SKP Fungsional Umum Penyuluh Kesehatan masyarakat

FORMULIR SASARAN KERJA PEGAWAI NEGERI SIPIL NO I. I. PEJABAT PENILAI 1 2 3 " 

Nama NIP Pan$%at&Gol.R'an$, TMT +abatan -nit K(rja

NO Hj. Rostini Taliba, AMG 1963!22 199"3 2 3 P(nata, III&), 1*"*213 K(ala -PT K(s(/atan 0o%oto -PT K(s(/atan 0o%oto

NO

II. PEGAWAI NEGERI SIPIL YANG DINILAI

1 2 3 " 

III. KEGIATAN TUGAS JABATAN

Nama NIP Pan$%at&Gol.R'an$, TMT +abatan -nit K(rja

TARGET

AK

1 2 3 " 

M(n$analisis data s(ba$ai ba/an ('s'nan r(n)ana %($iatan (n'l'/an masara%at M(n's'n dra4t laoran /asil id(nti4i%asi ot(nsi 5ilaa/ M(n's'n dra4t mat(ri (n'l'/an %(s(/atan M(la%'%an 'ji )oba dan (n(m'rnaan atas m(dia romosi %(s(/atan M(la%'%an (n$ola/an data /asil (al'asi m(dia (n'l'/an

6 # ! 9 1 11

Amrin Madolan, SKM 19!"# 29" 1 1 P(nata M'da T%t I, III&b, 1*"*213 P(n'l'/ K(s(/atan Masara%at -PT K(s(/atan 0o%oto

KUANT/OUTPUT

KUAL/MUTU

WAKTU

BIAYA

* * * * *

22 1 22 " 22

o%'m(n o%'m(n o%'m(n K($iatan o%'m(n

1 1 1 1 1

12 12 12 12 12

'lan 'lan 'lan 'lan 'lan

* * * * *

M(n's'n dra4t %ons( (doman&and'an&j'%nis (doman&and'an&j'%nis (n$(mban$an (doman (n'l'/an %(s(/atan masara%at 'nt'% sat' ro$ram

*

22

o o%'m(n

1

12

'lan

*

M(n$ola/ ba/an&data&in4ormasi s(ba$ai ba/an (n$(mban$an (doman M(la%sana%an ado%asi M(n's'n dra4t laoran %($iatan M( M (n's'n 0aoran (la%sanaan t'$as M(n's'n laoran lain*lain

* * * * *

22 22 22 12 12

o%'m(n K($iatan o%'m(n o%'m(n o%'m(n

1 1 1 1 1

12 12 12 12 12

'lan 'lan 'lan 'lan 'lan

* * * * *

Lokotoy, 02 Januari 2014 Pegawai Negeri Sipil Yang Dinilai

Pejabat Penilai,

Hj. Rostini Talia! AMG

A"#in Ma$olan! SKM

NIP: 1!"0#22 140" 2 00"

NIP: 1#0040$ 20004 1 001

PENILAIAN CAPAIAN CAPAIAN SASARAN KERJA KE RJA PEGAWAI PEGAWAI NEGERI SIPIL Jangka %aktu Penilaian 02 Januari &'(' "1 De&e)ber 2014 NO I. K%&iatan T'&as Jaatan (

TARGET

AK )

*uant+ utput

*ual+-utu

%aktu

.iaya

+

,

-



*

1

M(n$analisis data s(ba$ai ba/an ('s'nan r(n)ana %($iatan (n'l'/an masara%at

*

2

M(n's'n dra4t laoran /asil id(nti4i%asi ot(nsi 5ilaa/

3

M(n's'n dra4t mat(ri (n'l'/an %(s(/atan

"

AK

REALISASI *uant+ utput

*ual+-utu

0

(1



22

o%'m(n

1

12

'lan

*



*

1

o%'m(n

1

12

'lan

*

*

22

o%'m(n

1

12

'lan

*

M(la%'%an 'ji )oba dan (n(m'rnaan atas m(dia romosi %(s(/atan

*

"

K($iatan

1

12

'lan



M(la%'%an (n$ola/an data /asil (al'asi m(dia (n'l'/an

*

22

o%'m(n

1

12

6

M(n's'n dra4t %ons( (doman&and'an&j'%nis (n$(mban$an (doman (n'l'/an %(s(/atan masara%at 'nt'% sat' ro$ram

*

22

o%'m(n

1

#

M(n$ola/ ba/an&data&in4ormasi s(ba$ai ba/an (n$(mban$an (doman

*

22

o%'m(n

!

M(la%sana%an ado%asi

*

22

K($iatan

9

M(n's'n dra4t laoran %($iatan

*

22

1

M(n's'n 0aoran (la%sanaan t'$as

*

11

M(n's'n laoran lain*lain

*

%aktu ((

.iaya ()

12

o%'m(n

9

12

'lan

*



1

o%'m(n

9

12

'lan

*



1!

o%'m(n

9

12

'lan

*

*



"

K($iatan

9

12

'lan

*

'lan

*



22

o%'m(n

9

12

'lan

*

12

' 'lan

*



1!

o%'m(n

9

12

'lan

*

1

12

'lan

*



22

o%'m(n

9

12

'lan

*

1

12

'lan

*



22

K($iatan

9

12

'lan

*

o%'m(n

1

12

'lan

*



22

o%'m(n

9

12

'lan

*

12

o%'m(n

1

12

'lan

*



12

o%'m(n

9

12

'lan

*

12

o%'m(n

1

12

'lan

*



12

o%'m(n

9

12

'lan

*

II. T'&as Ta"a2an $an K#%ati3itas 4

1

P%n&%lola Data $an In5o#"asi P%n&%lola P#o"6%s K%7%&a8aian

2

96#%ati5itas:

Nilai ;a7aian SKP Lokotoy, "1 D Pejabat

Hj. Rostini

NIP: NIP: 1! 1!"0 "0#2 #2

PENILAIAN CAPAIAN CAPAIAN SASARAN KERJA KE RJA PEGAWAI PEGAWAI NEGERI SIPIL Jangka %aktu Penilaian 02 Januari &'(' "1 De&e)ber 2014 NO I. K%&iatan T'&as Jaatan

TARGET

AK

(

)

*uant+ utput

*ual+-utu

%aktu

.iaya

+

,

-



*

1

M(n$analisis data s(ba$ai ba/an ('s'nan r(n)ana %($iatan (n'l'/an masara%at

*

2

M(n's'n dra4t laoran /asil id(nti4i%asi ot(nsi 5ilaa/

3

M(n's'n dra4t mat(ri (n'l'/an %(s(/atan

"

AK

REALISASI *uant+ utput

*ual+-utu

0

(1



22

o%'m(n

1

12

'lan

*



*

1

o%'m(n

1

12

'lan

*

*

22

o%'m(n

1

12

'lan

*

M(la%'%an 'ji )oba dan (n(m'rnaan atas m(dia romosi %(s(/atan

*

"

K($iatan

1

12

'lan



M(la%'%an (n$ola/an data /asil (al'asi m(dia (n'l'/an

*

22

o%'m(n

1

12

6

M(n's'n dra4t %ons( (doman&and'an&j'%nis (n$(mban$an (doman (n'l'/an %(s(/atan masara%at 'nt'% sat' ro$ram

*

22

o%'m(n

1

#

M(n$ola/ ba/an&data&in4ormasi s(ba$ai ba/an (n$(mban$an (doman

*

22

o%'m(n

!

M(la%sana%an ado%asi

*

22

K($iatan

9

M(n's'n dra4t laoran %($iatan

*

22

1

M(n's'n 0aoran (la%sanaan t'$as

*

11

M(n's'n laoran lain*lain

*

%aktu

.iaya

((

()

12

o%'m(n

9

12

'lan

*



1

o%'m(n

9

12

'lan

*



1!

o%'m(n

9

12

'lan

*

*



"

K($iatan

9

12

'lan

*

'lan

*



22

o%'m(n

9

12

'lan

*

12

' 'lan

*



1!

o%'m(n

9

12

'lan

*

1

12

'lan

*



22

o%'m(n

9

12

'lan

*

1

12

'lan

*



22

K($iatan

9

12

'lan

*

o%'m(n

1

12

'lan

*



22

o%'m(n

9

12

'lan

*

12

o%'m(n

1

12

'lan

*



12

o%'m(n

9

12

'lan

*

12

o%'m(n

1

12

'lan

*



12

o%'m(n

9

12

'lan

*

II. T'&as Ta"a2an $an K#%ati3itas 4

1

P%n&%lola Data $an In5o#"asi P%n&%lola P#o"6%s K%7%&a8aian

2

96#%ati5itas:

Nilai ;a7aian SKP Lokotoy, "1 D Pejabat

Hj. Rostini

NIP: NIP: 1! 1!"0 "0#2 #2

(*

;APAIAN SKP (+

22.

#3.2

266. 2"#.!2

PENGHITUNGAN

per&en waktu per&en biaya kuantita& kualita& # 3 . 1  1  1  1  2

waktu

biaya

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140" 2 00"

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ANAK LAMPIRAN 1-c PERKA BKN NOMOR 1 TAHUN 2013 TENTANG KETENTUAN PELAKSANAAN PP No. 46 TAHUN 2011 TENTAN PENILAIAN PRESTASI KERJA PN

SURAT KETERANGAN MELAKSANAKAN TUGAS TAMBAHAN 1. Yan !"#$an%a !"#$an%a $anan $anan %&!a'a( %&!a'a( &n&) a. Na*a ) H. Ra*+&, SKM,MM !. NIP ) 164016 1/03 1 00


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SURAT KETERANGAN MELAKSANAKAN TUGAS TAMBAHAN 1. Yan !"#$an%a !"#$an%a $anan $anan %&!a'a( %&!a'a( &n&) a. Na*a ) H. Ra*+&, SKM,MM !. NIP ) 164016 1/03 1 00 c. Pana$Go+onan Ran ) P"*!&na T$. I, I! %. Ja!a$an ) K"a+a 5&na K""(a$an %an KB Ka! Ba+$ ". Un&$ K"#7a ) 5&na K""(a$an %an KB Ka!. Ba+$ 8. In$an& ) 5&na K""(a$an %an KB Ka!. Ba+$ 2. 5"nan &n& &n& *"n9a$aan *"n9a$aan !a('a !a('a a%a#a) a%a#a) a. Na*a ) A*#&n Ma%o+an, SKM !. NIP ) 10040: 20004 1 001 c. Pan Pana a$ $Go Go+o +on nan an Ra Ran n,, TMT TMT ) P"na P"na$a $a M% M%a a T$ T$ I, III III! !,, 1-41-4-20 2013 13 %. Ja!a$an ) P"n9+( K""(a$an Ma9a#aa$ ". Un&$ K"#7a ) UPT5 K""(a$an Loo$o9 8. In$an& ) 5&na K""(a$an %an KB Ka!. Ba+$ . Jana 'a$ "n&+a&an ) 02 Jana#& % 315""*!"# 2014 3. T"+a( *"+aanaan) *"+aanaan) a. Ta Ta $a*!a(an $a*!a(an "!aa "!aa&) &) 1; P"n P"n"+ "+o+ o+a a 5a$a 5a$a %an In8o In8o#*a #*a& & 2; P"n P"n" "+o+a +o+a P#o P#o* *" " 3; K""a'a&an !. J*+a( $a $a*!a(an ) 3 , %&!"#&an n&+a& 1 5"*&&an #a$ "$"#anan &n& %&!a$ %"nan "!"na#-!"na#n9a n$ %aa$ %&"#naan "!aa&*ana *"$&n9a. Bana&, 31 5""*!"# 2014 P"7a!a$ 9an M"*!a$ K"$"#anan K"a+a 5&na K""(a$an %an KB Ka!a$"n Bana& La$

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