Form SKP Contoh.xlsx

7/25/2019 Form SKP Contoh.xlsx

1/37

Created by Bangpeg2013

KANTOR REGIONAL IIIBADAN KEPEGAWAIAN NEGARA

MENU SASARAN KERJAPEGAWAI NEGERI SIPIL

1. DATA SASARAN KERJA PEGAWAI

3. FORMULIR SKP

4. PENGUKURAN CAPAIAN SKP

5. BUKU CATATAN PERILAKU KERJAPNS

2. COVER


2/37

DATA SASARAN KERJA PEGAWAI

1 YANG DINILAI

a. Nama !J.NINIK JO!ARIYA!"SST.K#$

$. NIP 1%&'()2' 2((212 2 (('*. Pa+,-a/G0.Ra+, PENATA MUDA / III A

. Ja$aa+ Ba+ P#a-a+a La+6a+

#. U+ K#76a UPTD PUSKESMAS ANYAR

2 PEJABAT PENILAI

a. Nama 7. !6. E89 Wa:9 A+a9a+

$. NIP 1%'%(%(3 2(('(4 2 ((3

*. Pa+,-a/G0.Ra+, P#+aa /III

. Ja$aa+ K#;aa UPTD P-#ma DTP A+9#7

#. U+ K#76a UPTD P-#ma DTP A+9#7

3 ATASAN PEJABAT PENILAI

a. Nama 7. !6. S7 N7:a9a

$. NIP 1%5%1125 1%))(2 2 ((1

*. Pa+,-a/G0.Ra+, P#m$+a Uama Ma / IV C. Ja$aa+ K#;aa D+a

#. U+ K#76a D+a K##:aa+ Ka$;a#+ S#7a+,


3/37

BACKTO

MENUUTAM

A


4/37

PENILAIAN PRESTASI KERJA

PEGAWAI NEGERI SIPIL

Jangka Waktu Penilaian

Januari s! Dese"#er$%&'

Nama P#,a


5/37

BACKTOMENUUTAM

A


6/37

-ORMULIR SASARAN KERJA


NO I) PEJABAT PENILAI NO II) PEGAWAI NEGERI SIPIL *ANG DINILAI

1 Nama 7. !6. E89 Wa:9 A+a9a+ 1 Nama !J.NINIK JO!ARIYA!"SST.K#$

2 NIP 1%'%(%(3 2(('(4 2 ((3 2 NIP 1%&'()2' 2((212 2 (('

3 Pa+,-a/G0.RaP#+aa /III 3 Pa+,-a/G0.Ra PENATA MUDA / III A

4 Ja$aa+ K#;aa UPTD P-#ma DTP A+9#7 4 Ja$aa+ Ba+ P#a-a+a La+6a+

5 U+ K#76a UPTD P-#ma DTP A+9#7 5 U+ K#76a UPTD PUSKESMAS ANYAR

NO III) KEGIATAN TUGAS JABATAN AK TARGET

KUANTOUTPUT WAKTU BIA*A

I PELAYANAN KEBIDANAN

A P#7a;a+ P#a9a+a+ -#$a+a+ .

M#m;#7a;-a+ ;#a9a+a+ -#$a+a+ 0.008 2.1' 2&( K#,aa+ 1(( &$ #ln .

B P#+,-a6a+ -#;aa -#+/;a#+ .

1 M#a-a+a-a+ a+am+#a -#+ / ;a#+ ;aa .

a. Ka F00, .

1= a+;a maaa: (.(() 2.%' 3&( K#,aa+ 1(( &$ #ln .

2= $#7maaa: (.((3 (.%45 315 K#,aa+ 1(( &$ #ln .

$. Ka Pa00, .

-#,a- #+ /Pa#+ ;aa .

a. Ka F00, .

1= a+;a maaa: (.(() 2.%' 3&( K#,aa+ 1(( &$ #ln .

2= $#7maaa: (.((2 (.'3 315 K#,aa+ 1(( &$ #ln .

$. Ka Pa00,

-#,a


7/37

M#a--a+ ;#+,am$a+ #aa+/$a:a+ a$07a07m

a. M#a--a+ ;#+,am$a+ a7a: #; (.((5 (.14 2) -#+/;a#+ 1(( &$ #ln .

$. M#a--a+ ;#+,am$a+ a7a: 8#+a (.((3 (.12 4( -#+/;a#+ 1(( &$ #ln .

#. M#a--a+ ;#+,am$a+ 7+# (.((3 (.(1) ' -#+/;a#+ 1(( &$ #ln .

?. M#a--a+ ;#+,am$a+ a7 -#$a+ (.((1 (.((' ' -#+/;a#+ 1(( &$ #ln .

4 M#a--a+ ;#m#7-aa+ a$07a07m ##7:a+a

a. M#a--a+ ;#m#7-aa+ a7a:

1= M#a--a+ ;#m#7-aa+ !B (.((' (.(% 15 K#,aa+ 1(( &$ #ln .

2= M#a--a+ ;#m#7-aa+ ,0 a7a: (.((2 (.(3 15 K#,aa+ 1(( &$ #ln .

5 M#a--a+ ;#m#7-aa+ 7+# .

a. M#a--a+ ;#m#7-aa+ 7+# ;70#+ (.((5 (.(5 1( K#,aa+ 1(( &$ #ln .

$. M#a--a+ ;#m#7-aa+ 7+# 7#- (.((3 (.(3 1( K#,aa+ 1(( &$ #ln .

C P#+#,a-a+ a,+0a -#$a+a+

M#m$a a,+0a -#$a+a+ #a #+,a+ :a ;#+,a6a+ Paa

a. Ka >00,

1= a+;a maaa: (.((5 1.)5 3&( K#,aa+ 1(( &$ #ln .

2= $#7maaa: (.((1 (.315 315 K#,aa+ 1(( &$ #ln .

$. Ka ;a00, .

-#,a00,

1= a+;a maaa: (.((5 1.)5 3&( K#,aa+ 1(( &$ #ln .

2= $#7maaa: (.((3 (.%45 315 K#,aa+ 1(( &$ #ln .

$. Ka ;a00, .

-#,a


8/37

M#+9+ 7#+*a+a 0;#7a0+a a:a+ -#$a+a+ ;aa

a. Ka >00,

1= a+;a maaa: (.((& 2.5% 3&( 7#+*a+a 1(( &$ #ln .

2= $#7maaa: (.((3 (.%45 315 7#+*a+a 1(( &$ #ln .

$. Ka ;a00,

-#,a00,

1= a+;a maaa: (.((5 1.)5 3&( K#,aa+ 1(( &$ #ln .

2= $#7maaa: (.((2 (.'3 315 K#,aa+ 1(( &$ #ln .

$. Ka ;a00, .

-#,a00, .

1= a+;a maaa: (.((& 2.5% 3&( K#,aa+ 1(( &$ #ln .

2= $#7maaa: (.((2 (.'3 315 K#,aa+ 1(( &$ #ln .

$. Ka ;a00,

-#,a00,

a. Ta+;a maaa:


9/37

1=.P#7a+a+

Kaa I (.((5 (.(5 1( -#+/;a#+ 1(( &$ #ln .

Kaa II (.((5 (.(5 1( -#+/;a#+ 1(( &$ #ln .

Kaa III (.((5 (.(5 1( -#+/;a#+ 1(( &$ #ln .

Kaa IV (.((' (.(' 1( -#+/;a#+ 1(( &$ #ln .

(.1 31.5 315 -#+/;a#+ 1(( &$ #ln .

(.((3 (.1) '( -#+/;a#+ 1(( &$ #ln .

$. B#7maaa:

1=.P#7a+a+

Kaa I (.((' (.(% 15 K#,aa+ 1(( &$ #ln .

Kaa II (.((' (.(% 15 K#,aa+ 1(( &$ #ln .

Kaa III (.((' (.(% 15 K#,aa+ 1(( &$ #ln .

Kaa IV (.((' (.(% 15 K#,aa+ 1(( &$ #ln .

(.((1 (.14 14( K#,aa+ 1(( &$ #ln .

(.((1 (.2 2(( K#,aa+ 1(( &$ #ln .

2 Ka ;a00,

-#,a


10/37

$. -#0m;0- (.((4 (.() 2( K#,aa+ 1(( &$ #ln .

2 M#a--a+ -0+#+, ;aa -#+ / ;a#+ ;aa

a. Ka >00,

1= Ta+;a maaa: (.((2 (.&4 3&( -#+/;a#+ 1(( &$ #ln .

$. Ka ;a00, 1(( &$ #ln .

-#,a00, (.(() 76-a+ 1(( &$ #ln .

2 Ka ;a00, (.(3 (.12 4 76-a+ 1(( &$ #ln .

J E8aa a:a+ -#$a+a+

M#a-a+a-a+ #8aa a:a+ -#$a+a+ -#+ / ;a#+ ;aa

a. Ka >00,

1= Ta+;a maaa: (.(' 22.2 3&( a;07a+ 1(( &$ #ln .

$. Ka ;a00,

-#,a00,

1= Ta+;a maaa: (.(() 2.%' 3&( a;07a+ 1(( &$ #ln .

$. Ka ;a00,

-#,a


11/37

$. P#+a+,,+,6a


12/37

$. Daam ma6aa: ma: 9a+, a- 0#: LIPI '

2

a. Daam $#+- $- )

$. Daam $#+- ma-aa: 4

3

a.)

$. Daam ma6aa: ma: 9a+, a- 0#: LIPI 4

4

a. Daam $#+- $- &.5

$. Daam $#+- ma-aa: 3.5

52

'2.5

B

1 M#+#76#ma:-a+ / m#+9a7 aam $a+, -#$a+a+

a. &

$. Daam ma6aa: ma: 9a+, a- 0#: LIPI 3.5

2

a.3


3 M#m$a a$7a- a+ ma: 9a+, ma aam ; 1.5

M#m$a -a79a / -a79a ma: :a ;#+#a+ ";#+,-a6a+"78#9 a+ #8aa $a+, -#$a+a+

M#m$a -a79a / -a79a ma: $#7;a +6aa+

Daam $#+- $- 9a+, #7$-a+ a+ #a7-a+ #*a7a +a0+a

M#m$a -a79a / -a79a ma: $#7;a +6aa+aa aa+ ma: #+,a+ ,a,aa+ #+7 $a+,-#$a+a+ 9a+, a- ;$-a-a+

M#m$a a+ ma: ;0;#7 9a+, $a+,-#$a+a+ 9a+, #$a7a-a+ m#a m#a

M#+9am;a-a+ ;7aa7a+ $#7;a +6aa+ " ,a,aa+a+ aa aa+ ma: $a+, -##:aa+ ;aa

P#+#76#ma:a+ /;#+9a7a+ $- a+ $a:a+ a++9a $a+, -#$a+a+

Daam $#+- $- 9a+, #7$-a+ a+ #a7-a+ #*a7a +a0+a

M#+#6#ma: -a+/ m#+9a7 aam $aa+, -#$a+a+9a+, a- ;$-a-a+

Daam $#+- $- 9a+, #7$-a+ a+ #a7-a+ #*a7a +a0+a


13/37

C P#m$aa+ $- ;#0ma+/6-a-/6-+ $a+, -#$a+a+

2

D M#+#m-a+ #-+00, #;a ,+a $a+, -#$a+a+

M#+#m-a+ #-+00, #;a ,+a $a+, -#$a+a+ 5

II. TUGAS TAMBAHAN DAN KREATIVITAS/UNSUR PENUNJANG :

1BIDAN KOORDINATOR

SP2TP

2(kreatifita!

(kreatifita!

S#7a+," Ja+a7 2(15

P#6a$a P#+a" P#,a


14/37

PENILAIAN CAPAIAN SASARAN KERJA


Ja+,-a Wa- P#+aa+

Ja+a7 / D##m$#72(15

NO I) KEGIATAN TUGAS TAMBA(AN AK

TARGET

AKKa+/ O; Wa- Ba9a K

& $ / , ' 0 1 2

I PELAYANAN KEBIDANAN

A P#7a;a+ P#a9a+a+ -#$a+a+

M#m;#7a;-a+ ;#a9a+a+ -#$a+a+ 2.1' 2&( K#,aa+ 1(( 12 $+ 2.152 26

B P#+,-a6a+ -#;aa -#+/;a#+

1 M#a-a+a-a+ a+am+#a -#+ / ;a#+ ;aa

a. Ka F00,

1= a+;a maaa: 2.%' 3&( K#,aa+ 1(( 12 $+ 2.%(4 36

2= $#7maaa: (.%45 315 K#,aa+ 1(( 12 $+ (.%42 31

$. Ka Pa00,-#,a


15/37

4 M#a--a+ ;#m#7-aa+ a$07a07m ##7:a+a

a. M#a--a+ ;#m#7-aa+ a7a:

1= M#a--a+ ;#m#7-aa+ !B (.(% 15 K#,aa+ 1(( 12 $+ (.(&2

2= M#a--a+ ;#m#7-aa+ ,0 a7a: (.(3 15 K#,aa+ 1(( 12 $+ (.(24

5 M#a--a+ ;#m#7-aa+ 7+#

a. M#a--a+ ;#m#7-aa+ 7+# ;70#+ (.(5 1( K#,aa+ 1(( 12 $+ (.(4

$. M#a--a+ ;#m#7-aa+ 7+# 7#- (.(3 1( K#,aa+ 1(( 12 $+ (.(24

C P#+#,a-a+ a,+0a -#$a+a+

M#m$a a,+0a -#$a+a+ #a #+,a+ :a ;#+,a6a+ Paa

a. Ka >00,

1= a+;a maaa: 1.)5 3&( K#,aa+ 1(( 12 $+ 1.)15

2= $#7maaa: (.315 315 K#,aa+ 1(( 12 $+ (.314

$. Ka ;a00,

-#,a00,1= a+;a maaa: 1.)5 3&( K#,aa+ 1(( 12 $+ 1.)15

2= $#7maaa: (.%45 315 K#,aa+ 1(( 12 $+ (.%42

$. Ka ;a00,

-#,a


16/37

a. Ka >00,

1= a+;a maaa: 1.)5 3&( K#,aa+ 1(( 12 $+ 1.)15

2= $#7maaa: (.'3 315 K#,aa+ 1(( 12 $+ (.'2)

$. Ka ;a00,

-#,a00,

1= a+;a maaa: 2.5% 3&( K#,aa+ 1(( 12 $+ 2.541

2= $#7maaa: (.'3 315 K#,aa+ 1(( 12 $+ (.'2)

$. Ka ;a00,

-#,a


17/37

(.((1 14( K#,aa+ 1(( 12 $+ (.132

(.((1 2(( K#,aa+ 1(( 12 $+ (.1)2

2 Ka ;a00,

-#,a00,

1= Ta+;a maaa: (.((2 3&( -#+/;a#+ 1(( 12 $+ (.&2'

$. Ka ;a00,-#,a00, (.(()

2 Ka ;a00, (.(3 4 76-a+ 1(( 12 $+ (.(%

J E8aa a:a+ -#$a+a+

M#a-a+a-a+ #8aa a:a+ -#$a+a+ -#+ / ;a#+ ;aa

a. Ka >00,

1= Ta+;a maaa: (.(' 3&( a;07a+ 1(( 12 $+ 21.&)

$. Ka ;a00,

-#,a


18/37

( 1= Ta+;a maaa: (.(() 3&( a;07a+ 1(( 12 $+ 2.%(4

$. Ka ;a00,

( -#,a


19/37

1

a. 12.5

$. Daam ma6aa: ma: 9a+, a- 0#: LIPI '

2 (

a. Daam $#+- $- )

$. Daam $#+- ma-aa: 4

3 (

a. )

$. Daam ma6aa: ma: 9a+, a- 0#: LIPI 4

4 (

a. Daam $#+- $- &.5

$. Daam $#+- ma-aa: 3.5

5 2

' 2.5

B (

1 M#+#76#ma:-a+ / m#+9a7 aam $a+, -#$a+a+ (

a. &

$. Daam ma6aa: ma: 9a+, a- 0#: LIPI 3.52 (

a. 3


3 M#m$a a$7a- a+ ma: 9a+, ma aam ;#+#7 1.5

C P#m$aa+ $- ;#0ma+/6-a-/6-+ $a+, -#$a+a+ (

2

D M#+#m-a+ #-+00, #;a ,+a $a+, -#$a+a+ (

M#+#m-a+ #-+00, #;a ,+a $a+, -#$a+a+ 5

II) TUGAS TAMBA(AN DAN KREATI6ITAS 5

1 BIDAN KOORDINATOR

SP$TP

78#9 a+ #8aa $a+, -#$a+a+ 9a+,

a am #+ 9a+, #7 a+ a+ # a7 a+#*a7a +a0+a

;#+,-a6a+"78#9 a+ #8aa $a+, -#$a+a+ 9a+,

aa+ ma: #+,a+ ,a,aa+ #+7 $a+,a am #+ 9a+, #7 a+ a+ # a7 a+

#*a7a +a0+a

aa+ ma: #+,a+ ,a,aa+ #+7 $a+, -#$a+a+

#m a a+ m a ;0; #7 9a+, a+, # a+a+

aa aa+ ma: $a+, -##:aa+ ;aa ;#7#ma+#+#7 #ma a+ ;#+9a 7a+ a+ a a+ a ++9a a+,

a am #+ 9a+, #7 a+ a+ # a7 a+#*a7a +a0+a

#+# #ma a+ m#+9a 7 aam a a+, # a+a+a+ a- $-a-a+a am #+ 9a+, #7 a+ a+ # a7 a+

#*a7a +a0+a

#m a ;# 0ma++ # + ;# a a+aa+ ;# + #-+ $a+ -#$a+a+


20/37

2 7kreati8tas9

7kreati8tas9

Nilai Ca:aian SKP


21/37

;#7#+ ;#7#+ $-a+a -aa


22/37

( ( DIV/(

( ( DIV/(

1 ( ( )( )' &' &' 1(( VALUE

1 ( ( )( )' &' &' 1(( VALUE

( ( DIV/(

1 ( ( )( )& &' &' 1(( VALUE

1 ( ( )( )& &' &' 1(( VALUE

( ( DIV/( ( ( DIV/(

( ( DIV/(

1 ( ( %).1() )& &' &' 1(( VALUE

1 ( ( %%.')3 )& &' &' 1(( VALUE

( ( DIV/(

1 ( ( &5 )' &' &' 1(( VALUE

( ( DIV/(

( ( DIV/(

( ( DIV/(

1 ( ( %).1() )& &' &' 1(( VALUE

1 ( ( %%.')3 )& &' &' 1(( VALUE

( ( DIV/(

1 ( ( &5 )' &' &' 1(( VALUE

( ( DIV/(

( ( DIV/(

( ( DIV/(

1 ( ( %).1() )& &' &' 1(( VALUE

1 ( ( %%.')3 )& &' &' 1(( VALUE

( ( DIV/(

1 ( ( &5 )' &' &' 1(( VALUE

( ( DIV/(

( ( DIV/(

( ( DIV/(


23/37

( ( DIV/(

1 ( ( %).1() )& &' &' 1(( VALUE

1 ( ( %%.')3 )& &' &' 1(( VALUE

( ( DIV/(

1 ( ( &5 )' &' &' 1(( VALUE

( ( DIV/(

( ( DIV/(

1 ( ( %).1() )& &' &' 1(( VALUE 1 ( ( %%.')3 )& &' &' 1(( VALUE

( ( DIV/(

1 ( ( &5 )' &' &' 1(( VALUE

( ( DIV/(

( ( DIV/(

( ( DIV/(

( ( DIV/(

( ( DIV/(

( ( DIV/(

( ( DIV/(

( ( DIV/(

1 ( ( )( )& &' &' 1(( VALUE

1 ( ( )( )& &' &' 1(( VALUE

1 ( ( )( )& &' &' 1(( VALUE

1 ( ( )( )& &' &' 1(( VALUE

1 ( ( %%.3'5 )) &' &' 1(( VALUE

1 ( ( )3.333 )) &' &' 1(( VALUE

( ( DIV/(

( ( DIV/(

1 ( ( )( )' &' &' 1(( VALUE

1 ( ( )( )' &' &' 1(( VALUE

1 ( ( )( )' &' &' 1(( VALUE

1 ( ( )( )' &' &' 1(( VALUE

BACK


24/37

1 ( ( %4.2)' )& &' &' 1(( VALUE

1 ( ( %1 )& &' &' 1(( VALUE

( ( DIV/(

1 ( ( &5 )& &' &' 1(( VALUE

( ( DIV/(

( ( DIV/(

( ( DIV/(

( ( DIV/( ( ( DIV/(

( ( DIV/(

( ( DIV/(

1 ( ( %).2&' )& &' &' 1(( VALUE

1 ( ( &5 )' &' &' 1(( VALUE

( ( DIV/(

( ( DIV/(

1 ( ( %).1() )' &' &' 1(( VALUE

( ( DIV/(

1 ( ( 5( )' &' &' 1(( VALUE

( ( DIV/(

( ( DIV/(

( ( DIV/(

1 ( ( &5 )' &' &' 1(( VALUE

( ( DIV/(

( ( DIV/(

( ( DIV/(

1 ( ( %).1() )& &' &' 1(( VALUE

( ( DIV/(

1 ( ( &5 )' &' &' 1(( VALUE

( ( DIV/(

( ( DIV/(

( ( DIV/(

TOMENUUTAMA


25/37

1 ( ( %).1() )& &' &' 1(( VALUE

( ( DIV/(

1 ( ( &5 )' &' &' 1(( VALUE

( ( DIV/(

( ( DIV/(

( ( DIV/(

( ( DIV/(

( ( DIV/( ( ( DIV/(

1 ( ( 1(( )) &' &' 1(( VALUE

( ( DIV/(

( ( DIV/(

1 ( ( )3.333 )' &' &' 1(( VALUE

( ( DIV/(

( ( DIV/(

( ( DIV/(

( ( DIV/(

( ( DIV/(

( ( DIV/(

( ( DIV/(

1 ( ( )4 )5 &' &' 1(( VALUE

1 ( ( %4.''& )) &' &' 1(( VALUE

1 ( ( )( )& &' &' 1(( VALUE

( ( DIV/(

1 ( ( &5 )5 &' &' 1(( VALUE

( ( DIV/(

1 ( ( 1(( )) &' &' 1(( VALUE

( ( DIV/(

( ( DIV/(

( ( DIV/(

( ( DIV/(


26/37

( ( DIV/(

( ( DIV/(

( ( DIV/(

( ( DIV/(

( ( DIV/(

( ( DIV/(

( ( DIV/(

( ( DIV/( ( ( DIV/(

( ( DIV/(

( ( DIV/(

( ( DIV/(

( ( DIV/(

( ( DIV/(

( ( DIV/(

( ( DIV/(

( ( DIV/(

( ( DIV/(

( ( DIV/(

1.&'G)N)=/G)=1((= &'

1.&'I)P)=/I)=1((= &'


27/37

4)21

REF

5%

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28/37

2'3.'3

2'1.11

2'2.')

23&

2'1.11

2'2.')

23&

253.2%

25%

24'.33

24'.33


29/37

242

242

243

243

2'1.11

2'2.')

23&

2'1.11

2'2.')

23&

2'1.11

2'2.')

23&


30/37

2'1.11

2'2.')

23&

2'1.112'2.')

23&

243

243

243

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2'3.3&

24&.33

242

242

242

242


31/37

25&.2%

254

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2'1.2)

23&

2'(.11

212

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32/37

2'1.11

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2'4

245.33

245

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2'4


33/37


34/37


35/37

BUKU CATATAN PENILAIAN PERILAKU PNS

Nama !J.NINIK JO!ARIYA!"SST.K#$

NIP 1%&'()2' 2((212 2 (('

N0 Ta+,,a U7aa+

1 2 3 4

1 P#+aa+ SKP am;a #+,a+ a-:7 D##m$#7 2(14

#a+,-a+ ;#+aa+ ;#7a- -#76a+9a aaa:

#$a,a $#7-

O7#+a P#a9a+a+ &&.(( Ba-=

I+#,7a &).(( Ba-=

K0mm#+ &&.(( Ba-=

D;+ &&.(( Ba-=

K#76aama &%.(( Ba-= 7. !6. E89 Wa:9 A+a9a+

K#;#mm;+a+ 1%'%(%(3 2(('(4 2 ((3

Jma: 3))

Na Raa7aa &&.'( Ba-=

Nama/NIP a+ Pa7a?P#6a$a P#+a

Ja+a7 /D##m$#72(15

K#;aa UPTD P-#ma DTPA+9#7


36/37

BACKTO

MENUUTAM

A


37/37

5. KEBERATAN DARI PEGAWAI NEGERI SIPIL

YANG DINILAI APABILA ADA=

Ta+,,a ................................

'. TANGGAPAN PEJABAT PENILAI ATAS KEBERATAN

Ta+,,a ................................

&. KEPUTUSAN ATASAN PEJABAT PENILAI ATASKEBERATAN

Ta+,,a ................................

). REKOMENDASI

%. DIBUAT TANGGAL"

PEJABAT PENILAI

7. !6. E89 Wa:9 A+a9a+1%'%(%(3 2(('(4 2 ((3

1(. DITERIMA TANGGAL"

PEGAWAI NEGERI SIPIL YANG

DINILAI"

!J.NINIK JO!ARIYA!"SST.K#$

1%&'()2' 2((212 2 (('

11. DITERIMA TANGGAL"ATASAN PEJABAT YANG MENILAI

7. !6. S7 N7:a9a

1%5%1125 1%))(2 2 ((1

Form SKP Contoh.xlsx

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