SK TATA NASKAH BARU.doc

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PEMERINTAH KABUPATEN CIREBON DINAS KESEHATAN  Jalan Sunan Muria No. 6 Telp (0231) 320273 Fax (0231) 320273 Website !in"es#$irebon."ab.%o.i! e&ail !in"es#$irebon."ab.%o.i! Su&ber'611

*,-T-SN *,/ NS *STN *-,TN 45N NM5 

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Se"retariat

 TNTN8  TT NS* NS  /N8*-N8N NS *STN *-,TN 45N

*,/ NS *STN *-,TN  CIREBON,

Meni Meni&b &ban an% %

 a. ba9:a ba9:a !ala !ala& & ran% ran%"a "a &enun &enun;a ;an% n% "ela "elan$ n$ar aran an pela pela"s "san anaan aan tu%a tu%as s po"o po"o" " ina inas s *ese *ese9a 9ata tan n !i bi!a bi!an% n% a!&i a!&ini nist stra rasi si ,e&erinta9an perlu penb !an $ !i atas> perlu &enetap"an "eputusan *epala inas *ese9atan tentan% ,e!o&an Tata Nas"a9 inas *ese9atan *abupaten

Men%in%at



4irebon= 1. -n!an%'un!an%

No&or

1

Ta9un

200?

tentan%

*eterbu"aan n@or&asi ,ubli" (/e&baran Ne%ara 5epubli" n!o n!one nesi sia a Ta9un Ta9un 200? 200? No&o No&orr 61> 61> Ta&b Ta&ba9a a9an n /e&b /e&bar aran an Ne%ara ?6)= 2. ,era ,eratu tura ran n ,e&e ,e&eri rint nta9 a9 No&o No&orr 2? Ta9u Ta9un n 2012 2012 tent tentan an% % ,ela ,ela"s "san anaa aan n

-n!a -n!an% n%''-n! n!an an% %

No&o No&orr

?

ta9u ta9un n

200A 200A

tentan tentan% % "earsi "earsipan pan (le&ba (le&baran ran Ne%ara Ne%ara 5epubl 5epubli" i" n!one n!onesia sia  Ta9un

2012

No&or

?>

ta&ba9an

le&baran

Ne%ara

5epubli" n!onesia No&or 2?6)= 3. ,eraturan ,eraturan Menteri ,en!a
No&o No&orr

6 Ta9u Ta9un n

2016 2016

2

 Tentan% ,e!o&an Mana;e&en ,us"es&as= . ,era ,eratu tura ran n "epa "epala la rsi rsip p nasi nasion onal al no&o no&orr 2 ta9u ta9un n 201 201 tent tentan an% %

,e!o ,e!o&a &an n

tat tata

nas" nas"a9 a9

ina inas s

(er (erit ita a

Ne%ar e%ara a

5epubli" n!onesia Ta9un 201 no&or ?2)= 6. ,eraturan ,eraturan upati 4irebon 4irebon No&or 101 Ta9un 2017 Tentan% Tentan%  Tata Nas"a9 inas !i /in%"up ,e&erinta9 aera9 !an

Mene Meneta tap" p"an an

,e&erinta9 esa *abupaten 4irebon. MM-T-S*N  *,-T ,-T-S -SN N *,/ ,/  N NS S *S *S TN TN

**-, ,TN TN

45N TNTN8 TT NS* NS  /N8*-N8N *ST-

NS *STN *-,TN 45N.  entu" !an susunan nas"a9 surat !inas !i lin%"un%an inas *ese9atan *abupaten 4irebon ter!iri atas *ebi;a"an  Surat *eputusan= Stan!ar perasional ,rose!urS,= $. ,e!o&an,an!uan= !. *eran%"a $uan= a@tar Tili"= e. Surat !aran= f. Surat iasa= g. Surat *eteran%an= h. Surat ,erinta9= i. Surat Bin=  j. Surat ,erinta9 Tu%as= k. Surat *uasa= l. Surat -n!an%an= m. Surat *eteran%an Mela"sana"an Tu%as= n. Surat ,an%%ilan= o. Nota inas= p. 5e"o&en!asi= q. Surat ,en%antar= r. Notulen= s. a@tar a!ir= t. Surat ,er;an;ian= u. /aporan asil *e%iatan= . :. Manual Mutu=  x. o"u&en ,eren$anaan /i&a Ta9un (5en$ana Strate%is)=  <. 5en$ana -sulan *e%iatan (5-*)= B. 5en$ 5en$an ana a ,el ,ela" a"sa sana naan an *e%i *e%iat atan an (5,* (5,*)= )= aa. aa. o"u o"u&e &en n lain lain ses sesuai uai "ebu "ebutu tu9an 9an..  For&at !an bentu" pro!u" nas"a9 !inas seba%ai&ana a. b.

*-

!i&a"su! pa!a !i"tu& *ST- ter$antu& !ala& la&piran  
"eputusan ini=  *eputusan ini bela"u se;a" tan%%al !itetap"an> apabila !i "e&u! e&u!iian

9ari 9ari

itetap"an Su&ber !ite !ite&u &u"a "an n "e" "e"!i elir elirua uan n a"an a"an

!ila" ila"u" u"an an

tan%%al 1 Januari 201? perbai"an seba%ai&ana,a!a &estin

N S-N

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NM5

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I.

KETENTUAN UMUM 1. Penggu Pengguna naan an kerta kertas; s; a. *ert *ertas as
"

&& x 12 &&) e. Mar%ins Mar%ins "ertas selain selain nas"a9 pi!ato= pi!ato= 1#  Top

 20 &&

2#

otto&

 2 &&

!#

/e@t

 30 &&

"#

5i%9t

 20 &&

@. Mar% Mar%in ins s "ert "ertas as untu untu" " nas" nas"a9 a9 pi!a pi!ato to &en< &en &en%%una"an ;enis 9uru@  boo" boo"&an &an ol! ol! st 1> sesuai "ebutu9an= b. ,en%eti"an ,en%eti"an nas"a9 !inas sarana a!&insitrasi a!&insitrasi !an "o&uni"asi "o&uni"asi per"an per"antor toran an &en%%u &en%%una" na"an an ;enis ;enis 9uru@ 9uru@ arial arial u"uran u"uran 12 atau atau !isesuai"an "ebutu9an !an spasi 1 atau 1> sesuai "ebutu9an. !. Peneta"an #arna dan kua$itas kertas; a. Warna "ertas "ertas nas"a9 !inas a!ala9 a!ala9 :arna puti9= b. *ualit *ualitas as "erta "erta untu" untu" nas"a9 nas"a9 !inas asli a!ala9 a!ala9 CS ?0 %ra&> %ra&> se!an%"an untu" nas"a9 !inas &e&uat sebutan ,e&erinta9 *abupaten 4irebon> na&a Satuan *er;a ,eran%"at aera9> ala&at> no&or telepon> no&or faksimile, no&or  faksimile, website, email  !an  !an "o!e pos= b. *op nas"a9 !inas !inas -nit -nit ,ela"s ,ela"sana ana Te"nis Te"nis (-,T) (-,T) &en%%u &en%%una" na"an an la&ban% !aera9 9ita& puti9 !ite&pat"an pa!a ba%ian atas "iri "ertas> "ertas> &e&uat sebutan ,e&erinta9 ,e&erinta9 *abupaten *abupaten 4irebon> na&a -,T> ala&at> no&or telepon> no&or faksimile, no&or  faksimile, website, email  !an  !an "o!e pos= $. Jenis 9uru@ 9uru@ pa!a "op !inas !inas untu" nas"a9 nas"a9 !inas !ala& bentu" bentu" !an !an

susu susuna nan n

pro! pro!u" u" 9u"u 9u"u& &


Sura Suratt

*epu *eputu tusa san nS* S*>>

&en%%una"an ;enis 9uru@ boo"&an ol! st sesuai "ebutu9an. -"uran 9uru@ pa!a na&a institusi a!ala9 12 !an !itebal"an= !. Jenis 9uru@ pa!a "op !inas sarana

a!&insitrasi

!an

"o&uni"asi per"antoran &en%%una"an ;enis 9uru@ arial u"uran 12 atau !isesuai"an "ebutu9an !an spasi 1 atau 1> sesuai "ebutu9an. -"uran 9uru@ pa!a na&a institusi a!ala9 1 !an !itebal"an. $. Penu$isan Naa;

$

a. ,enulisan ,enulisan na&a pe;abat pe;abat untu" nas"a9 !inas !inas !ala& bentu" bentu" !an !an susunan pro!u" 9u"u& ti!a" &en%%una"an %elar> pan%"at !an No&or n!u" ,e%a:ai (N,). b. ,enulisan na&a pe;abat

untu"

nas" as"a9

!inas

sara arana

a!&insitrasi !an "o&uni"asi per"antoran &en%%una"an %elar> pan%"at !an No&or n!u" ,e%a:ai (N,). &. Penandat Penandatanga anganan nan naska' naska' dinas dinas;; a. ,ena ,enan!a n!ata tan% n%an anan an nas" nas"a9 a9 !ina !inas s !ala !ala& & bent bentu" u" !an !an susu susuna nan n pro!u" pro!u" 9u"u& !an nas"a9 nas"a9 !inas !inas

sarana a!&ins a!&insitras itrasii

!an "o&uni"asi per"antoran !ila"u"an ole9 "epala S*,= b. ,enan!a ,enan!atan tan%an %anan an nas"a9 nas"a9 !inas !inas !ala& !ala& bentu" bentu" !an susunan susunan pro!u" pro!u" 9u"u& 9u"u& !an nas"a9 nas"a9 !inas !inas

sarana sarana a!&ins a!&insitr itrasi asi !an

"o&un "o&uni" i"as asii per" per"an anto toran ran !ila !ila"u "u"a "an n ole9 ole9 se"r se"ret etar aris is

S*, S*,

!ila"u"an sesuai !en%an "etentuan perun!an%an
sarana sarana a!&ins a!&insitr itrasi asi !an

"o&uni"asi per"antoran !ila"u"an ole9 "epala -,T. (. Pengguna Penggunaan an tinta tinta naska' naska' dinas. dinas. a. Tinta Tinta "o!e "o!e "las "lasi@ i@i" i"as asii !o"u !o"u&en &en !an !an na&a na&a bi!an% bi!an% S*, S*, ter"ai ter"aitt sesuai sesuai !en%an !en%an substa substansi nsi nas"a9 nas"a9 !inas !inas surat= b. ,eno&oran ,eno&oran nas"a9 nas"a9 !inas surat "o!e "lasi@i"asi !o"unen !an na&a -,T ter"ait sesuai !en%an substansi nas"a9 !inas surat= $. ,en%at ,en%aturan uran no&or no&or nas"a nas"a9 9 !inas !inas a!ala9 a!ala9 seba%a seba%aii beri"u beri"ut t 1) No&o No&orr urut urut terb terbit itn< n
%

peran%"at !aera9 a!ala9  $&= b. -"ur -"uran an %ari %aris s ten% ten%a9 a9 lin% lin%"a "ara ran n ten% ten%a9 a9 ste& ste&pe pell ;aba ;abata tan n !an !an ste&pel peran%"at !aera9 a!ala9 3>? $&= $. -"ur -"uran an %ari %aris s ten% ten%a9 a9 lin% lin%"a "ara ran n !ala !ala& & ste& ste&pe pell ;aba ;abata tan n !an !an peran%"at !aera9 a!ala9 2>7 $&= !. Jara" Jara" antara antara 2 (!ua) (!ua) %aris %aris
na&a na&a ,e&e ,e&eri rint nta9 a9 *abu *abupa pate ten n

4irebon> na&a S*, n> na&a S*, !an na&a -,T
II.

1.

BENTUK DAN +ORMAT NASKAH DINAS Ke,i e,i-ak -akan  Su Surat rat Ke Ke"utu "utusa san n; a. ,en%ertian Surat "eputusan a!ala9 nas"a9 !inas !ala& bentu" !an susunan pro!u" pro!u" 9u"u& 9u"u& t> in!iDi in!iDi!ua !uall !an @inal. b. 4iri'$iri Materi Materi bersi@ bersi@at at peneta penetapan pan>> !ituan% !ituan%"an "an !ala& !ala& !i"tu& !i"tu& *ST*ST->> *- !an seterusn seterusn penan!atan%an penan!atan%anann
itulis si&etris> !ileta""an !i ten%a9 &ar%ins

3) *ebi *ebi;a ;a"a "an n  !ia: !ia:al alii !en% !en%an an "ata "ata "epu "eputu tusa san> n> tanpa tanpa !ia:a !ia:ali li "ata surat "#

No&or

!o"u&en

!ibuat

&en%i"uti

"etentuan

seba%ai&ana ter$antu& !ala& "etentuan  point ? !i atas. $#  Jabatan

 ;abatan pe&buat "eputusan !itulis si&etris>

!ileta""an !i ten%a9 ten%a9 &ar%in &ar%ins s !an !ia"9i !ia"9iri ri !en%an !en%an tan!a tan!a "o&a ( > ) b) *onsi! *onsi!era eran n 1) Meni&ban% i.

Me&u Me&uat at urai uraian an sin% sin%"a "att tent tentan an% % po"o po"o"' "'po po"o "o" " pi"i pi"ira ran n  

ii. ii.

uru@ uru@ a:al a:al "at "ata EMe EMeni&b ni&ban an% % !itul ituliis !en%a en%an n 9uru 9uru@  @ 

&

"apital !ia"9iri !en%an tan!a ba$a titi" !ua (  ) !an !ileta""an !i ba%ian "iri> iii.

*onsi onsi! !eran eran &eni &eni&b &ban an% %

!ia: !ia:al alii

!en% !en%an an peno peno&o &ora ran n

&en% &en%%u %una na"a "an n 9uru 9uru@@ "e$i "e$ill !an !an !i&u !i&ula laii !en% !en%an an "ata "ata Eba9:a !en%an Eb 9uru@ "e$il 2) Men%in%at i.

Me&uat

!asar

perun!an%an

"e:enan%an
!an

peraturan

&e&erinta9"an

pe&buat

peraturansurat "eputusan tersebut ii.

*ata

EMen%in%at

!itulis

se;a;ar

!en%an

"ata

EMeni&ban% iii. iii.

,eru ,erun! n!an an%a %an n !itul !itulis is tanp tanpa a &en%% &en%%un una" a"an an %ari %aris s &irin &irin% % ()

iD.

,erun!an%an

!i

urut"an

sesuai

9irar"i

t at a

perun!an%an !en%an ta9un a:al !isebut lebi9 !a9ulu. 3) ira irar" r"ii per perun un!a !an% n%an an i.

-n!an%'-n!an%

ii.

,erat eratur uran an ,en ,en%% %%an anti ti -n! -n!an an%' %'-n -n!a !an% n%==

iii.

,eraturan ,e&erinta9=

i. i.

,eraturan ,resi!en=

.

*eputusan ,resi!en=

i.

,eraturan Menteri *ese9atan=

ii.

*eputusan Menteri "ese9atan=

iii.

,eraturan aera9=

i'.

 x.

,eraturan 8ubernur= ,eraturan upati.

) i"tu& i.

i"tu& EMM-T-S*N !itulis si&etris !i ten%a9 seluru9n
ii. ii.

i"t i"tu& u& EMen EMenet etap ap"a "an n 9uru 9uru@@ a:al a:al !itu !ituli lis s !en% !en%an an 9uru 9uru@  @  "apital> "apital> !itulis !itulis se;a;ar se;a;ar !en%an !en%an "ata EMeni&ban% EMeni&ban% !an EMen%in%at

iii.

Na&a Na&a "epu "eputu tusa san n

sesu sesuai ai !en% !en%an an ;u!u ;u!ull

"epu "eputu tusa san> n>

!ituli !itulis s seluru seluru9n< 9n
atan%

tubu9

&e&uat

se&ua

substansi

(

peratu peraturan ransur surat at "eputu "eputusan san
  

i$antu&"an

saat

berla"un
surat

"eputusan>

peruba peruba9an> 9an> pe&bata pe&batalan lan>> pen$ab pen$abuta utan n "etent "etentuan> uan> !an peraturan lain
iii.

"eputusan !an pa!a 9ala&an tera"9ir !itan!atan%ani ole9 pe;abat
) *a"i *a"i peraturansurat "eputusan &erupa"an ba%ian a"9ir subs substa tans nsii


pera peratu tura rans nsura uratt

&e&u &e&uat at

pena penan! n!a a

"epu "eputu tusa san> n>

tan% tan%an an

pene penera rapa pan n

pen% pen%un! un!an% an%an an

perat peratur uran an

"eputusan
Te&p Te&pat at !an !an tan tan%% %%al al pene penettapan apan Na&a Na&a ;ab ;abat atan an !ia !ia"9 "9ir irii !en% !en%an an tan tan!a !a "o& "o&a a

iii.

Tan!a tan% an%an pe;abat

iD. iD.

Na&a Na&a len len%" %"ap ap pe; pe;ab abat at
D. ita itan! n!at atan% an%an anii ole9 ole9 "epa "epala la" "oo oor! r!in inat ator or F*T, F*T, tanp tanpa a %elar !an N, Di.

Ji"a surat "eputusan lebi9 !ari satu 9ala&an> 9ala&an "e!ua> "eti%a !an seterusn
"op "op

sura surat> t>

!an !an

penan penan!a !ata tan% n%ana anan n

"epala F*T, !ileta""an !i 9ala&an tera"9ir. Dii. Dii. /M, /M,5 5N N



/a&p /a&pir iran an ,er ,erat atur uran anS Sur urat at *ep *eput utus usan an

*, *,-T-S -T-SN N *, *,/ /  NS *S STN TN * *-,T -,T N 45 45 N N

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Dii Diii.

ent entu" u" !an @or& @or&at at penu penullisan isan Sura Suratt "ep "eputus utusan an !i -nit -nit ,ela ,ela"s "san ana a Te"n Te"nis is (-,T) -,T) ,us" ,us"es es&a &as s a!al a!ala9 a9 seba%ai beri"ut

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Surat ,iasa; a. ,en%ertian Surat Surat bias biasa a a!al a!ala9 a9 nas"a nas"a9 9 !inas !inas n> pertan per&intaan ;a:aban atau saran !an seba%ain bulan> ta9un=

$) ,e;a ,e;aba batt ala ala&a &att
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al Surat.

2) si sura suratt biasa biasa !iru& !iru&us"a us"an n !ala& !ala& bentu" bentu" uraian uraian 3) a%ian a%ian a"9i a"9irr surat surat bias biasa a ter!i ter!iri ri atas atas a) Na&a ;a ;abata atan= b) Tan! Tan!a a tan% tan%an an pe; pe;ab abat at== $) Na&a Na&a pe;ab pe;abat> at> pan%"a pan%"att !an !an N, N, ba%i ba%i ,NS= ,NS= !) Ste& Ste&pe pell ;aba ;abata tani ninst nstans ansi= i= e) Te&busan. ,enan!atan%anan. Surat *eteran%an
 ;abatann n> seb seba%ai a%ai&a &ana na tertera pa!a 9ala&an beri"ut.

21

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Nomor "i'at *ampiran Perial

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Tempat@ tanggal@ bulan dan taun Kepada )t. !!!!!!!!!!!!!!! !!!!!!!!!!!!!!!!!. di$ !!!!!!!!!!!!!!!!!.

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Tembusan0 1. )t!!!!!!!!!! 2. )t. !!!!!!!!!.

1/. 1/. a.

Sura Suratt kete keterranga angan n; ,en%ertian

22

Surat Surat "ete "eteran ran%a %an n a!al a!ala9 a9 nas"a nas"a9 9 !inas !inas
Susunan Surat *eteran%an ter!iri atas  1) *epa *epala la Sura Suratt *ete *etera ran% n%an= an= 2) si si Sura Suratt *ete *etera ran% n%an an== 3) a%i a%ian an "9i "9irr Surat Surat *et *eter eran% an%an. an. !. 1) *epala Surat *eteran%an ter!iri atas  1) *ata E Surat Surat *eteran% *eteran%an an E !ite&p !ite&pat"an at"an !i ba%ian ba%ian ten%a9 le&bar le&bar nas"a9= 2) No&or No&or !an Ta9u Ta9un n atau !apat !apat &en%% &en%%una" una"an an No&or No&or pan;a pan;an% n% &enurut "ebutu9an. !. 2) si Surat *eteran%an ter!iri atas  1) Na&a Na&a !an Jabata Jabatan n N,> ,an% ,an%"at "at  8olo 8olon%a n%an> n> Jabata Jabatan= n= 3) Ma"s Ma"su! u! *ete *etera ran% n%an an.. !. 3) a%ian "9ir Surat *eteran%an ter!iri atas  1) Na& a&a a te&pat= 2) Tan% Tan%%a %al> l> ula ulan n !an !an Ta9un Ta9un== 3) Tan! Tan!a a tan tan%a %an n ,e; ,e;ab abat at== ) Na& a&a a Jab Jaba atan= ) Na&a Na&a Jela Jelas s ,e; ,e;ab abat at== 6) ,an% ,an%"a "att !an !an N,= ,= 7) Ste& Ste&pe pell Jaba Jabata tan n  ns nsta tans nsi. i.

$. ,ena ,enan! n!at atan an% %anan anan.. Surat *eteran%an !en%an &en%%una"an "op "op nas"a nas"a9 9 !ina !inas s F*T F*T, ,


!aera9 :arna 9ita& !ite&pat"an !iba%ian "iri atas. !. ent entu" u"  &o!e &o!ell nas" nas"a9 a9 !ina !inas s Sura Suratt *ete *etera ran% n%an an>> seba seba%a %ai& i&an ana a tertera pa!a 9ala&an beri"ut.

2!

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Puskesmas Dengan ini menerangkan baa0 a. Nama/NIP 0 !!!!!!!!!!!.NIP !!!!!!!!!!!!!! b. Pang Pangka kat/ t/Ao Aolo lon ngan gan 0 !!!! !!!!!! !!!! !!!! !!!! !!!! !!!! !!!! !!!! !!!! !!!! !!!! !!! ! #. abatan 0 !!!!!!!!!!!!!!!!!!!!!!!!!!! d. 4aksud 0 !!!!!!!!!!!!!!!!!!!!!!!!!!! !!!!!!!!!!!!!!!!!!!!!!!!!!! Demikian "urat Keterangan ini dibuat untuk digunakan seperlunBa.

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Tembusan 0 1. )t!!!! )t!!!!!!! !!!!!!! !!!!!!! !!!!!! !!!!!! !!!!! !! 2. )t!!!!!!!!!!! )t!!!!!!!!!!!!!!!!! !!!!!!!!!!!. !!!!!.

10. 10.

Surat rat Per Perin intta'; 1. ,en%ertian Surat Surat perint perinta9 a9 a!ala9 a!ala9 nas"a9 nas"a9 !inas !inas !ari !ari atasan atasan
ba:a ba:a9a 9an n

pe"er;aan tertentu. 2. Susunan


beri berisi si

peri perint nta9 a9

untu untu" "

&ela &ela"s "san ana" a"an an

2"

Susunan surat perinta9 ter!iri atas 1) *epala *epala Surat Surat ,erint ,erinta9 a9 ter! ter!iri iri atas atas a) Tulisa Tulisan n ESur ESurat at ,erint ,erinta9 a9== b) No&or. 2) si si Surat Surat ,eri ,erint nta9 a9 ter! ter!ir irii atas atas a) Na&a pe;abat pe;abat !an ;abatan ;abatan perinta9> ;enis perinta9 "9usus "9usus  
9arus

!ila"sana"an

!an

:a"tu


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,enan!atan%anan Surat Surat iBin iBin !en%an &en%%una"an &en%%un a"an "op "op nas" nas"a9 a9 !inas !inasF F*T *T, ,


!aera9 :arna 9ita& !ite&pat"an !iba%ian "iri atas. !.

ent entu" u"&o &o!e !ell nas" nas"a9 a9 !inas !inas Sura Suratt Bi Bin> n> seba seba%a %ai& i&ana ana tert terter era a pa! pa!a a 9ala&an beri"ut.

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Sura Suratt Peri Perint nta' a' Tug Tugas as;; a. ,en%ertian Sura Suratt ,eri ,erint nta9 a9 Tu%a Tu%as s a!al a!ala9 a9 nas" nas"a9 a9 !ina !inas s !ari !ari atas atasan an na&a> ,an%"at  8olon%an> N,> Jabatan l> ula ulan n !an !an Ta9un Ta9un== 3) Na& a&a a ;a ;abatan= an= ) Tan!a Tan!a Tan%a Tan%an n ,e;ab ,e;abat at
7) Ste& Ste&pe pell Jaba Jabata tan nn nst stans ansi. i. ,enan!atan%anan Surat Surat ,eri ,erint nta9 a9 Tu%a Tu%as s
!.

entu" entu"&o &o!el !el nas"a9 nas"a9 !inas !inas Sura Suratt ,eri ,erinta9 nta9 Tu%as> Tu%as> seba%a seba%ai&a i&ana na tertera pa!a 9ala&an beri"ut.

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Surat Kuasa;

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a. ,en%e ,en%erti rtian an Surat Surat *uasa

a!ala9 a!ala9 nas"a9 nas"a9 !inas !ari !ari pa;abat pa;abat
"epa!a ba:a9an berisi pe&berian :e:enan% !en%an atas na&an
&ela &ela" "u"an u"an

sesu sesuat atu u

tin! tin!a" a"an an

tert terte entu ntu

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ran% ran%"a "a

"e!inasan. b. Susuna Susunan n Susunan surat "uasa ter!iri atas 1) *epa *epala la Sura Suratt *uas *uasa a ter! ter!iri iri atas atas a)

Tulis Tulisan an ESur ESurat at *uas *uasa a !ite !ite&pa &pat"a t"an n !i ten%a9 ten%a9 le&ba le&barr nas"a nas"a9 9 !inas=

b)

Tulis Tulisan an ENo& ENo&or or Surat Surat *uas *uasa a !ite& !ite&pat pat"a "an n !i ba:a ba:a9 9 tulis tulisan an ESurat *uasa

2) si Surat Surat *uas *uasa a ter! ter!iri iri atas atas a) Na&a pe;abat pe;abat>> pan%"a pan%"at> t> N, N, !an !an ;abatan ;abatan
Tulisan EE-ntu"=

%) al'9al al'9al l> bula bulan n !an !an ta9un ta9un pe&b pe&buat uatan= an= $) Na&a Na&a ;ab ;abat atan an pe& pe&be beri ri "ua "uasa sa== !) Tan!a Tan!a tan% tan%an an pe;a pe;abat bat pe& pe&be beri ri "uas "uasa= a= e) Na&a ;elas ;elas pe&ber pe&berii pe&be pe&beri ri "uasa "uasa (pan% (pan%"at "at !an N, N, ba%i ba%i ,NS) @)

Ste& Ste&pe pell ;aba ;abata tan nin inst stan ans si=

%) Tuli Tulisa san n EIan EIan% % &e&b &e&ber er "ua "uasa sa= = 9) Na&a Na&a ;aba ;abatan tan
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$. ,ena ,enan n!atan% tan%a anan nan Surat Surat *uasa *uasa !itan !itan!at !atan% an%ani ani ole9 ole9 ,i&p ,i&pina inan n !an !an atau atau peran peran%" %"at at !aera9 atas :e:enan% ;abatann
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Tanggal@ tempat@ bulan dan taun )ang memberi kuasa K5P,*, DIN," K5"5H,T,N

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Surat urat Undang dangan an;;

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Na&a Na&a te& te&pa pat> t> tan%%a tan%%al> l> bulan bulan !an ta9un ta9un !ite& !ite&pat pat"a "an n !i !i "anan atas=

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la&at la&at un!an% un!an%an an te&pat> tan%%al> bulan !an ta9un=

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No&or> No&or> si@at> si@at> /a&pi /a&piran ran !an !an 9al 9al !i"e !i"eti" ti" se$ar se$ara a Dert Derti" i"al> al> !ite&pat"an !i sebela9 "iri atas.

3) si Surat Surat -n!an -n!an%an %an ter!i ter!iri ri atas atas 9) Ma"s Ma"su! u! !an !an tu; tu;ua uan= n= i)  ;)

ari ari pen :a"tu :a"tu !an te&pat pen
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Tulisan ,e ,enutup.

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Tan! Tan!a a tan tan%a %an n pe; pe;ab abat at pen pen%u %un! n!an an%= %=

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Tempat@ Tanggal@ 6ulan dan Taun

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Surat urat "en "eng gant antar; ar; a. ,en%ertian Surat Surat pen%a pen%anta ntarr a!ala a!ala9 9 nas"a9 nas"a9 !inas !inas beris berisii ;enis ;enis !an !an ;u&la ;u&la9 9 baran% tan%%al> bulan bulan !an ta9un ta9un==

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NOTULEN "idang/rapat Hari/Tanggal >aktu Pa Panggilan >aktu "idang/rapat  ,#ara

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&utu. utu.

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pa!a pa!a li&a li&a ta9u ta9un n

a!a a!ala9 la9

&en! &en!at atan an% %

pros roses se$a se$ara ra

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opti opti&a &all

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pen%e&ban%an

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Ren2a Ren2ana na Usu$an Usu$an Kegiat Kegiatan an :RUK :RUK;; a. ,en% ,en%e ertia rtian n 5en$ana -sulan "e%iatan (5-*) a!ala9 ren$ana usulan "e%iatan  
a"an

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ta9un

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ber!asar"an analisis $apaian pro%ra& ta9un sebelu&n
inte inte%r %ras asii

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;a:a ;a:ab b

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04. 04.

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a!a a!ala9

&an &a na;e a;e&en &en

peren$anaan pela"sanaan pro%ra& "e%iatan pa!a ta9un ber;alan ber!asar"an 5-* pa!a ta9un
01. 01.

D!ku D!kue en n $ain $ain ses sesua uaii ke,u ke,utu tu'a 'an n o"u o"u&e &en n lain lain sesu sesuai ai "ebu "ebutu tu9a 9an n a!al a!ala9 a9 !o"u !o"u&e &en n
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