentations at scientific meetings: …………………..
(Please list oral presentations using format below.)
Mazlan AB, Kamal A, Susila R. Contribution of Health Research Towards National
Health Development. Paper presented at the Health Research Seminar. Malaysia,
Kuala Lumpur, July.
NO.
1.
TITLE
2.
3.
4. Number of poster presentations at scientific meetings: …………………..
(Please list poster presentations using format below.)
Noraznawati I, Ho TM, Nathan S, Wan KL. Identification of recombinant clones of
house dust mites, S. pontifica. Poster presented at 11th National Biotechnology
Seminar, Malacca, November.
NO.
1.
TITLE
2.
3.
5. Training (Please list number of personnel trained for each category below.)
CATEGORY
NUMBER PERSONNEL TRAINED
B.Sc or equivalent
M.Sc or equivalent
PhD or equivalent
Short courses (No of courses: ………)
Attachment training
Others (Please specify)
6. Intellectual Property
CATEGORY
Patent obtained
Patent pending
Patent application to be filled
Copyright
NUMBER
7. Linkages (Please list the names of the linkages established)
CATEGORY
NAME
Linkages with local research 1.
institutions
2.
3.
Linkages with foreign research 1.
institutions
2.
3.
Linkages with local industries
1.
2.
3.
Linkages with foreign industries 1.
2.
3.
8. Commercialization (Please state whether the findings of this project have any
potential for commercialization. If commercialization has already started, please
describe any commercialization activities that had already been undertaken)
versi 1
LAPORAN PEMANTAUAN HASIL PENYELIDIKAN
INSTITUT PENYELIDIKAN PERUBATAN (Institute for Medical Research)
Jalan Pahang, 50588 Kuala Lumpur
MAKLUMAT PROJEK PENYELIDIKAN
Kod JPP-IMR:
NMRR:
Tajuk Projek:
Ketua Penyelidik:
Tarikh Mula (mmm-yy) :
Tarikh Tamat (mmm-yy):
Jumlah Peruntukan (RM):
HASIL-HASIL PENYELIDIKAN
1. PENERBITAN:
You CH, Lee KY, Chev RY, Menguy R (1980). Electrogastrographic study of patients with unexplained
masses, bloating and vomiting. Gastroenterology 79(2):311-314.
No Tajuk
Status
1.
2.
3.
4.
5.
Status:
DGA : DG Approval :setelah mendapat kelulusan Ketua Pengarah Kesihatan
SUB : Submitted to Journal Editor
ACC : Accepted / In-Press
PUB : Published
1
versi 1
2. LAPORAN TEKNIKAL:
Public Health Institute, Ministry of Health. National Health and Morbidity Survey (1986-1987): Purpose,
scope and methodology. Malaysia, Kuala Lumpur, 1987. (ISBN No)
No
Tajuk
1.
2.
3.
3. PEMBENTANGAN LISAN:
Mazlan AB, Kamal A, Susila R. Contribution of Health Research Towards National Health
Development. Paper presented at the 2nd Health Research Seminar. Kuala Lumpur, 12- 14 July 2005.
No
Tajuk
1.
2.
3.
4. PEMBENTANGAN POSTER:
Noraznawati I, Ho TM, Nathan S, Wan KL. Identification of recombinant clones of house dust mites, S.
pontifica. Poster presented at 11th National Biotechnology Seminar, Malacca, 10 – 12 November 2005.
No
Tajuk
1.
2.
3.
2
versi 1
5. PATEN:
Tajuk Paten:
Tahun Paten:
Status:
Approval
Names of
Patents Holder
[Inventor’s]:
Disediakan oleh:
Tandatangan Ketua Penyelidik;
(Nama dan Cop Rasmi)
Tarikh:
3
versi 2
PERMOHONAN MENGHADIRI SEMINAR DAN
MEMBENTANGKAN KERTAS SAINTIFIK SERTA PEMBIAYAAN
INSTITUT PENYELIDIKAN PERUBATAN (Institute for Medical Research)
Jalan Pahang, 50588 Kuala Lumpur
Arahan Kepada Pemohon
1. Borang ini mengandungi tiga bahagian: Bahagian A, Bahagian B dan Bahagian C. Untuk
Bahagian A dan Bahagian B perlu dipenuhkan. Manakala Bahagian C hendaklah
mendapat kelulusan Ketua Unit, Ketua Pusat dan Pengarah Institut Penyelidikan
Perubatan.
2. Borang yang telah diisi dengan lengkap hendaklah dihantar untuk kelulusan Pengarah
dan disertakan brosur seminar dan abstrak pembentangan.
3. Permohonan yang telah mendapat kelulusan Pengarah, perlu menghantar satu (1)
salinan borang kepada Urusetia JPP-IMR.
BAHAGIAN A
I. MAKLUMAT BERKENAAN PEMOHON
a.
Nama Pemohon:
b.
Jawatan / Gred:
c.
Unit:
d.
Pusat:
II. BUTIR-BUTIR PEMBENTANGAN
a.
Jenis Pembentangan:
b.
Tajuk:
c.
Nama dan Jabatan
Penulis Bersama:
d.
Anjuran:
e.
Tarikh Persidangan:
f.
Tempat Persidangan:
LISAN
POSTER
1
versi 2
III. BUTIR-BUTIR PENYELIDIKAN
a.
Kod Projek JPP-IMR:
b.
Ketua Penyelidik:
c.
Peruntukan:
d.
Tajuk Penyelidikan:
Jika penyelidikan yang tidak mempunyai kod JPP-IMR, sila nyatakan kod
projek agensi berkenaan dan peruntukan seperti berikut :
Kod Penyelidikan:
Peruntukan:
IV. BUTIR-BUTIR PEMBIAYAAN
ANGGARAN KOS
RM
1.
Yuran Pendaftaran
2.
Anggaran kos perjalanan
3.
Anggaran kos hotel / makanan
JUMLAH
BAHAGIAN B
Saya pernah menghadiri Persidangan/Seminar/Bengkel berikut dalam tahun ini di dalam
dan luar negara
i. Nama persidangan dll
:
Tempat
:
Tempoh
:
ii. Nama persidangan dll
:
Tempat
:
Tempoh
:
Tandatangan pemohon :
(Nama & Cop Rasmi)
Tarikh:
2
versi 2
BAHAGIAN C
Ulasan Ketua Unit, Institut Penyelidikan Perubatan, Kuala Lumpur
......................................................................................................................................
Permohonan ini disokong/tidak disokong.
Tarikh :
...................................................
(Tandatangan & Cop Ketua Unit)
Ulasan Ketua Pusat, Institut Penyelidikan Perubatan
.......................................................................................................................................
Permohonan ini disokong/tidak disokong.
Tarikh :
...................................................
(Tandatangan & Cop Ketua Pusat)
Ulasan Pengarah, Institut Penyelidikan Perubatan
.......................................................................................................................................
Saya selaku Pengarah Institut Penyelidikan Perubatan dengan ini;
a) meluluskan /tidak meluluskan permohonan ini.
b) pembiayaan permohonan ini menggunakan peruntukan :_______________________
Tarikh :
...................................................
(Tandatangan & Cop Pengarah)
3
versi 2
PERMOHONAN KELULUSAN MENERBITKAN HASIL
PENYELIDIKAN
INSTITUT PENYELIDIKAN PERUBATAN (Institute for Medical Research)
Jalan Pahang, 50588 Kuala Lumpur
Arahan Kepada Pemohon
1. Borang ini mengandungi tiga bahagian: Bahagian A, Bahagian B dan Bahagian C.
Bahagian A dan Bahagian B perlu dipenuhkan. Bahagian C perlu mendapat kelulusan
Ketua Unit, Ketua Pusat dan Pengarah Institut Penyelidikan Perubatan.
2. Borang yang telah diisi dengan lengkap hendaklah dihantar untuk kelulusan Pengarah
dan disertakan satu salinan draf manuskrip.
3. Permohonan yang telah mendapat kelulusan Pengarah, perlu menghantar satu (1)
salinan borang tersebut kepada Urusetia JPP-IMR.
BAHAGIAN A
I. MAKLUMAT BERKENAAN PEMOHON
a.
Nama Pemohon:
b.
Jawatan / Gred:
c.
Unit:
d.
Pusat:
II. BUTIR-BUTIR PENERBITAN
a.
Nama dan Unit/Pusat/Institusi Pengarang-Pengarang:
b.
Tajuk Penerbitan:
c.
Nama jurnal/prosiding/monograf/buletin dan lain-lain penerbitan di mana kertas
dicadang diterbitkan:
1
versi 2
BAHAGIAN B
I.
BUTIR-BUTIR PENYELIDIKAN
a.
Kod Projek JPP-IMR:
b.
Ketua Penyelidik:
c.
Peruntukan:
d.
Tajuk Penyelidikan:
Jika penyelidikan yang tidak mempunyai kod JPP-IMR, sila nyatakan kod
projek agensi berkenaan dan peruntukan seperti berikut :
Kod Penyelidikan:
Peruntukan:
II.
OBJEKTIF-OBJEKTIF PENYELIDIKAN
a)
b)
c)
d)
e)
2
versi 2
III.
CIRI-CIRI PENYELIDIKAN (tandakan [X] di kotak yang sesuai)
a)
Jenis Penyelidikan
Biomedical
Health systems
Health behavioural
Health economics
Environmental
Others :
b) Bidang penyelidikan
Perolehan pengetahuan baru
Meningkatkan pendiagnosaan penyakit
Meningkat rawatan penyakit
Meningkat kawalan penyakit
Meningkat pencegahan penyakit
Others :
c)
Kumpulan yang boleh mengguna hasil penyelidikan
Pegawai-pegawai Perubatan
Penyelidik-penyelidik
Pengarah-pengarah Program
Pegawai-pegawai Makmal
Other:
PENGESAHAN:
Bersama-sama ini disertakan satu salinan draf manuskrip untuk kelulusan menerbitkan
hasil penyelidikan.
Tandatangan pemohon :
(Nama & Cop Rasmi )
Tarikh :
3
versi 2
BAHAGIAN C
Ulasan Ketua Unit, Institut Penyelidikan Perubatan, Kuala Lumpur
......................................................................................................................................
Permohonan ini disokong/tidak disokong.
Tarikh :
......................................................
(Tandatangan & Cop Ketua Unit)
Ulasan Ketua Pusat, Institut Penyelidikan Perubatan
.......................................................................................................................................
Permohonan ini disokong/tidak disokong.
Tarikh :
.
...................................................
(Tandatangan & Cop Ketua Pusat)
Ulasan Pengarah, Institut Penyelidikan Perubatan
.......................................................................................................................................
Permohonan ini dilulus/tidak diluluskan.
Tarikh :
...................................................
(Tandatangan & Cop Pengarah)
4
versi 2
URUSETIA JAWATANKUASA PENILAIAN PENYELIDIKAN
INSTITUT PENYELIDIKAN PERUBATAN
BORANG SOAL SELIDIK KEPUASAN PELANGGAN
Projek penyelidikan berikut telah dibiayai oleh agensi tuan/puan dan mempunyai kaitan
langsung dengan program/aktiviti jabatan tuan/puan. Selaras dengan keperluan MS ISO
9001:2008, pihak tuan/puan diharap dapat meluangkan masa untuk melengkapkan penilaian
tuan/puan terhadap projek ini dengan mengisi borang soal selidik mengikut skala berikut:
1 = tidak memuaskan, 2 = lemah, 3 = memuaskan, 4 = baik, 5 = cemerlang
Kod JPP-IMR:
NMRR ID:
Tajuk Projek:
Ketua Projek:
1
2
3
3.2
3.3
3.4
4
5
1. Pelaksanaan Projek
1.1 Pencapaian Objektif
1.2 Ketepatan Masa
1.3 Keberkesanan Kos
1.4 Persembahan Laporan
2. Kegunaan Hasil Penyelidikan
2.1 Releven kepada Program
2.2 Feasability/Practicability aplikasi hasil kajian
2.3 Potensi Impak terhadap program/pesakit
2.4 Potensi Komersial
3. Sumbangan Penyelidikan
3.1 Pembangunan Modal Insan
3.2 Pemindahan Teknologi
3.3 Kolaborasi dan Jaringan antara institusi
3.4 Impak Jurnal
Komen Pelanggan (jika ada):
Untuk kegunaan Urusetia JPP-IMR
1.1
1.2
1.3
1.4
1.5
2.1
2.2
2.3
2.4
3.1
Tahap Kepuasan Pelanggan : [Jumlah skala / (Bil. Jawapan x 5)] x 100 = _____ %
Disemak dan disahkan oleh: _____________________________
(Nama/Cop & Tarikh)
Jumlah