Lampiran RPI/PKBP/1

TEMUDUGA IBUBAPA
No. Rujukan

Tarikh

..

A:

MAKLUMAT PERIBADI MURID

Nama

Jantina

Keturunan

Agama

Tarikh Lahir

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

Umur

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

No. SB/KP

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

Anak ke berapa

Kategori

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

No. OKU : ........................

Alamat

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

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

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

No. telefon

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

B:

MAKLUMAT IBU BAPA / PENJAGA

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

(i)
Nama bapa

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

No. KP

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

Pekerjaan

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

Alamat Majikan :

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

..

No. telefon pejabat

No. telefon bimbit

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

(ii)
Nama ibu

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

No. KP

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

Pekerjaan

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

Alamat Majikan :

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

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

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

No. telefon pejabat

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

No. telefon bimbit

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

(iii)
Nama penjaga

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

No. KP

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

Pekerjaan

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

Alamat Majikan :

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

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

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

No. telefon pejabat

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

No. telefon bimbit

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

C:

PERSEKITARAN KEDIAMAN

Tinggal dengan siapa

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

Siapa mengasuh

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

Kawasan petempatan

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

D:

SEJARAH PERUBATAN

Sebelum Lahir

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

Semasa Lahir

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

Selepas Lahir

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

Dianogsis Doktor / Pakar Perubatan

Nama Doktor / Pakar

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

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

Jenis masalah yang dikenalpasti

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

E:

LAIN-LAIN MASALAH PERUBATAN

Pintar cerdas
Cerebal Palsy
Sindrom Down
ADHD
ADD
Autisme
Disleksia
Hyperaktif
Hipoaktif
Slow Leaner
Lelah
Spastik
Penglihatan

Rabun
Buta

Pendengaran

Ringan
Sederhana
Teruk

Mental

Ringan
Sederhana
Teruk

Sawan

Kekerapan dalam sehari : .........................................................

Jenis rawatan / ubat : ..........................................................

Lain-lain Penyakit : (Nyatakan) ...............................................................................................

F:

JENIS IMUNISASI YANG DITERIMA

Hepatitis A/B
Campak
Polio
Rubella
Lain-lain (Nyatakan) : .............................................................................................................

G:

EMOSI / TINGKAH LAKU

Jenis perlakuan luar biasa : (contoh, goyang tangan) ..................................................................................

Ketakutan pada sesuatu : .............................................................................................................................
Benci pada sesuatu : ....................................................................................................................................
Minat pada sesuatu :
Menonton TV
Mendengar lagu
Membaca
Lain-lain (Nyatakan): .............................................................................................................

H:

PERKEMBANGAN SOSIAL

Pernah mendapat didikan Taska / Tadika : Ya / Tidak

Boleh berinteraksi dengan orang lain : Ya / Tidak
Nyatakan (siapa) : ...................................................................................
Rumusan aktiviti yang dilakukan seharian :
.......................................................................................................................................................................
.......................................................................................................................................................................
Bahasa yang kerap digunakan di rumah :
.......................................................................................................................................................................

Lampiran RPI/PKBP/4
Laporan Penilaian Murid Bermasalah Pembelajaran
Akhir Tahun
SULIT

Nama murid : ......................................................................................... Tarikh : .....................................

Nama guru : .........................................................................................
1.

Pencapaian (Peningkatan dalam perkembangan, kemajuan dan pemerhatian

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

2.

Pendekatan berkesan
....................................................................................................................................................
....................................................................................................................................................

3.

Aspek yang perlu dipertingkatkan

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

4.

Rumusan / cadangan
.....................................................................................................................................................
.....................................................................................................................................................

5.

Tanda Tangan Penilai Akhir : .......................................................