KEMENTERIAN AGAMA

KELOMPOK KERJA PENGAWAS PAI (POKJAWAS PAI)
KANTOR KABUPATEN CILACAP
Alamat : Jalan DI. Panjaitan No.44 Telp. (0282)531155 Cilacap
LOMBA PERPUSTAKAAN SEKOLAH/MADRASAH
TAHUN ..............................
I.

II.

IDENTITAS SEKOLAH
1. Nama Sekolah/Madrasah
2. Alamat Sekolah/Madrasah
3. Dabin
4. Kecamatan
5. Kota
6. Hari, Tanggal Supervisi

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PENILAIAN
NO.
A.
1.
2.
3.
4.
5.
B.
1.
2.
3.
4.
5.
6.
7.
C.
1.
2.
3.
4.
D.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
E.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.

UNSUR YANG DINILAI
RUANG PERPUSTAKAAN
Perpustakaan Tersendiri/Ikut Ruang Lain
Luas Ruangan
Ruang Baca
Ruang Koleksi
Ruang Pelayanan
KOLEKSI
Buku Non Fisik
Buku Fiksi
Buku Referensi
Majalah
Surat Kabar
Audio Visual
Penambahan Koleksi
KETENAGAAN
Dukungan Kepala Sekolah
Dukungan Komite Sekolah
Petugas Khusus
Pendidikan/Pelatihan
KELENGKAPAN ADMINISTRASI
Buku Induk Perpustakaan
Kartu Anggota/Peminjam
Kantor Kartu Buku
Kartu Buku
Label
Lembar Tanggal Kembali
Kartu Katalog
Tata Tertib Perpustakaan
Buku Pengunjung
Buku Peminjam
Buku Tamu
Buku Klasifikasi DDC
Buku Tajuk Subyek
Denah Ruang Perpustakaan
Program Kerja Perpustakaan
Laporan
Statistik
PERABOT
Rak Buku
Rak Koran
Rak Majalah
Almari Katalog
Almari Buku Referensi
Meja Baca
Kursi Baca
Papan Pamer
Meja Baca Perorangan
Meja Kursi Petugas
Alat Pembersih
Papan Pengumuman
JUMLAH

A

NILAI
B
C

D

KETERANGAN

A
B
C
D

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=
=
=

90 – 100
70 – 80
55 – 69
54 – ...

A
B
C
D

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=
=
=

4
3
2
1 

Nilai rata-rata

:

Temuan-temuan di lapangan :

Jumlah Seluruh Nilai
×100 =
45× 4

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Saran-saran

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Cilacap, ..................................
Tim Penilai

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