FormKPA

PERMOHONANKERJAPRAKTEK

NO

NRP

JMLSKSYANGTELAH
DITEMPUH
(min80SKSlulus)

NAMAMAHASISWA

Di:
NO

NAMAPERUSAHAAN

ALAMATPERUSAHAAN

Selama1(satu)bulan,terhitungmulaitanggal:..................s.d.....................

Denganfungsifungsiketeknikindustrian:
SetDirection
: ManajemenStrategi
SetStrategy
: ManajemenStrategi
DirectBussines
: ManajemenOrganisasi

ManajemenKinerja
DevelopProduct/Services
: PerancangandanPengembanganJasa

PerancangandanPengembanganProduk

Ergonomi
GetOrder
: ManajemenPemasaran
FulfillOrder
: PerencanaanFasilitas

SistemManufaktur

PerencanaandanPengendalianProduksi

TeknikPengendalianKualitas

PemeliharaandanTeknikKeandalan

ProsesJasa

PerancangandanPengukuranKerja

ManajemenRantaiPasok
ProductSupport
: KeandalandanManajemenGaransi

CustomerRelationshipManagement(CRM)
HumanResourcesManagement
: ManajemenSumberDayaManusia
FinancialAccounting
: AnalisisBiaya
InformationTechnology
: ManajemenSistemInformasi
MaintenanceManagement
: PemeliharaandanTeknikKeandalan
SupportingTools
: AnalisisdanPengambilanKeputusan

ManajemenProyek

PenelitianOperational

Surabaya,......................................................
Telahdicekoleh,
Menyetujui,

AdministratorKP

KoordinatorKP

FormKPB

PENUNJUKANDOSENPEMBIMBINGINTERNALKERJAPRAKTEK

MohonbantuanBapak/Ibu,

Nama
:......................................................................................................................................

UntukmenjadiDosenPembimbingInternalKerjaPraktekmahasiswaberikutini:
NO

NRP

NAMAMAHASISWA

Di:
NAMAPERUSAHAAN

ALAMATPERUSAHAAN

Fungsiketeknikindustrianyangdisetujuiperusahaan:
SetDirection
: ManajemenStrategi
SetStrategy
: ManajemenStrategi
DirectBussines
: ManajemenOrganisasi

ManajemenKinerja
DevelopProduct/Services
: PerancangandanPengembanganJasa

PerancangandanPengembanganProduk

Ergonomi
GetOrder
: ManajemenPemasaran
FulfillOrder
: PerencanaanFasilitas

SistemManufaktur

PerencanaandanPengendalianProduksi

TeknikPengendalianKualitas

PemeliharaandanTeknikKeandalan

ProsesJasa

PerancangandanPengukuranKerja

ManajemenRantaiPasok
ProductSupport
: KeandalandanManajemenGaransi

CustomerRelationshipManagement(CRM)
HumanResourcesManagement
: ManajemenSumberDayaManusia
FinancialAccounting
: AnalisisBiaya
InformationTechnology
: ManajemenSistemInformasi
MaintenanceManagement
: PemeliharaandanTeknikKeandalan
SupportingTools
: AnalisisdanPengambilanKeputusan

ManajemenProyek

PenelitianOperational
.
Selama2(dua)bulan,terhitungmulaitanggal:...........................................s.d...............................................
LaporanKPdiserahkanselambatnyatanggal:..............................................

Surabaya,......................................
KoordinatorKP

FormKPC

ARAHANPELAKSANAANKERJAPRAKTEK

NO

NRP

NAMAMAHASISWA

Arahansesuaifungsiketeknikindustrian:

1. ...........................................................................................................................................................................
...........................................................................................................................................................................
..............................................................................................................................
2.

...........................................................................................................................................................................
...........................................................................................................................................................................
..............................................................................................................................

3.

...........................................................................................................................................................................
...........................................................................................................................................................................
..............................................................................................................................

4.

...........................................................................................................................................................................
...........................................................................................................................................................................
..............................................................................................................................

5.

...........................................................................................................................................................................
...........................................................................................................................................................................
..............................................................................................................................

6.

...........................................................................................................................................................................
...........................................................................................................................................................................
..............................................................................................................................

PenyerahanLaporanKerjaPraktekpalinglambattanggal:...................................................................
(satubulansetelahberakhirnyapelaksanaanKerjaPraktekdiperusahaan)

Surabaya,...............................................
DosenPembimbingInternal,

Tembusan:PerusahaantempatKP

FormKPD

CATATANAKTIVITASKERJAPRAKTEK
(LOGBOOKPELAKSANAANKP)

NRPMAHASISWA
NAMAMAHASISWA
PERIODEKP

NAMAPERUSAHAAN
ALAMATPERUSAHAAN

HARI

:.........................................................................................................
:.........................................................................................................
:............................................s.d.........................................

:.........................................................................................................
:.........................................................................................................

TANGGAL

JENISAKTIVITAS

PARAFPEMBIMBING
EKSTERNAL

FormKPE

PENILAIANKERJAPRAKTEKDARIPEMBIMBINGEKSTERNAL
(Mohondiserahkankepadamahasiswadalamamploptertutup)

NRP

NAMAMAHASISWA

TelahmelaksanakanKerjaPraktekselamatanggal:...................................s.d....................................
Tugasfungsiketeknikindustrianyangdiberikan:
1.

...........................................................................................................................................................................
...........................................................................................................................................................................
..............................................................................................................................

2.

...........................................................................................................................................................................
...........................................................................................................................................................................
..............................................................................................................................

3.

...........................................................................................................................................................................
...........................................................................................................................................................................
..............................................................................................................................

Dengannilai*):
1.

Kemampuanmahasiswa:
a.

Dalammelakukanfungsiketeknikindustrian

:.......................................

b.

Dalamberkomunikasidanbekerjadalamtimdiduniakerja

:........................................

2.

Kehadiran

:..................%daritotalperiodeKP

Sertatidakmempunyaitanggunganapapundiperusahaan
NamaPenilai:

Tandatangan&stempelPerusahaan

...............................................................................
...............................................................................
Jabatan:

...............................................................................

...............................................................................

TanggalPenilaian:............................................

*) A

81100

AB

7180

6670

BC

6165

5660

4155

040

FormKPF

TANDATERIMALAPORAN
KERJAPRAKTEK

TelahmenerimaLaporanKerjaPraktek:
NO

NRP

NAMAMAHASISWA

Di:
NAMAPERUSAHAAN

ALAMATPERUSAHAAN

Surabaya,..................................................
Penerima,

FormKPF

TANDATERIMALAPORAN
KERJAPRAKTEK

TelahmenerimaLaporanKerjaPraktek:
NO

NRP

NAMAMAHASISWA

Di:
NAMAPERUSAHAAN

ALAMATPERUSAHAAN

Surabaya,..................................................
Penerima,

FormKPG

PENILAIANKERJAPRAKTEKDARIPEMBIMBINGINTERNAL

NRP

NAMAMAHASISWA

Dengannilai*)**)
1

Laporankegiatanmeliputi:
- Kelengkapanlogbook
- Muatanlaporan
Kemampuanmengkomunikasikanhasilpelaksanaan
kegiatankepadapembimbing

25%

25%

*)KomponenpenilaianKerjaPraktekadalahsebagaiberikut:
1.

2.

OlehPembimbingEksternal
a. Prosentasekehadiran(25%)
b. Kemampuanmahasiswa(25%):
i. Pengalamandandanketerlibatandalammelakukanfungsifungsiketeknikindustrian
ii. Kemampuanberkomunikasidanbekerjadalamtimdiduniakerja
OlehPembimbingInternal
a. Laporankegiatan(25%):
i. Kelengkapanlogbook
ii. Muatanlaporan
b. Kemampuanmengkomunikasikanhasilpelaksanaankegiatankepadapembimbing(25%)

**) A

81100

AB

7180

6670

BC

6165

5660

4155

040

Catatan:Nilaiharapdiberikanbilamahasiswatelahmenyerahkan:
- TandaterimalaporanKPdariperusahaan
- TandaterimalaporanKPdariRuangBacaJurusanTeknikIndustri

FormKPH

PERMOHONANPERPANJANGANWAKTU
KERJAPRAKTEK

NO

NRP

MENYETUJUIDOSEN
PEMBIMBINGINTERNAL

NAMAMAHASISWA

MohonperpanjanganwaktuKerjaPraktekdi:
NAMAPERUSAHAAN

ALAMATPERUSAHAAN

Sampaidengantanggal...........................................................................
Denganalasan:
..................................................................................................................................................................................
..................................................................................................................................................................................
..................................................................................................................................
..................................................................................................................................................................................
..................................................................................................................................................................................
..................................................................................................................................

Surabaya,.....................................................
Yangmengajukan:

1.

................................................................

2.

................................................................

Menyetujui,
KoordinatorKP

FormKPI

PERMOHONANPEMBATALANKERJAPRAKTEK

NO

NRP

NAMAMAHASISWA

MenyatakanmembatalkanKerjaPraktekdi:
NAMAPERUSAHAAN

ALAMATPERUSAHAAN

Denganalasan:
..................................................................................................................................................................................
..................................................................................................................................................................................
..................................................................................................................................
..................................................................................................................................................................................
..................................................................................................................................................................................
..................................................................................................................................
Sebagaipendukungpermohonan,dokumenyangdilampirkan:
1.

...........................................................................................................................................................

2.

............................................................................................................................................................

3.

...........................................................................................................................................................

Surabaya,.....................................................
Yangmengajukan:

1.

................................................................

2.

................................................................

Menyetujui,
KoordinatorKP