Nama Mahasiswa : . . . . . . . . . . . . . . . . . . . . . . . . .

NIM :.........................
Kelas :.........................
Kelompok :.........................

INSTRUMEN PENGAMATAN LAPANG PENGANTAR EKONOMI

PERTANIAN 2016
Form untuk Kelembagaan
I. Identifikasi Lokasi dan Kelembagaan

Desa :.............................................................................

Kecamata :.............................................................................

Kota/Kabupaten :.............................................................................

Kelembagaan ekonomi dan bidang usaha yang ada atau pernah ada di wilayah desa
(lingkari nomor yang terdapat dalam tabel):
Tabel 1. Nama Kelembagaan Ekonomi dan Bidang Usaha di Pedesaan
No. Kelembagaan Ekonomi No. Bidang Usaha
1.1 DPM-LUEPa) 2.1 Unit Penggilingan Padi
1.2 Badan Usaha Milik Desa (BUM- 2.2 Pengepul
Des)
1.3 Lembaga Usaha Simpan Pinjam 2.3 Tengkulak
(USP)
1.4 perbankan (BPR atau swamitra) 2.4 Toko/kios saprodi & alsintan
1.5 Kredit komersial: kredit umum 2.5 Sewa Alsintan
pedesaan (Kupedes)
1.6 Simpanan pedesaan (Simpedes) 2.6 Jasa sewa pick-up/truk
1.7 Kredit Bimas/KUT/KKP/KKPEb) 2.7 Toko Pengecer bahan pokok
1.8 SPP (Simpan Pinjam Perempuan) 2.8 Usaha kelompok
1.9 2.9
1.10 2.1
0
Keterangan: a) Dana Penguatan Modal Lembaga Usaha Ekonomi pedesaan untuk pembelian
gabah/beras petani
b
) KUT = Kredit Usahatani; KKP = Kredit Ketahanan Pangan; KKPE= Kredit
Ketahanan Pangan & Energi

Nara sumber: 1. .............................................................................

2. .............................................................................
3. .............................................................................
4. .............................................................................

II. Gambaran Umum Identitas/Profil Kelembagaan:

1. Apa nama kelembagaan dan bidang usaha yang kelompok Anda amati (dengan
memilih salah satu yang ada dalam Tabel 1 di atas)?
....................................................................................................................................
....................................................................................................................................
....................................................................................................................................
................................................................................................................................
Visi apa sajakah yang dimiliki kelembagaan tersebut?
....................................................................................................................................
....................................................................................................................................
....................................................................................................................................
....................................................................................................................................
...............................................................................................................................
Misi apa yang dilakukan kelembagaan tersebut untuk mencapai visinya?
....................................................................................................................................
....................................................................................................................................
....................................................................................................................................
....................................................................................................................................
...............................................................................................................................
2. Bagaimana latar belakang berdirinya kelembagaan itu (sebutkan pula tahun
berdirinya)?
....................................................................................................................................
....................................................................................................................................
....................................................................................................................................
....................................................................................................................................
...............................................................................................................................
3. Dimanakah lokasi kelembagaan tersebut (sebutkan spesifik)?
....................................................................................................................................
....................................................................................................................................
....................................................................................................................................
....................................................................................................................................
...............................................................................................................................
4. Siapa sajakah yang termasuk anggota dari lembaga tersebut? Apakah petani atau
masyarakat ikut terlibat? Jika tidak, lantas siapa yang berwenang. Jika iya,
bagaimana proporsi kerja yang dilakukan?
....................................................................................................................................
....................................................................................................................................
 ....................................................................................................................................
....................................................................................................................................
...............................................................................................................................
5. Bagaimana sistem kepengurusan yang ada pada kelembagaan yang kelompok
Anda amati?
....................................................................................................................................
....................................................................................................................................
....................................................................................................................................
....................................................................................................................................
...............................................................................................................................

III. Peran dan Fungsi Kelembagaan Ekonomi Pertanian

1. Apa saja rencana kegiatan/bantuan yang dirancang oleh kelembagaan terhadap
masyarakat sekitar (khususnya petani)?
..................................................................................................................................
..................................................................................................................................
..................................................................................................................................
..................................................................................................................................
..................................................................................................................................
2. Dari beberapa kegiatan yang telah dirancang, kegiatan apa saja yang sudah
dijalankan?
..................................................................................................................................
..................................................................................................................................
..................................................................................................................................
..................................................................................................................................
..................................................................................................................................
3. Apakah kegiatan yang dilakukan hanya ditujukan untuk masyarakat/petani
sekitar, atau juga mencakup masyarakat/petani daerah lain?
..................................................................................................................................
..................................................................................................................................
..................................................................................................................................
..................................................................................................................................
..................................................................................................................................
4. Dari manakah sumber pendanaan untuk kegiatan/bantuan yang dilaksanakan?
Apakah ada keterlibatan pemerintah atau pihak lain dalam pendanaan
kegiatan/bantuan yang diberikan kepada petani/masyarakat sekitar?
..................................................................................................................................
..................................................................................................................................
..................................................................................................................................
..................................................................................................................................
..................................................................................................................................
 5. Untuk membantu petani di desa ini, apakah sudah ada pembagian kerja dalam tim
pelaksana kegiatan? Seperti bagian yang membantu kredit, penyaluran,
sosialisasi, dan lain sebagainya?
...................................................................................................................................
...................................................................................................................................
...................................................................................................................................
...................................................................................................................................
...................................................................................................................................
6. Bagaimana respon yang ditunjukkan oleh petani/masyarakat terhadap
kegiatan/bantuan yang telah diberikan?
..................................................................................................................................
..................................................................................................................................
..................................................................................................................................
..................................................................................................................................
..................................................................................................................................
7. Apakah kegiatan yang dilaksanakan dapat mencapai sasaran yang diharapakan?
Jika tidak, bagaimana upaya yang dilakukan untuk memperbaiki kinerja
pelaksanaan kegiatan/bantuan untuk petani?
..................................................................................................................................
..................................................................................................................................
..................................................................................................................................
..................................................................................................................................
..................................................................................................................................
8. Selain dari kegiatan/bantuan yang telah dilaksanakan, apa saja pelayanan lain
yang dapat diberikan oleh kelembagaan bagi petani/masyarakat setempat?
..................................................................................................................................
..................................................................................................................................
..................................................................................................................................
..................................................................................................................................
..................................................................................................................................

IV. Akses Petani/Masyarakat terhadap Kelembagaan Ekonomi Pertanian

1. Bagaimana proses pendataan petani/masyarakat yang ingin menjadi anggota
kelembagaan? Apa saja syarat-syarat yang diajukan?
...................................................................................................................................
...................................................................................................................................
...................................................................................................................................
...................................................................................................................................
...................................................................................................................................
2. Apakah petani/masyarakat dapat dengan mudah mendapatkan segala informasi
yang dibutuhkan?
...................................................................................................................................
...................................................................................................................................
...................................................................................................................................
...................................................................................................................................
...................................................................................................................................
 3. Apakah petani/masyarakat diberikan fasilitas khusus untuk dapat mendapatkan
kemudahan dalam mengatasi permasalahan?
...................................................................................................................................
...................................................................................................................................
...................................................................................................................................
...................................................................................................................................
...................................................................................................................................
4. Apa saja persyaratan yang harus dipenuhi oleh pentane/masyarakat yang ingin
mengajukan peminjaman modal untuk usahataninya?
...................................................................................................................................
...................................................................................................................................
...................................................................................................................................
...................................................................................................................................
...................................................................................................................................
5. Bagaimana ketentuan yang diberikan kepada petani untuk pengembalian modal
yang dipinjamkan?
...................................................................................................................................
...................................................................................................................................
...................................................................................................................................
...................................................................................................................................
...................................................................................................................................

Nama Mahasiswa : . . . . . . . . . . . . . . . . . . . . . . . . .
NIM :.........................
Kelas :.........................
Kelompok :.........................

INSTRUMEN PENGAMATAN LAPANG PENGANTAR EKONOMI

PERTANIAN 2016
Form untuk Petani
I. Identitas Petani
1. Nama :
 2. Jenis Kelamin : Perempuan/Laki-laki (coret yang tidak perlu)
3. Usia : .......................tahun
4. Pendidikan Terakhir bapak/ibu :
a. SD
b. SMP
c. SMA
d. Lainnya, yaitu
5. Jumlah Anggota Keluarga : ................... orang
6. Jenis komoditas yang dibudidayakan?
a. Padi
b. Jagung
c. Lainnya, yaitu
7. Luas lahan yang bapak/ibu miliki : ........................ha
8. Status penguasaan lahan :
a. Penyewa
b. Pemilik penggarap
c. Lainnya, yaitu

II. Peran Kelembagaan/Unit Usaha bagi Petani

1. Selama menjalankan usahatani, apakah Bapak/Ibu pernah menerima bantuan atau
mengikuti kegiatan dari kelembagaan setempat?
..................................................................................................................................
..................................................................................................................................
..................................................................................................................................
..................................................................................................................................
..................................................................................................................................
2. Apa saja yang Bapak/Ibu lakukan selama menerima bantuan atau mengikuti
kegiatan dari kelembagaan setempat?
..................................................................................................................................
..................................................................................................................................
..................................................................................................................................
..................................................................................................................................
..................................................................................................................................
3. Dari bantuan yang diterima atau kegiatan yang dilakukan, apa saja manfaat yang
dapat Bapak/Ibu peroleh?
..................................................................................................................................
..................................................................................................................................
..................................................................................................................................
..................................................................................................................................
..................................................................................................................................
4. Selain dari kegiatan/bantuan yang telah dilaksanakan, apa saja pelayanan lain
yang Bapak/Ibu dapatkan dari kelembagaan setempat?
..................................................................................................................................
..................................................................................................................................
..................................................................................................................................
..................................................................................................................................
..................................................................................................................................
III. Akses Petani/Masyarakat terhadap Kelembagaan/Unit Usaha
1. Bagaimana proses Bapak/Ibu mengikuti/bergabung dalam kelembagaan
setempat? Apa saja syarat-syarat yang diajukan?
...................................................................................................................................
...................................................................................................................................
...................................................................................................................................
...................................................................................................................................
...................................................................................................................................
2. Apakah Bapak/Ibu dapat dengan mudah mendapatkan segala informasi yang
dibutuhkan?
...................................................................................................................................
...................................................................................................................................
...................................................................................................................................
...................................................................................................................................
...................................................................................................................................
3. Apakah Bapak/Ibu diberikan fasilitas khusus untuk dapat mendapatkan
kemudahan dalam mengatasi permasalahan?
...................................................................................................................................
...................................................................................................................................
...................................................................................................................................
...................................................................................................................................
...................................................................................................................................
4. Apakah Bapak/Ibu pernah meminjam modal usaha pada lembaga setempa? Apa
saja syarat-syarat yang diajukan?
...................................................................................................................................
...................................................................................................................................
...................................................................................................................................
...................................................................................................................................
...................................................................................................................................
5. Bagaimana ketentuan yang diberikan kepada Bapak/Ibu untuk pengembalian
modal yang dipinjamkan?
...................................................................................................................................
...................................................................................................................................
...................................................................................................................................
...................................................................................................................................
...................................................................................................................................