Copy of Form SKP-Final

8/18/2019 Copy of Form SKP-Final

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DATA SASARAN KERJA PEGAWAI

1 YANG DINILAI

a. Nama : HARI WIDAYATI, S.KEP

b. NIP : 19710726 199403 2 002c. Pa!"a#$G%&.R'a! : PENATA TINGKAT I$ III (

(. )aba#a : PERAWAT PENYELIA

*. +# K*-a : PK/ HA)I/ENA

2 PE)AAT PENILAI

a. Nama : DERAH/AN, SP.//

b. NIP : 1966009 199303 1 00

c. Pa!"a#$G%&.R'a! : PENATA TINGKAT I$ III (

(. )aba#a : KEPALA P+SKES/AS

*. +# K*-a : +PT.PK/ HA)I/ENA

3 ATASAN PE)AAT PENILAI

a. Nama : AH/AD RDHI, SK/./.KES

b. NIP : 196200 1903 1 00

c. Pa!"a#$G%&.R'a! : PE/INA TINGKAT I $ I b(. )aba#a : SEKERTARIS DINAS KESEHATAN LA/SEL

*. +# K*-a : DINAS KESEHATAN LA/P+NG SELATAN

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PENILAIAN PRESTASI KERJA

PEGAWAI NEGERI SIPIL

Jangka Waktu Penilaian2 Januari !" #$ Dee%&er 2'$(

Nama P*!a5a : )ARI WIDA*ATI+ S,KEP

NIP : 19710726 199403 2 002Pa!"a# G%&%!a R'a : PENATA TINGKAT I$ III (

)aba#a : PERAWAT PENYELIA

+# K*-a : PK/ HA)I/ENA

BADAN KEPEGAWAIAN NEGARA

TA)UN 2'$(


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-ORMULIR SASARAN KERJA


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

1 Nama DERAH/AN, SP.// 1 Nama HARI WIDAYATI, S.KEP

2 NIP 1966009 199303 1 00 2 NIP 19710726 199403 2 002

3 Pa!"a#$G%&.R'a! PENATA TINGKAT I$ III ( 3 Pa!"a#$G%&.R'a! P*a#a T!"a# I$ III (

4 )aba#a KEPALA P+SKES/AS HA)I/ENA 4 )aba#a P*-a5a# P**&a

+# K*-a +PT.P+SKES/AS HA)I/ENA +# K*-a P'"*ma Ham*a

NO III, KEGIATAN TUGAS JABATAN AK TARGET

KUANT!OUTPUT KUAL!MUTU WAKTU BI

1 0.030 7.2 240 &a8%-a 100 12 b'&a

2 0.01 2.4 240 &a8%-a 100 12 b'&a

3 0.01 1.44 96 -'m'a 100 12 b'&a

4 0.02 4. 240 -'m'a 100 12 b'&a

/*-*caa"a #(a"a "*8*-a5a#a *(*-aa 8a(a "*&%m8%" 0.00 0.4 96 -*caa 100 12 b'&a

6 0.007 1.6 240 -*caa 100 12 b'&a

7 0.003 0.72 240 #(a"a 100 12 b'&a

0.01 2.4 240 #(a"a 100 12 b'&a

9 0.00 1.12 144 #(a"a 100 12 b'&a

10 /*&a"'"a 8*'&'a "*8a(a maa-a"a# 0.04 1.92 4 "*!a#a 100 12 b'&a

11 0.01 0.4 4 "a& 100 12 b'&a

12 0.007 0.4 120 &a8%-a 100 12 b'&a

., .. )a'a- 20

P*aba# P*&a, P*!a5a N*!*- S8& Ya! D&a

/*&a"aa"a 8*!"aa "*8*-a5a#a b*-'8a 8*!"aa (aa-8a(a maa-a"a#

/**-ma "%'a 8*!"aa "*8*-a5a#a b*-'8a 8*!"aa(aa-

/*&a"aa"a aa&a (a#a '#'" m*-'m'"a (a!%a"*8*-a5a#a aa&a *(*-aa 8a(a "*&%m8%"

/*&a"aa"a aa&a (a#a '#'" m*-'m'"a (a!%a"*8*-a5a#a aa&a *(*-aa 8a(a maa-a"a#

/*-*caa"a #(a"a "*8*-a5a#a *(*-aa 8a(amaa-a"a#

/*&a"aa"a #(a"a "*8*-a5a#a #(a"a "*8*-a5a#a(aa- 8a(a "a#a!%- II

/*&a"aa"a #(a"a "*8*-a5a#a #(a"a "*8*-a5a#a(aa- 8a(a "a#a!%- III

/*&a"aa"a #(a"a "*8*-a5a#a #(a"a "*8*-a5a#a"%m8&*" 8a(a "a#a!%- II

/*&a"aa"a *;a&'a "*8*-a5a#a *(*-aa "*8a(a"*&%m8%"

/**-ma "%'a *;a&'a "*8*-a5a#a *ca-a *(*-aa8a(a "*&%m8%"


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DERA)MAN+ SP,MM )ARI WIDA*ATI+ S,KEP

1966009 199303 1 00 19710726 199403 2 002


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Perhatian: Jika Tidak adaBiaya, Kolomini haruskosong(JANGAN diisiolehhuruf/angka/ta

nda baaa!a!un, "K :#


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PENILAIAN CAPAIAN SASARAN KERJA


)a!"a Wa"#' P*&aa

2 )a'a- $( 31 D**mb*- 2014

NO I, KEGIATAN TUGAS JABATAN AK TARGET

AK K'a#$ '#8'# Wa"#' aa

$ 2 # ( . / 0 1

1 7.2 240 100 12 b'&a ? 6.12 204

2 2.4 240 100 12 b'&a ? 1.1 11

3 1.44 96 100 12 b'&a ? 1.14 76

4 4. 240 100 12 b'&a ? 3.4 192

0.4 96 100 12 b'&a ? 0.40 1

6 1.6 240 100 12 b'&a ? 1.344 192

7 0.72 240 100 12 b'&a ? 0.612 204

2.4 192 100 12 b'&a ? 1.63 163

9 1.12 144 100 12 b'&a ? 0.976 122

10 /*&a"'"a 8*'&'a "*8a(a maa-a"a# 1.92 4 100 12 b'&a ? 1.2 3

11 0.4 4 "a& 100 12 b'&a ? 0.3 3 "a

12 0.4 120 100 12 b'&a ? 0.672 96

II, TUGAS TAMBA)AN DAN KREATI3ITAS 4

A Tuga Ta%&a5an 4

1

2

Kreati6ta

1

Nilai Ca7aian SKP

K'a&$/'#'

K'a#$'#8'#

/*&a"aa"a 8*!"aa "*8*-a5a#a b*-'8a 8*!"aa(aa- 8a(a maa-a"a#

&a8%-a

&a8%

/**-ma "%'a 8*!"aa "*8*-a5a#a b*-'8a8*!"aa (aa-

&a8%-a

&a8%

/*&a"aa"a aa&a (a#a '#'" m*-'m'"a (a!%a"*8*-a5a#a aa&a *(*-aa 8a(a "*&%m8%"

-'m'a

-'ma

/*&a"aa"a aa&a (a#a '#'" m*-'m'"a (a!%a"*8*-a5a#a aa&a *(*-aa 8a(a maa-a"a#

-'m'a

-'ma

/*-*caa"a #(a"a "*8*-a5a#a *(*-aa 8a(a"*&%m8%"

-*caa

-*ca

/*-*caa"a #(a"a "*8*-a5a#a *(*-aa 8a(amaa-a"a#

-*caa

-*ca

/*&a"aa"a #(a"a "*8*-a5a#a #(a"a "*8*-a5a#a

(aa- 8a(a "a#a!%- II

#(a"

a

#(

a/*&a"aa"a #(a"a "*8*-a5a#a #(a"a "*8*-a5a#a(aa- 8a(a "a#a!%- III

#(a"a

#(a

/*&a"aa"a #(a"a "*8*-a5a#a #(a"a "*8*-a5a#a"%m8&*" 8a(a "a#a!%- II

#(a"a

#(a

"*!a#a

"*!a

/*&a"aa"a *;a&'a "*8*-a5a#a *(*-aa "*8a(a"*&%m8%"

/**-ma "%'a *;a&'a "*8*-a5a#a *ca-a*(*-aa 8a(a "*&%m8%"

&a8%-a

&a8%


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a('!, 31 D

P*aba#

DERAH/A

1966009 19


13/24

8*-* 8*-* b"'a##a "'a&#a 5a"#' baa RWB24 RWC24 RB24 RC24

$# $(

246 2.00 1 2 0 76 76 100 2

DI$0 DI$0 1 0 0 47.917 0 76 76 100

DI$0 DI$0 1 0 0 79.167 0 76 76 100

DI$0 DI$0 1 0 0 0 0 76 76 100

DI$0 DI$0 1 0 0 4.37 76 76 100

DI$0 DI$0 1 0 0 0 76 76 100

DI$0 DI$0 1 0 0 76 76 100

DI$0 DI$0 1 0 0 4.96 76 76 100

DI$0 DI$0

1 0 0 4.722 76 76 100

DI$0 DI$0 1 0 0 79.167 0 76 76 100

DI$0 DI$0 1 0 0 79.167 0 76 76 100

DI$0 DI$0 1 0 0 0 0 76 76 100

@1.76=G?N$G=100

@1.76=I?P$I=100

0,2$ 12

8Baik9

PENG)ITUNGA

N

NILAICAPAIAN

SKP

BACK

TOMENUUTAMA

r5atian4 T(a" a(a R*a&aa, K%&%m a-'%! @)ANGAN ( '-'>$a!"a$#a(aca a8a8', K :


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b*- 2014

&a,

2

P.//

3 1 00


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0.0000 246 246 246

0.0000 203.92 203.92 203.92

0.0000 23.17 23.17 23.17

0.0000 236 236 236

0.0000 24.3 24.3 24.3

0.0000 241 241 241

0.0000 246 246 246

0.0000 24.9 24.9 24.9

0.0000 24.72 24.72 24.72

0.0000 23.17 23.17 23.17

0.0000 23.17 23.17 23.17

0.0000 236 236 236

@76?@@@@1.76=G?N$G=100?100

@76?@@@@1.76=I?P$I=100?100


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BUKU CATATAN PENILAIAN PERILAKU PNS

Nama : HARI WIDAYATI, S.KEP

NIP : 19710726 199403 2 002

N% Ta!!a& +-aa

1 2 3 4

1 P*&aa SKP am8a (*!a a"- D**mb*- 2014 F

79.21 *(a!"a 8*&aa 8*-&a"' "*-aa a(a&a

*ba!a b*-"'# :

-*#a P*&aaa F 0.00 @a"

I#*!-#a F 79.00 @a"

K%m#m* F .00 @a"

D8& F .00 @a"

K*-aama F 0.00 @a" DERAH/AN, SP.//

K*8*mm8a F 0.00 @a" 1966009 199303 1 00

)'m&a F 49

N&a Ra#a?-a#a F 1.0 @a"

Nama$NIP (a Pa-a>P*aba# P*&a

2 )a'a- $(31 D**mb*-

2014

KEPALA P+SKES/ASHA)I/ENA


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PENILAIAN PRESTASI KERJAPEGAWAI NEGERI SIPIL

)ANGKA WAKT+ PENILAIAN

ADAN KEPEGAWAIAN NEGARA 2 )a'a- $( 31 D**mb*- 2014

1. YANG DINILAI

a. N A / A )ARI WIDA*ATI+ S,KEP

b. NIP 19710726 199403 2 002

c. Pa!"a#, !%&%!a -'a! P*a#a T!"a# I$ III (

(. )aba#a$P*"*-aa P*-a5a# P**&a

*. +# -!aa P'"*ma Ham*a

2. PE)AAT PENILAI

a. N A / A DERA)MAN+ SP,MM

b. NIP 1966009 199303 1 00

c. Pa!"a#, !%&%!a -'a! PENATA TINGKAT I$ III (

(. )aba#a$P*"*-aa KEPALA P+SKES/AS HA)I/ENA

*. +# -!aa +PT.P+SKES/AS HA)I/ENA

3. ATASAN PE)AAT PENILAI

a. N A / A A)MAD ROD)I+ SKM,M,KES

b. NIP 196200 1903 1 00

c. Pa!"a#, !%&%!a -'a! PE/INA TINGKAT I $ I b

(. )aba#a$P*"*-aa SEKERTARIS DINAS KESEHATAN LA/SEL

*. +# -!aa DINAS KESEHATAN LA/P+NG SELATAN

4. +NS+R YANG DINILAI )+/LAH

a. Saa-a K*-a P*!a5a @SKP 79.21 60 47.2

1. -*#a P*&aaa 0.00 @a"

2. I#*!-#a 79.00 @a"

3. K%m#m* .00 @a"


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b.

4 D8& .00 @a"

. K*-aama 0.00 @a"

6. K*8*mm8a 0.00 @a"

)'m&a 49.00 0

N&a Ra#a?-a#a 1.0 @a"

N&a P*-&a"' "*-a 1.0 40 32.60

N&a P-*#a K*-a0.12

@a"

. KEERATAN DARI PEGAWAI NEGERI SIPIL Ta!!a& ................................

YANG DINILAI @APAILA ADA

6. TANGGAPAN PE)AAT PENILAI ATAS KEERATAN Ta!!a& ................................

7. KEP+T+SAN ATASAN PE)AAT PENILAI ATAS Ta!!a& ................................

KEERATAN

. REK/ENDASI Ta!!a& ................................

10. DITERI/A TANGGAL,9. DI+AT TANGGAL,

PEGAWAI NEGERI SIPIL YANG PE)AAT PENILAI

DINILAI,

DERAH/AN, SP.//

HARI WIDAYATI, S.KEP 1966009 199303 1 00

19710726 199403 2 00211. DITERI/A TANGGAL,

ATASAN PE)AAT YANG /ENILAI

P*-&a"'K*-a


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AH/AD RDHI, SK/./.KES

196200 1903 1 00


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Documents

Copy of Form SKP-Final