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MENU SASARAN KERJA PEGAW PEGAWAI NEGERI SIPIL 1. DATA AARAN KER!A PEGAWAI 2. CO(ER 3. "OR#$LIR KP %. PENG$K$RAN CAPAIAN KP &. B$K$ CATA CATATAN PERIL PERILAK$ AK$ KER!A KE R!A PN '. PENILAIAN PRETAI KER!A PN

KANTOR REGIONAL IIIBADAN KEPEGAWAIAN NEGARA

DATA SASARAN KERJA PEGAWAI

INSTANSI

: UPT PUSKESMAS PANARUNG

JANGKA WAKTU PENILAIA : 02 Januari 2015 s.d 31 Desemer 2015

1 YANG DINILAI a. Nama

: LOLY

. NIP

: 1!"#0112 200$0# 2 00$

%. Pan&'a()G*+.,uan& : Pena(a -uda ) IIIa d. Jaa(an

: idan Pe+a'sana Lan/u(an

e. Uni( Ker/a

: UPTD Pus'esmas Panarun&

2 PEJABAT PENILAI a. Nama

: JAMALUDIN, A.Md. Kep

. NIP

: 1!$00# 1!""02 1 002

%. Pan&'a()G*+.,uan& : Pena(a TK I) IIId 1 Ari+ 2013 d. Jaa(an

: Kea+a UPTD Pus'esmas Panarun&

e. Uni( Ker/a

: UPTD Pus'esmas Panarun&

3 ATASAN PEJABAT PENILAI a. Nama

: drg. TIUR SIMATUPANG

. NIP

: 1!5!1025 1!"$10 2 003

%. Pan&'a()G*+.,uan& : Pemina U(ama -uda ) I% 1 Ari+ 2012 d. Jaa(an

: Kea+a Dinas 'ese4a(an K*(a Pa+an&'a ,aa

e. Uni( Ker/a

: Dinas Kese4a(an K*(a Pa+an&'a ,aa

BACK TO MENU UTAMA

PENILAIAN PRESTASI KERJA PEGAWAI NEGERI SIPIL

Jag!a Wa!"# Pe$%a$a &2 Ja#ar$ 2&1' (.d 31 De(e)*er 2&1'

Nama Pe&a6ai

: LOLY

NIP

: 1!"#0112 200$0# 2 00$

Pan&'a( G*+*n&an ,uan&

: Pena(a -uda ) IIIa

Jaa(an

: idan Pe+a'sana Lan/u(an

Uni( Ker/a

: UPTD P#(!e()a( Paar#g

UPT PUSKESMAS PANARUNG TA+UN 2&1'

ORMULIR SASARAN KERJA PEGAWAI NEGERI SIPIL NO 1 2 3 # 5

I. PEJABAT PENILAI Nama NIP Pan&'a()G*+.,uan& Jaa(an Uni( Ker/a

JAMALUDIN, A.Md. Kep 1!$00# 1!""02 1 002 Pena(a TK I) IIId 1 Ari+ 2013 Kea+a UPTD Pus'esmas Panarun& UPTD Pus'esmas Panarun&

NO 1 2 3 # 5

I. KEGIATAN TUGAS JABATAN

AK

NO

II. PEGAWAI NEGERI SIPIL YANG DINILAI Nama LOLY NIP 1!"#0112 200$0# 2 00$ Pan&'a()G*+.,uan& Pena(a -uda ) IIIa Jaa(an idan Pe+a'sana Lan/u(an Uni( Ker/a UPTD Pus'esmas Panarun& TARGET KUANT-OUTPUT

KUAL-MUTU

WAKTU

1

-emersia'an e+aanan 'eidanan

3.20

#0

Ke&ia(an

100

12

u+an

2

-e+a'u'an KIE '+ien)asien se%ara 'e+*m*'

0.0#"

12

Ke+*m*'

100

12

u+an

3

me+a'u'an '*nse+in& '+ien)asien ada 'asus 7isi*+*&is (ana masa+a4

0.110

55

Ke&ia(an

100

12

u+an

#

-e+a'u'an d*'umen(asi ada asu4an 'eidanan 'asus 7isi*+*&is (ana masa+a4

0.0#0

5

10 + a*ran

100

12

u+an

5

-e+a'u'an ru/u'an asien ada 'asus 7isi*+*&is

0.150

5

10 ru/u'an

100

12

u+an

$

-e+a'u'an asu4an 'eidanan 'eada 'e+uar&a

0.055

55

Ke&ia(an

100

12

u+an



-e+a'sana'an eminaan ada *sandu dan dasa 6isma

0.0"0

#0

La*ran

100

12

u+an

"

-en/adi an&&*(a r*esi idan a'(i8

0.50

1

Ka+i

100

12

u+an

BIAYA

9 9 9

JU-LA

#.!53

Pe/aa( Peni+ai

Pa+an&'a ,aa 02 Januari 2015 Pe&a6ai Ne&eri Sii+ ;an& Dini+ai

JAMALUDIN, A.Md. Kep NIP. 1!$00# 1!""02 1 002

LOLY NIP. 1!"#0112 200$0# 2 00$

PENILAIAN APAIAN SASARAN KERJA PEGAWAI NEGERI SIPIL Nama : LOLY Jan&'a Wa'(u Peni+aian 02 Januari 2015 s.d 31 Desemer 2015 TARGET NO


1

2

AK

Kuan() >u(u( /

'

REALISASI Wa'(u

iaa

0



AK

Kuan() >u(u(

Kua+) -u(u



1&

iaa

11

12

NILAI APAIAN SKP

PENG+ITUN GAN 13

1/


3.20

#0

Ke&ia(an

100

12

u+an

9

3.20

#0

Ke&ia(an

!0

12

u+an

2$$

"".$

2


0.0#"

12 Ke+*m*'

100

12

u+an

9

0.0#"

12 Ke+*m*'

!0

12

u+an

2$$

"".$

3


0.110

55

100

12

u+an

9

0.110

55

"!

12

u+an

2$5

"".33

#


0.0#0

5 10 +a*ran

100

12

u+an

9

0.0#0

5 10 +a*ran

"0

12

u+an

25$

"5.33

5


0.150

5 10 ru/u'an

100

12

u+an

9

0.150

5 10 ru/u'an

!0

12

u+an

2$$

"".$

$


0.055

55

Ke&ia(an

100

12

u+an

9

0.05#

5#

Ke&ia(an

"0

12

u+an

25#

"#.3




0.0"0

#0

La*ran

100

12

u+an

9

0.02#

12

La*ran

"5

12

u+an

1!1

$3.$




0.50

1

Ka+i

100

12

u+an

9

0.50

1

Ka+i

"$

12

u+an

2$2

".33

Ke&ia(an

#.!53



Wa'(u

1

Jum+a4

3

Kua+) -u(u

Ke&ia(an

#."!$

II. TUGAS TAMBA+AN DAN KREATI4ITAS 5 1

P$)p$a P#("# P%a)*67a Ba8a9

2

:!rea"$;$"a(<

1

:!rea"$;$"a(<

N$%a$ apa$a SKP

Pa+an&'a ,aa 31 Desemer 2015 Pe/aa( Peni+ai


BUKU ATATAN PENILAIAN PERILAKU PNS Nama

: L>L;

'./2 :Ba$!<

PENILAIAN APAIAN SASARAN KERJA PEGAWAI NEGERI SIPIL Nama : LOLY Jan&'a Wa'(u Peni+aian 02 Januari 2015 s.d 31 Desemer 2015 TARGET NO


1

AK

2

Kuan() >u(u(

3

'

REALISASI Wa'(u

iaa

0



AK

Kuan() >u(u(

Kua+) -u(u



1&

iaa

11

12

NILAI APAIAN SKP

PENG+ITUN GAN 13

1/


3.20

#0

Ke&ia(an

100

12

u+an

9

3.20

#0

Ke&ia(an

!0

12

u+an

2$$

"".$

2


0.0#"

12 Ke+*m*'

100

12

u+an

9

0.0#"

12 Ke+*m*'

!0

12

u+an

2$$

"".$

3


0.110

55

100

12

u+an

9

0.110

55

"!

12

u+an

2$5

"".33

#


0.0#0

5 10 +a*ran

100

12

u+an

9

0.0#0

5 10 +a*ran

"0

12

u+an

25$

"5.33

5


0.150

5 10 ru/u'an

100

12

u+an

9

0.150

5 10 ru/u'an

!0

12

u+an

2$$

"".$

$


0.055

55

Ke&ia(an

100

12

u+an

9

0.05#

5#

Ke&ia(an

"0

12

u+an

25#

"#.3




0.0"0

#0

La*ran

100

12

u+an

9

0.02#

12

La*ran

"5

12

u+an

1!1

$3.$




0.50

1

Ka+i

100

12

u+an

9

0.50

1

Ka+i

"$

12

u+an

2$2

".33

Ke&ia(an



Wa'(u

1

Jum+a4

/

Kua+) -u(u

#.!53

Ke&ia(an

#."!$

II. TUGAS TAMBA+AN DAN KREATI4ITAS 5 1

P$)p$a P#("# P%a)*67a Ba8a9

2

:!rea"$;$"a(<

1

:!rea"$;$"a(<

N$%a$ apa$a SKP

'./2 :Ba$!<

Pa+an&'a ,aa 31 Desemer 2015 Pe/aa( Peni+ai



: L>L;

NIP

: 1!"#0112 200$0# 2 00$

N*

Tan&&a+

Uraian

2

3

1

1

02 Januari 2015 s.d 31 Desemer 2015

Nama)NIP dan Para8 Pe/aa( Peni+ai #

Peni+aian SKP samai den&an a'4ir A&us(us 2015 ? "5.#2 sedan&'an eni+aian eri+a'u 'er/ana ada+a4 sea&ai eri'u( : >rien(asi Pe+aanan

?

"3

@ai' Kea+a UPTD Pus'esmas Panarun&

In(e&ri(as

?

"2

@ai'

K*mi(men

?

"1

@ai'

Disi+in

?

"1

@ai'

Ker/asama

?

"1

@ai'

Keemiminan

?

JA-ALUDIN A.-d. Ke NIP. 1!$00# 1!""02 1 002


: L>L;

NIP

: 1!"#0112 200$0# 2 00$

N*

Tan&&a+

Uraian

2

3

1

1


Nama)NIP dan Para8 Pe/aa( Peni+ai #

Peni+aian SKP samai den&an a'4ir A&us(us 2015 ? "5.#2 sedan&'an eni+aian eri+a'u 'er/ana ada+a4 sea&ai eri'u( : >rien(asi Pe+aanan

?

"3

@ai' Kea+a UPTD Pus'esmas Panarun&

In(e&ri(as

?

"2

@ai'

K*mi(men

?

"1

@ai'

Disi+in

?

"1

@ai'

Ker/asama

?

"1

@ai'

Keemiminan

?

Jum+a4

?

Ni+ai ,a(a9ra(a

? "1.$0

JA-ALUDIN A.-d. Ke NIP. 1!$00# 1!""02 1 002

#0" @ai'

PENILAIAN PRESTASI KERJA PEGAWAI NEGERI SIPIL JANGKA WAKTU PENILAIAN :

UPT PUSKESMAS PANARUNG 1.

2.

3.

#.


;ANG DINILAI a. N A - A

LOLY

. NIP

1!"#0112 200$0# 2 00$

%. Pan&'a( &*+*n&an ruan&

Pena(a -uda ) IIIa

d. Jaa(an)Pe'er/aan

idan Pe+a'sana Lan/u(an

e. Uni( >r&anisasi

UPTD Pus'esmas Panarun&

PEJAAT PENILAI a. N A - A

JAMALUDIN, A.Md. Kep

. NIP

1!$00# 1!""02 1 002


Pena(a TK I) IIId 1 Ari+ 2013


Kea+a UPTD Pus'esmas Panarun&

e. Uni( >r&anisasi


ATASAN PEJAAT PENILAI a. N A - A

drg. TIUR SIMATUPANG

. NIP

1!5!1025 1!"$10 2 003


Pemina U(ama -uda ) I% 1 Ari+ 2012


Kea+a Dinas 'ese4a(an K*(a Pa+an&'a ,aa

e. Uni( >r&anisasi

Dinas Kese4a(an K*(a Pa+an&'a ,aa

UNSU, ;ANG DINILAI a. Sasaran Ker/a Pe&a6ai @SKP

.

Peri+a'u Ker/a

JU-LA "5.#2

B $0C

1. >rien(asi Pe+aanan

"3.00

@ai'

2. In(e&ri(as

"2.00

@ai'

3. K*mi(men

"1.00

@ai'

# Disi+in

"1.00

@ai'

5. Ker/asama

"1.00

@ai'

0.00

0

Jum+a4

#0".00

0

Ni+ai ,a(a9ra(a

"1.$0

@ai'

$. Keemiminan

Ni+ai Peri+a'u 'er/a

"1.$0 B #0C

51.25

32.$#

5.

KEE,ATAN DA,I PEGAWAI NEGE,I SIPIL ;ANG DINILAI @APAILA ADA

Tan&&a+ ........................................... $.

TANGGAPAN PEJAAT PENILAI ATAS KEE,ATAN

Tan&&a+ ........................................... .

KEPUTUSAN ATASAN PEJAAT PENILAI ATAS KEE,ATAN

Tan&&a+ ........................................... ".

,EK>-ENDASI

!. DIUAT TANGGAL 31 Desemer 201# PEJAAT PENILAI

JAMALUDIN, A.Md. Kep NIP. 1!$00# 1!""02 1 002 10.

DITE,I-A TANGGAL 02 Januari 2015 PEGAWAI NEGE,I SIPIL ;ANG DINILAI

LOLY NIP. 1!"#0112 200$0# 2 00$ 11. DITE,I-A TANGGAL 05 Januari 2015 ATASAN PEJAAT ;ANG -ENILAI

PENILAIAN PRESTASI KERJA PEGAWAI NEGERI SIPIL JANGKA WAKTU PENILAIAN :

UPT PUSKESMAS PANARUNG

1.

2.

3.


;ANG DINILAI a. N A - A

LOLY

. NIP

1!"#0112 200$0# 2 00$


Pena(a -uda ) IIIa


idan Pe+a'sana Lan/u(an

e. Uni( >r&anisasi


PEJAAT PENILAI a. N A - A

JAMALUDIN, A.Md. Kep

. NIP

1!$00# 1!""02 1 002


Pena(a TK I) IIId 1 Ari+ 2013


Kea+a UPTD Pus'esmas Panarun&

e. Uni( >r&anisasi


ATASAN PEJAAT PENILAI a. N A - A

+. SUMANTRI +W, SKM, M.KES

. NIP

1!50#21 1!"0$ 1 001


Pemina U(ama -ada I)D


Se're(aris Daera4

e. Uni( >r&anisasi #.

Kaua(en Su'amara

UNSU, ;ANG DINILAI

JU-LA

a. Sasaran Ker/a Pe&a6ai @SKP

.

Peri+a'u Ker/a

"5.#2

B $0C

1. >rien(asi Pe+aanan

"3.00

@ai'

2. In(e&ri(as

"2.00

@ai'

3. K*mi(men

"1.00

@ai'

# Disi+in

"1.00

@ai'

5. Ker/asama

"1.00

@ai'

$. Keemiminan

0.00

0

Jum+a4

#0".00

0

Ni+ai ,a(a9ra(a

"1.$0

@ai'

Ni+ai Peri+a'u 'er/a

"1.$0 B #0C

51.25

32.$# "3."!

Ni+ai Pres(asi Ker/a @ai' 5.

KEE,ATAN DA,I PEGAWAI NEGE,I SIPIL ;ANG DINILAI @APAILA ADA

Tan&&a+ ...........................................

$.

TANGGAPAN PEJAAT PENILAI ATAS KEE,ATAN

Tan&&a+ ...........................................

.

KEPUTUSAN ATASAN PEJAAT PENILAI ATAS KEE,ATAN

Tan&&a+ ...........................................

".

,EK>-ENDASI

!. DIUAT TANGGAL 31 Desemer 201# PEJAAT PENILAI

JA-ALUDIN A.-d. Ke NIP. 1!$00# 1!""02 1 002 10.

DITE,I-A TANGGAL 02 Januari 2015 PEGAWAI NEGE,I SIPIL ;ANG DINILAI

L>L; NIP. 1!"#0112 200$0# 2 00$ 11. DITE,I-A TANGGAL 05 Januari 2015 ATASAN PEJAAT ;ANG -ENILAI

. SU-ANT,I W SK- -.KES NIP. 1!50#21 1!"0$ 1 001

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