PEMERINTAH KABUPATEN INDRAMAYU

DINAS PENDIDIKAN
UPTD PENDIDIKAN LOHBENER
SMA NEGERI 1 LOHBENER
Terakriditasi : A (Amat Baik)
Jalan Raya Utara Lohbener Telp. (0234) 276741. Kode Pos 45252
www.sman1lohbener.sch.id. Email: info@sman1lohbener.sch.id

ANGKET PENGAMATAN GURU

Nama Guru : .....................................................

Mata Pelajaran : .....................................................
Kelas Binaan : .....................................................

1. Peserta didik yang malas mengerjakan Tugas / PR :

1.1 ........................................................ 1.3 ........................................................
1.1 ........................................................ 1.4 ........................................................
1.2 ........................................................ 1.5 ........................................................

2. Peserta didik yang tergolong lambat dalam belajar dan kurang berprestasi :
1.2 ........................................................ 2.3 ........................................................
2.1 ........................................................ 2.4 ........................................................
2.2 ........................................................ 2.5 ........................................................

3. Peserta didik yang sering mengganggu proses belajar - mengajar :

1.3 ........................................................ 3.3 ........................................................
3.1 ........................................................ 3.4 ........................................................
3.2 ........................................................ 3.5 ........................................................

4. Peserta didik yang tergolong bersifat agresif :

1.4 ........................................................ 4.3 ........................................................
4.1 ........................................................ 4.4 ........................................................
4.2 ........................................................ 4.5 ........................................................

5. Peserta didik yang tergolong pendiam/tersisih/pemurung dsb :

1.5 ........................................................ 5.3 ........................................................
5.1 ........................................................ 5.4 ........................................................
5.2 ........................................................ 5.5 ........................................................

6. Peserta didik yang sering terlambat, bolos atau keluar kelas pada jam pelajaran yang Anda ajarkan :
1.6 ........................................................ 6.3 ........................................................
6.1 ........................................................ 6.4 ........................................................
6.2 ........................................................ 6.5 ........................................................

7. Peserta didik yang sering tidak masuk kelas karena sakit atau sering izin :
1.7 ........................................................ 7.3 ........................................................
7.1 ........................................................ 7.4 ........................................................
7.2 ........................................................ 7.5 ........................................................
8. Peserta didik yang menurut pengamatan Anda menghadapi masalah serius dan membutuhkan bantuan
1.8 ........................................................ 8.3 ........................................................
8.1 ........................................................ 8.4 ........................................................
8.2 ........................................................ 8.5 ........................................................

9. Peserta didik yang tergolong cepat dalam belajar dan berprestasi :

1.9 ........................................................ 9.3 ........................................................
9.1 ........................................................ 9.4 ........................................................
9.2 ........................................................ 9.5 ........................................................

10. Peserta didik yang berpakaian seragam dengan santun sesuai dengan peraturan sekolah, hormat
kepada guru dan sopan kepada temannya :
1.10 ........................................................ 10.3 ........................................................
10.1 ........................................................ 10.4 ........................................................
10.2 ........................................................ 10.5 ........................................................

Mengetahui, Lohbener , ….. Juli 2015

Kepala SMA Negeri 1 Lohbener Guru Mata Pelajaran

...............................................
ZAENAL ARIFIN, S.Pd
NIP.
Pembina
NIP. 19590119 198703 1 003