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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. IDENTITAS SEKOLAH
1. Nama Sekolah/Madrasah : .............................................................................................................
2. Alamat Sekolah/Madrasah : .............................................................................................................
3. Dabin : .............................................................................................................
4. Kecamatan : .............................................................................................................
5. Kota : .............................................................................................................
6. Hari, Tanggal Supervisi : .............................................................................................................
II. PENILAIAN
NILAI
NO. UNSUR YANG DINILAI KETERANGAN
A B C D
A. RUANG PERPUSTAKAAN
1. Perpustakaan Tersendiri/Ikut Ruang Lain
2. Luas Ruangan A = 90 – 100
B = 70 – 80
3. Ruang Baca
C = 55 – 69
4. Ruang Koleksi D = 54 – ...
5. Ruang Pelayanan
B. KOLEKSI A = 4
1. Buku Non Fisik B = 3
2. Buku Fiksi C = 2
3. Buku Referensi D = 1
4. Majalah
5. Surat Kabar
6. Audio Visual
7. Penambahan Koleksi
C. KETENAGAAN
1. Dukungan Kepala Sekolah
2. Dukungan Komite Sekolah
3. Petugas Khusus
4. Pendidikan/Pelatihan
D. KELENGKAPAN ADMINISTRASI
1. Buku Induk Perpustakaan
2. Kartu Anggota/Peminjam
3. Kantor Kartu Buku
4. Kartu Buku
5. Label
6. Lembar Tanggal Kembali
7. Kartu Katalog
8. Tata Tertib Perpustakaan
9. Buku Pengunjung
10. Buku Peminjam
11. Buku Tamu
12. Buku Klasifikasi DDC
13. Buku Tajuk Subyek
14. Denah Ruang Perpustakaan
15. Program Kerja Perpustakaan
16. Laporan
17. Statistik
E. PERABOT
1. Rak Buku
2. Rak Koran
3. Rak Majalah
4. Almari Katalog
5. Almari Buku Referensi
6. Meja Baca
7. Kursi Baca
8. Papan Pamer
9. Meja Baca Perorangan
10. Meja Kursi Petugas
11. Alat Pembersih
12. Papan Pengumuman
JUMLAH

Jumlah Seluruh Nilai


Nilai rata-rata :  100 
45  4

Temuan-temuan di lapangan : ..................................................................................................


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Saran-saran : ..................................................................................................
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Cilacap, ..................................
Tim Penilai

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