NAMA TKK YANG DINILAI JABATAN
: :
NAMA PEJABAT PENILAI : JABATAN :
NAMA PERANGKAT PERANGKAT DAERAH :
PERIODE PENILAIAN
I # 1 $ 7
. . . . . .
M'*k+t* ,-' -,* M'+,k, ,tr*b+t -,k,*, /*,0 J,2 2,0+k k'r3, t'-,t 4,kt+ J,2 -+, k'r3, t'-,t 4,kt+ T*k,t k'5,/*r, k'r3, P'3,t+5, 5+k+2, /*0*-*
$ 1 .$ 1 .$ 1 .$ 6 1 .$
! ! ! ! ! ! J+2,5 S+b Tot,
II # 1 $ 7
. . . . . .
M'2**k* SOP 9, /*',*0,0* /,,2 2'3,,k, -'k'r3,, M'2**k* +r,*, t+,0 P',-,*, t,r't k'r3, 2*+, J+2,5 -'9''0,*, -'k'r3,, -'rtr*4+, P'9''0,*, -'k'r3,, t'-,t 4,kt+ L,-or, b+,, -'rtr*4+,
! ! ; 7
! ! ! ! ! ! J+2,5 S+b Tot,
III # 1 $ 7
. . . . . .
It'r*t,0 Lo9,*t,0 K'r3,0,2, I*0*,t*< T,+ 3,4,b Or*'t,0* -',9,,
1 .$ 1 .$ 1 .$ 7 7 1 .$
! ! ! ! ! ! J+2,5 S+b Tot, J+2,5 Tot,
M''t,5+* ATASAN ATASAN PEJABAT PEJABAT PENILAI?KEPALA PENILAI?KEPALA PD N,2, >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> NIP.
PEGA=AI YANG DINILAI N,2, >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
:
B'k,0*" PEJABAT PENILAI N,2, >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> NIP.
.
M'*k+t* ,-' -,*
D,
(,2-*rk, /,
D,t, /*0*,-k, o'5
$
Skor ! b*,
S'kr't,r*0?K,b, TU?
Skor b*,
KTU
Skor # b*, Skor b*, Skor 1 b*,
#.
M'+,k, ,tr*b+t -,k,*, /*,0 H,0* 2o*tor* t'r,k5*r)
P*2-*,
(
b+, D,t, /*0*,-k, o'5
(/,,2 t,5+ t'r,k5*r)
1.$
Skor b*,
S'kr't,r*0?K,b, TU?
Skor # b*,
KTU
Skor b*, Skor 1 b*,
.
J,2 2,0+k k'r3, t'-,t 4,kt+ 0'0+,* 4,kt+ 9, t',5 /*t't+k,
D,
r+,,
&
2o*tor*
( b+, t'r,k5*r)
D,t, /*0*,-k, o'5
1.$
Skor ! b*,
S'kr't,r*0?K,b, TU?
Skor b*,
KTU
Skor # b*, Skor b*, Skor 1 b*,
1.
J,2 -+, k'r3, t'-,t 4,kt+ 0'0+,* 4,kt+ 9, t',5 /*t't+k,
D,
r+,,
&
2o*tor*
( b+, t'r,k5*r)
D,t, /*0*,-k, o'5
1.$
Skor ! b*,
S'kr't,r*0?K,b, TU?
Skor b*,
KTU
Skor # b*, Skor b*, Skor 1 b*,
$.
T*k,t k'5,/*r, k'r3,
D,
(,2-*rk, /,
D,t, /*0*,-k, o'5
6
Skor b*,
S'kr't,r*0?K,b, TU?
Skor # b*,
KTU
Skor b*, Skor 1 b*,
7.
P'3,t+5, 5+k+2, /*0*-*
S+r,t -'3,t+5, 5+k+2,
D,t, /*0*,-k, o'5
1.$
Skor ! b*,
(,2-*rk, 0+r,t k't'r,, t*/,k
S'kr't,r*0?K,b, TU?
Skor b*,
t'rk', -',,r, /*0*-*?0+r,t
KTU
Skor # b*,
-'3,t+5, /*0*-*)
Skor b*, Skor 1 b*,
.
M'2**k* SOP 9, /*',*0,0*
SOP 9, b'+2 ,t,+ 0+/,5 /*',*0,0*
At,0,?P*2-*,
/,,2 2'3,,k, -'k'r3,,
Skor b*, Skor # b*, Skor b*, Skor 1 b*,
#.
P',k0,,, +r,*, t+,0 (,2-*rk,)
Ur,*, t+,0 9, /*',*0,0*?
At,0,?P*2-*,
/*k't,5+* P*2-*,
Skor ! b*, Skor b*, Skor # b*, Skor b*, Skor 1 b*,
.
P',-,*, t,r't k'r3, 2*+,
L,-or, -',-,*, t,r't 2*+,
(,2-*rk, ,-or, t,r't k'r3, 2*+,9,)
( b+, t'r,k5*r)
At,0,?P*2-*,
!
Skor ! b*, Skor b*, Skor # b*, Skor b*, Skor 1 b*,
1.
J+2,5 -'9''0,*, -'k'r3,,
L,-or, k'*,t, tr*4+,
At,0,?P*2-*,
!
-'rtr*4+,
Skor b*, Skor # b*, Skor b*, Skor 1 b*,
$.
P'9''0,*, -'k'r3,, t'-,t 4,kt+ H,0* 2o*tor* P*2-*,
At,0,?P*2-*,
;
Skor b*, Skor # b*,
(,2-*rk, ,-or, k'*,t,)
Skor b*, Skor 1 b*,
7.
L,-or, b+,, -'rtr*4+,
L,-or, k'*,t, b+,,
At,0,?P*2-*,
7
Skor ! b*,
B'r*t, A,r,?T,/, t'r*2, -'9'r,5, ,-or, b+,,
Skor b*,
,-or, b+,, -'rtr*4+,
Skor b*,
Skor # b*,
Skor 1 b*,
It'r*t,0
S+r,t -'3,t+5, 5+k+2, (/,,2 t,5+ t'r,k5*r) /, 2o*tor* P*2-*,
S'kr't,r*0?KTU
1.$
Skor b*, Skor # b*, Skor b*, Skor 1 b*,
#
Lo9,*t,0
H,0* 2o*tor* P*2-*,
At,0,?P*2-*,
1.$
Skor ! b*, Skor b*, Skor # b*, Skor b*, Skor 1 b*,
K'r3,0,2,
H,0* 2o*tor* P*2-*,
At,0,?P*2-*,
1.$
Skor b*, Skor # b*, Skor b*, Skor 1 b*,
1
I*0*,t*<
H,0* 2o*tor* P*2-*,
At,0,?P*2-*,
7
(,2-*rk, 3'*0 **0*,t*< k'r3, 9, /*+0+k,?/*,k+k,)
Skor b*, Skor # b*, Skor b*, Skor 1 b*,
$
T,+ 3,4,b
H,0* 2o*tor* P*2-*,
At,0,?P*2-*,
7
Skor b*, Skor # b*, Skor b*, Skor 1 b*,
7
Or*'t,0* P',9,,
H,0* 2o*tor* P*2-*,
At,0,?P*2-*,
1.$
Skor b*,
(,2-*rk, 5,0* k+*0*o'r k'-,/,
Skor # b*,
-',,)
Skor b*, Skor 1 b*,
T*/,k 2'*k+t* ,-' -,* ,k+2+,0* ; k,* ,t,+ 'b*5 /,,2 (0,t+) b+," T*/,k 2'*k+t* ,-' -,* ,k+2+,0* 7 0./. 6 k,* /,,2 (0,t+) b+," T*/,k 2'*k+t* ,-' -,* ,k+2+,0* 1 0./. $ k,* /,,2 (0,t+) b+," T*/,k 2'*k+t* ,-' -,* ,k+2+,0* # k,* /,,2 (0,t+) b+," T*/,k 2'*k+t* ,-' -,* ! k,* /,,2 (0,t+) b+," T*/,k 2'+,k, ,tr*b+t -,k,*, /*,0 ,k+2+,0* 7 5,r* ,t,+ 'b*5 /,,2 b+," T*/,k 2'+,k, ,tr*b+t -,k,*, /*,0 ,k+2+,0* 1 0./. $ 5,r* /,,2 b+," T*/,k 2'+,k, ,tr*b+t -,k,*, /*,0 ,k+2+,0* 0./. 5,r* /,,2 b+," S'5,r*>5,r* 2'+,k, ,tr*b+t 'k,- -,/, -,k,*, /*,0 K't'r,2b,t, 2,0+k k'r3, ,k+2+,0* ; k,* ,t,+ 'b*5 /,,2 (0,t+) b+," K't'r,2b,t, 2,0+k k'r3, ,k+2+,0* 7 0./. 6 k,* /,,2 (0,t+) b+," K't'r,2b,t, 2,0+k k'r3, ,k+2+,0* 1 0./. $ k,* /,,2 (0,t+) b+," K't'r,2b,t, 2,0+k k'r3, ,k+2+,0* # k,* /,,2 (0,t+) b+," K't'r,2b,t, 2,0+k k'r3, ! k,* /,,2 (0,t+) b+, P+, 'b*5 ,4, ,k+2+,0* ; k,* ,t,+ 'b*5 /,,2 (0,t+) b+," P+, 'b*5 ,4, ,k+2+,0* 7 0./. 6 k,* /,,2 (0,t+) b+," P+, 'b*5 ,4, ,k+2+,0* 1 0./. $ k,* /,,2 (0,t+) b+," P+, 'b*5 ,4, ,k+2+,0* # k,* /,,2 (0,t+) b+," P+, 'b*5 ,4, ! k,* /,,2 (0,t+) b+, B'k'r3, 0',2, k+r, /,r* 1"1 3,2?5,r* ,t,+ k+r, /,r* ## 3,2?2*+ ,t,+ k+r, /,r* ; 3,2?b+, B'k'r3, 0',2, 1"$ > $"1 3,2?5,r* ,t,+ ##"$ > #6 3,2?2*+ ,t,+ > #! 3,2?b+, B'k'r3, 0',2, $"$ > 6"1 3,2?5,r* ,t,+ #6"$ > 6 3,2?2*+ ,t,+ # > 71 3,2?b+, B'k'r3, 0',2, 'b*5 /,r* 6"$ ?5,r* ,t,+ 'b*5 /,r* 6"$ 3,2?2*+ ,t,+ 'b*5 /,r* 7$ 3,2?b+, P'r,5 /*3,t+5* 5+k+2, /*0*-* b'r,t P'r,5 /*3,t+5* 5+k+2, /*0*-* 0'/, P'r,5 /*3,t+5* 5+k+2, /*0*-* r*, 'b*5 /,r* k,* P'r,5 /*3,t+5* 5+k+2, /*0*-* r*, k,* T*/,k -'r,5 /*3,t+5* 5+k+2, /*0*-*
T*/,k 2'2**k* SOP /,,2 2'3,,k, -'k'r3,," M'2**k* SOP t't,-* t*/,k?b'+2 /*',*0,0*" M'2**k* SOP 9, t',5 /*',*0,0* ,2+ b'+2 /*3,,k, 0',r, 2,k0*2, M'2**k* SOP 9, t',5 /*',*0,0* /, t',5 /*3,,k, 0',r, 2,k0*2, T*/,k 2'2**k* +r,*, t+,0" P',k0,,, +r,*, t+,0 t',5 2',-,* C #7 %" P',k0,,, +r,*, t+,0 t',5 2',-,* #7 1 %" P',k0,,, +r,*, t+,0 t',5 2',-,* $! %" 6 %" P',k0,,, +r,*, t+,0 t',5 2',-,* ;! !! %" T*/,k 2'2**k* r',, /, t,r't 2*+, 9, ** /*,-,*" M'2**k* r',, /, t,r't 2*+, t't,-* t'r,-,* 5,9, #$ %" M'2**k* r',, /, t,r't 2*+, t't,-* t'r,-,* 5,9, #7 > 1 %" M'2**k* r',, /, t,r't 2*+, t't,-* 5,9, t'r,-,* $! 6 %" M'2**k* r',, /, t,r't 2*+, /, t'r,-,* ;! !! %" P'9''0,*, -'k'r3,, /,,2 t*, b+, -'r*o/' -'*,*, 5,9, 2',-,* #$ %" P'9''0,*, -'k'r3,, /,,2 t*, b+, -'r*o/' -'*,*, 5,9, #7 > 1 %" P'9''0,*, -'k'r3,, /,,2 t*, b+, -'r*o/' -'*,*, 5,9, $! > 6 %" P'9''0,*, -'k'r3,, /,,2 t*, b+, -'r*o/' -'*,*, 5,9, ;! > !! %" T'r,2b,t /,,2 -'9''0,*, -'k'r3,," ,k+2+,0* $ k'*,t,? 'b*5 T'r,2b,t /,,2 -'9''0,*, -'k'r3,," ,k+2+,0* >1 k'*,t,? 'b*5 T'r,2b,t /,,2 -'9''0,*, -'k'r3,," ,k+2+,0* ># k'*,t,? 'b*5 S'+r+5 k'*,t, /*0''0,*k, t'-,t 4,kt+ T*/,k 2'2b+,t ,-or, b+,, M'2b+,t ,-or, b+,, t't,-* t'r,2b,t 2'9,2-,*k, 'b*5 /,r* 7 5,r* M'2b+,t ,-or, b+,, t't,-* t'r,2b,t 2'9,2-,*k, 1 0?/ 7 5,r* M'2b+,t ,-or, b+,, t't,-* t'r,2b,t 2'9,2-,*k, 0?/ 5,r* M'2b+,t /, 2'9,2-,*k, ,-or, b+,, t'-,t 4,kt+
K't,,t, -,/, -'r,t+r, & k'0'/*,, b'k'r3,0,2, +t+k 2'2'+5* t+t+t, or,*0,0* t'r*5,t r'/,5 K't,,t, -,/, -'r,t+r, & k'0'/*,, b'k'r3,0,2, +t+k 2'2'+5* t+t+t, or,*0,0* t'r*5,t 0'/, K't,,t, -,/, -'r,t+r, & k'0'/*,, b'k'r3,0,2, +t+k 2'2'+5* t+t+t, or,*0,0* t'r*5,t t** K't,,t, -,/, -'r,t+r, & k'0'/*,, b'k'r3,0,2, +t+k 2'2'+5* t+t+t, or,*0,0* t'r*5,t 0,,t t** M'5*/,r* -'r*t,5?k'b*3,k, P*2-*, t,-, ,,0, M'5*/,r* -'r*t,5?k'b*3,k, P*2-*, t't,-* 2'2b'r*k, ,,0, M'3,,k, -'r*t,5 ,t,0, t,-, 2',k+k, ,,*0, or2,t*< M'3,,k, -'r*t,5 ,t,0, /, t',5 2',k+k, ,,*0, or2,t*< M'3,,k, -'r*t,5 ,t,0, /, 0',r, ,kt*< 2'2b'r*k, 2,0+k, k'-,/, P*2-*, ,t,0 k'b*3,k, t'r0'b+t L'b*5 0+k, b'k'r3, 0'/*r* B*, b'k'r3, '/'r+ 2'/o2*,0* k'o2-ok M,0*5 2,2-+ 2'3,* k'r3,0,2, /', t*2 ,2+ 2,0*5 2'2**5>2**5 t*2 k'r3, M,2-+ b'rb,* -'k'r3,, /,,2 k'o2-ok k'r3, K,/, 2,0*5 2'2b+t+5k, -',4,0, /,,2 2''r3,k, -'k'r3,, T*/,k 2'9'r,5 3*k, r',,9, 2''2+* 5,2b,t," b'r+0,5, 2'*-t,k, 3,, ,* ,,r r',, *t+ b*0, b'r3,, '-,t /,,2 2',2b* k'-+t+0, /,,2 2',t*0*-,0* kr*0*0 9, 2++ S',r, ,kt*< 2',k+k, t*/,k, ,t*0*-,t*< ,t,+ 2'*-t,k, k'0'2-,t,?,r, b,r+ /,,2 2''r3,k, -'k'r3,, L'b*5 0'r* 2''r3,k, -'k'r3,, -r*b,/* /,r* -,/, 9, 2'3,/* t+-ok0*9, S'r* 2'+/,>+/, -'k'r3,, 0'5*, t*/,k t'-,t 4,kt+ '/'r+ ** 2'9''0,*k, -'k'r3,, 2'0k*-+ 5,r+0 '2b+r 0'k,*-+. M'3,,k, -'k'r3,, 0',r, 0*0t'2,t*0 0'5*, 0't*,- -'k'r3,9, 0',+ t'-,t 4,kt+. T'r*5,t k+r, r,2,5 /, k+r, b'r,*r,5 /,,2 2'2b'r*k, -',9,, K'r,2,5, /, '-,t t,,- /,,2 2'2b'r*k, -',9,, ,2+ t*/,k k'-,/, 0'2+, or, (2'2**5>2**5) R,2,5 ,2+ k+r, '-,t t,,- /,,2 2'2b'r*k, -',9,, R,2,5 /, '-,t t,,- /,,2 2'2b'r*k, -',9,,
#
/0t
M''t,5+* ATASAN PEJABAT PENILAI?KEPALA PD N,2, >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
NIP
PERIODE PENILAIAN : OKTOBER 0./. DESEMBER #
B'k,0*" PEJABAT PENILAI N,2, >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> NIP.
NAMA TKK YANG DINILAI
:
JABATAN
:
P'r*o/' P'*,*, M*+ k
NAMA PERANGKAT DAERAH :
NO
URAIAN KERJA MINGGUAN
TARGET KERJA?MINGGU
APAIAN TARGET KERJA 8OLUME
%
M''r*2, 0+r,t?b'rk,0 2,0+k
! 0+r,t?b'rk,0
!
!!
#
M'2b+,t 0+r,t k'+,r
# 0+r,t
#
!!
1 $ 7 6 ;
/,( 0't'r+0(9, /*0'0+,*k,( /'(),( +r,*,( t+),0
. .
J+2,5
#!!
.
r,t,>r,t, ,-,*, t,r't k'r3,
!!.!!
M''t,5+* ATASAN PEJABAT PENILAI?KEPALA PD N,2, >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> NIP.
>>>>>>>>>>>>
:
F B+, :
KETERANGAN
(3+2,5 % : 3+2,5 +r,*, k'r3, 2*+,)
B'k,0*" PEMBUAT N,2, >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
NAMA TKK YANG DINILAI
:
JABATAN
:
P'r*o/' P'*,*, B+,
NAMA PERANGKAT DAERAH :
NO
NAMA KEGIATAN
=AKTU PELAKSANAAN RENANA REALISASI KETERANGAN
@'r*<*k,0* b'rk,0 KP
#6>No@
#>D'
T'r,2b,t
#
So0*,*0,0* Nor2, K'-',4,*,
#>No@
#>No@
T'-,t =,kt+
/0t...
RENANA
JUMLAH KEGIATAN REALISASI TEPAT =AKTU
PROSENTASE (%)
#
$!
M''t,5+* ATASAN PEJABAT PENILAI?KEPALA PD N,2, >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> NIP.
PE >>>>>>>>>>
: Oktob'r 0./. D'0'2b'r
KETERANGAN R'k,-*t+,0* b'rk,0 9, ,*k -,k,t t'r,2-*r L,-or, k'*,t, t'r,2-*r
B'k,0*" BUAT LAPORAN N,2, >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
NAMA TKK PEMBUAT DAN PELAKSANA PROGRAM KERJA JABATAN NAMA PERANGKAT DAERAH
NO
JENIS KEGIATAN
RENANA =AKTU PELAKSANAAN
JUMLAH 8OLUME
P'r*o/' A-r* & Oktob'r
#.$!! or,
PERTRI=ULAN
M,,3'2' A/2**0tr,0* P',4,* ,. P'9''0,*, K',*k, P,k,t b. P'9''0,*, K,rt+ P',4,*
#
: : :
# -'r*o/' .#$! SK
M,r't
;!! or,
>
. P'9''0,*, K,rt+ I0tr*
S't*,- B+,
6!! or,
6$ k,rt+
. P'9''0,*, K,rt+ S+,2*
S't*,- B+,
$!! or,
#$ k,rt+
/. P'9''0,*, T,0-'
S't*,- B+,
67! or,
! SK
M,r't >
# UTPD : .;!! or,
UPTD : 1$! or,
So0*,*0,0* Nor2, K'-',4,*,
M''t,5+* ATASAN PEMBUAT & PELAKSANA PROGRAM KERJA N,2, >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
NIP.
B ' k , 0 * "
B'k,0*" PEMBUAT >>>>>>>>>>>
PRODUK?HASIL PERTAHUN .$!! SK K',*k, P,k,t ;!! K,rt+ P',4,* 6!! K,rt+ I0tr*?S+,2* $!! K,rt+ I0tr*?S+,2* 67! SK T,0-' T'r,k0,,9, K'*,t, t'r0'b+t /,,2 L,-or, K'*,t,
& PELAKSANA PROGRAM KERJA N,2, >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
