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    Formulir Sasaran Kerja Pegawai Negeri Sipil

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    anli hamsmi
    1. This document contains a form for evaluating the work performance of civil servants, listing the job holder's name and position as well as the civil servant being evaluated. 2. It lists 12 main job activities for the civil servant being evaluated, including conducting basic nursing care treatments and health education programs. Targets are set for outputs, quality, timelines, and budgets. 3. The form also includes sections to evaluate whether the targets were achieved based on real outputs, quality, timelines and budgets. Scores are calculated and an overall achievement score is given.

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    Formulir Sasaran Kerja Pegawai Negeri Sipil

    Uploaded by

    anli hamsmi
    40 views7 pages
    1. This document contains a form for evaluating the work performance of civil servants, listing the job holder's name and position as well as the civil servant being evaluated. 2. It lists 12 main job activities for the civil servant being evaluated, including conducting basic nursing care treatments and health education programs. Targets are set for outputs, quality, timelines, and budgets. 3. The form also includes sections to evaluate whether the targets were achieved based on real outputs, quality, timelines and budgets. Scores are calculated and an overall achievement score is given.

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    STRUKTUR ORGANISASI PUSKESMAS SESUAI PERMENKES

    Original Title

    Form Skp Jfu

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    1. This document contains a form for evaluating the work performance of civil servants, listing the job holder's name and position as well as the civil servant being evaluated. 2. It lists 12 main job activities for the civil servant being evaluated, including conducting basic nursing care treatments and health education programs. Targets are set for outputs, quality, timelines, and budgets. 3. The form also includes sections to evaluate whether the targets were achieved based on real outputs, quality, timelines and budgets. Scores are calculated and an overall achievement score is given.

    Copyright:

    © All Rights Reserved
    Download as XLS, PDF, TXT or read online from Scribd
    Download as xls, pdf, or txt
    40 views7 pages

    Formulir Sasaran Kerja Pegawai Negeri Sipil

    Uploaded by

    anli hamsmi
    1. This document contains a form for evaluating the work performance of civil servants, listing the job holder's name and position as well as the civil servant being evaluated. 2. It lists 12 main job activities for the civil servant being evaluated, including conducting basic nursing care treatments and health education programs. Targets are set for outputs, quality, timelines, and budgets. 3. The form also includes sections to evaluate whether the targets were achieved based on real outputs, quality, timelines and budgets. Scores are calculated and an overall achievement score is given.

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    FORMULIR SASARAN KERJA

    PEGAWAI NEGERI SIPIL


    NO I. PEJABAT PENILAI NO II. PEGAWAI NEGERI SIPIL YANG DINILAI
    1 Nama JULIANTI 1 Nama Azafudin, SKM
    2 NIP 19840423 200701 2 002 2 NIP 19680915 199103 1 008
    3 Pangkat/Gol.Ruang Pengatur, II/c 3 Pangkat/Gol.Ruang Penata, III/c
    4 Jabatan Perawat Pelaksana 4 Jabatan Kepala Puskesmas Lakologou
    5 Unit Kerja Puskesmas Lakologou 5 Unit Kerja Puskesmas Lakologou
    TARGET
    NO III. KEGIATAN TUGAS JABATAN AK
    KUANT/OUTPUT KUAL/MUTU WAKTU BIAYA

    1 Melaksanakan Pengkajian Keperawatan pada Keluarga 0.003 0.678 281 Keluarga 100 12 Bulan
    Melaksanakan analisa data sederhana untuk merumuskan diagnosa
    2 0.001 0.18 503 Diagnosa 100 12 Bulan
    keperawatan pada individu

    3 Merencanakan tindakan keperawatan sederhana pada individu 0.001 0.191 620 tindakan 100 12 Bulan

    4 Melaksanakan tindakan keperawatan dasar kategori I 0.001 0.196 386 tindakan 100 12 Bulan

    5 Melaksanakan tindakan keperawatan dasar kategori II 0.001 0.167 279 tindakan 100 12 Bulan

    6 Melaksanakan tindakan keperawatan dasar kategori III 0.002 0.444 217 tindakan 100 12 Bulan
    7 Melaksanakan tindakan keperawatan dasar kategori IV 0.003 0.657 182 tindakan 100 12 Bulan
    8 Melaksanakan tindakan keperawatan kompleks kategori I 0.001 0.153 151 tindakan 100 12 Bulan
    9 Menyusun program penyuluhan dengan metode sederhana 0.010 0.639 217 Dokumen 100 12 Bulan

    10 melaksanakan penyuluhan kepada keluarga 0.003 0.099 281 Keluarga 100 12 Bulan
    Melaksanakan evaluasi
    11 keperawatan sederhana 0.001 0.12 480 Pasien 100 12 Bulan
    12 pada individu tugas khusus
    Melaksanakan 2
    Baubau , 2 Januari 2014
    Pejabat Penilai, Pegawai Negeri Sipil Yang Dinilai

    JULIANTI Azafudin, SKM


    19840423 200701 2 002 19680915 199103 1 008
    Catatan :
    * AK Bagi PNS yang memangku jabatan fungsional tertentu
    PENILAIAN CAPAIAN SASARAN KERJA
    PEGAWAI NEGERI SIPIL
    Jangka Waktu Penilaian …. Januari s.d. 31 Desember 20…..
    TARGET REALISASI
    NO I. Kegiatan Tugas Jabatan AK AK PENGHITUNGAN
    Kuant/ Output Kual/Mutu Waktu Biaya Kuant/ Output Kual/Mutu Waktu Biaya
    1 2 3 4 5 6 7 8 9 10 11 12 13

    Melaksanakan Pengkajian Keperawatan pada Keluarga


    1 0.678 281 Keluarga 100 12 Bulan 0 0.843 281 Keluarga 100 12 Bulan 276.00

    Melaksanakan analisa data sederhana untuk merumuskan diagnosa


    2 keperawatan pada individu 0.177 503 Diagnosa 100 12 Bulan 0 0.503 503 Diagnosa 100 12 Bulan 276.00

    3 Merencanakan tindakan keperawatan sederhana pada individu 0.191 620 tindakan 100 12 Bulan 0 0.62 620 tindakan 100 12 Bulan 276.00
    4 Melaksanakan tindakan keperawatan dasar kategori I 0.196 386 tindakan 100 12 Bulan 0 0.386 386 tindakan 100 12 Bulan 276.00
    Melaksanakan tindakan keperawatan dasar kategori II
    5 0.167 279 tindakan 100 12 Bulan 0 0.279 279 tindakan 100 12 Bulan 276.00

    6 Melaksanakan tindakan keperawatan dasar kategori III 0.444 217 tindakan 100 12 Bulan 0 0.434 217 tindakan 100 12 Bulan 276.00
    7 Melaksanakan tindakan keperawatan dasar kategori IV 0.657 182 tindakan 100 12 Bulan 0 0.546 182 tindakan 100 12 Bulan 276.00
    8 Melaksanakan tindakan keperawatan kompleks kategori I 0.153 151 tindakan 100 12 Bulan 0 0.151 151 tindakan 100 12 Bulan 276.00
    9 Menyusun program penyuluhan dengan metode sederhana 0.099 281 Keluarga 100 12 Bulan 0 0.843 281 Keluarga 100 12 Bulan 276.00
    10 melaksanakan penyuluhan kepada keluarga 0.12 480 Pasien 100 12 Bulan 0 0.48 480 Pasien 100 12 Bulan 276.00
    11 Melaksanakan evaluasi keperawatan sederhana pada individu 0.12 480 pasien 100 12 Bulan 0 #REF! pasien Bulan 0.00
    12 Melaksanakan tugas khusus 0 0 0 0 0 0 0 0 0 0 #DIV/0!

    II. TUGAS TAMBAHAN DAN KREATIVITAS/UNSUR


    PENUNJANG :

    1 (tugas tambahan)
    (tugas tambahan)

    2 (kreatifitas)
    (kreatifitas)

    Nilai Capaian SKP

    …….., 31 Desember 20…..


    Pejabat Penilai,

    JULIANTI
    19840423 200701 2 002
    NILAI
    CAPAIAN
    SKP persen waktu persen biaya kuantitas kualitas waktu biaya RW<24 RW>24
    14

    69.00 1 69 0 #DIV/0! 100 100 76 #DIV/0! 76 100

    69.00 1 69 0 #DIV/0! 100 100 76 #DIV/0! 76 100


    69.00 1 69 0 #DIV/0! 100 100 76 #DIV/0! 76 100
    69.00 1 69 0 #DIV/0! 100 100 76 #DIV/0! 76 100
    69.00 1 69 0 #DIV/0! 100 100 76 #DIV/0! 76 100
    69.00 1 69 0 #DIV/0! 100 100 76 #DIV/0! 76 100
    69.00 1 69 0 #DIV/0! 100 100 76 #DIV/0! 76 100
    69.00 1 69 0 #DIV/0! 100 100 76 #DIV/0! 76 100
    69.00 1 69 0 #DIV/0! 100 100 76 #DIV/0! 76 100
    69.00 1 69 0 #DIV/0! 100 100 76 #DIV/0! 76 100
    0.00 1 0 100 #DIV/0! 0 0 0 #DIV/0! 176 0
    #DIV/0! 0 0 #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!

    (1.76*G8-N8)/G8)*100)
    (1.76*I8-P8)/I8)*100)

    276

    62.73 11
    (Cukup)

    mber 20…..
    enilai,

    NTI
    701 2 002
    RB<24 RB>24

    0.0000 #DIV/0! 276 276


    #DIV/0! #DIV/0! 276 276

    0.0000 #DIV/0! 276 276


    #DIV/0! #DIV/0! 276 276
    #DIV/0! #DIV/0! 276 0.0000 #DIV/0! 276 276 276
    #DIV/0! #DIV/0! 276 0.0000 #DIV/0! 276 276 276

    #DIV/0! #DIV/0! 276 0.0000 #DIV/0! 276 276 276


    #DIV/0! #DIV/0! 276 0.0000 #DIV/0! 276 276 276
    #DIV/0! #DIV/0! 276 0 #DIV/0! 276 276 276
    #DIV/0! #DIV/0! 276 0 #DIV/0! 276 276 276
    #DIV/0! #DIV/0! 276 0 #DIV/0! 276 276 276
    #DIV/0! #DIV/0! 276 0 #DIV/0! 276 276 276
    #DIV/0! #DIV/0! 0 100 #DIV/0! 176 0 176
    #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!

    (76-((((1.76*G8-N8)/G8)*100)-100))
    (76-((((1.76*I8-P8)/I8)*100)-100))
    UNSUR YANG DINILAI Jumlah
    4. 6. TANGGAPAN PEJABAT PENILAI
    a. Sasaran Kerja Pegawai (SKP) ATAS KEBERATAN
    62.73 x 60% 37.64

    1. Orientasi Pelayanan (Buruk)

    2. Integritas (Buruk)

    3. Komitmen (Buruk)

    4. Disiplin (Buruk)

    b. Perilaku Kerja 5. Kerjasama (Buruk)

    6. Kepemimpinan (Buruk)
    Tanggal, ………………….
    7. Jumlah 0

    8. Nilai rata – rata 0.00 (Buruk)


    7. KEPUTUSAN ATASAN PEJABAT
    PENILAI ATAS KEBERATAN
    9. Nilai Perilaku Kerja 0.00 x 40% 0.00

    37.64

    NILAI PRESTASI KERJA (Buruk)

    5. KEBERATAN DARI PEGAWAI NEGERI


    SIPIL YANG DINILAI (APABILA ADA)

    Tanggal, …………………. Tanggal, ………………….


    8. REKOMENDASI

    PENILAIAN PRESTASI KERJA


    PEGAWAI NEGERI SIPIL

    KEMENTERIAN PEKERJAAN UMUM JANGKA WAKTU PENILAIAN


    DIREKTORAT JENDERAL BINA MARGA BULAN : Januari s/d 31 Desember 20....
    1.
    YANG DINILAI

    a. N a m a Azafudin, SKM

    b. N I P 19680915 199103 1 008


    9. DIBUAT TANGGAL, …………..
    PEJABAT PENILAI c. Pangkat, Golongan ruang, TMT Penata, III/c

    d. Jabatan/Pekerjaan Kepala Puskesmas Lakologou

    e. Unit Organisasi Puskesmas Lakologou


    JULIANTI
    19840423 200701 2 002 2.
    PEJABAT PENILAI

    a. N a m a JULIANTI
    10. DITERIMA TANGGAL, …………
    PEGAWAI NEGERI SIPIL YANG DINILAI b. N I P 19840423 200701 2 002

    c. Pangkat, Golongan ruang, TMT Pengatur, II/c

    d. Jabatan/Pekerjaan Perawat Pelaksana


    Azafudin, SKM
    19680915 199103 1 008 e. Unit Organisasi Puskesmas Lakologou

    3.
    ATASAN PEJABAT PENILAI
    11.DITERIMA TANGGAL, ....................
    ATASAN PEJABAT PENILAI a. N a m a

    b. N I P

    c. Pangkat, Golongan ruang, TMT


    0
    0 d. Jabatan/Pekerjaan

    e. Unit Organisasi

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