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FORMULIR SASARAN KERJA

PEGAWAI NEGERI SIPIL


NO I. PEJABAT PENILAI NO II. PEGAWAI NEGERI SIPIL YANG DINILAI
A 1 Nama Daroti, SE 1 Nama SITI SAROH, AMK
2 NIP 19620629 198403 2 007 2 NIP/ NRPTT 19790603 201409 2 003
3 Pangkat/Gol.Ruang Penata/IIIc 3 Pangkat/Gol.Ruang Pengatur - II / c
4 Jabatan KASUBAG Kepegawaian 4 Jabatan Perawat Puskesmas Ketanggungan
5 Unit Kerja Dinas Kesehatan Kabupaten Brebes. 5 Unit Kerja Puskesmas Ketanggungan
TARGET
NO III. KEGIATAN TUGAS JABATAN AK
KUANT/OUTPUT KUAL/MUTU WAKTU BIAYA

1 Melaksanakan Pengkajian keperawatan berupa pengkajian dasar pada Kelompok 0.001 0.144 144 laporan 100 12 bulan -

2 Menerima Konsultasi Pengkajian keperawatan berupa pengkajian dasar 0.001 0.12 120 laporan 100 12 bulan -

3 Melaksanakan analisis data untuk merumuskan dianogsa keperawatan analisis sederhana pada keluarga 0.015 2.16 144 rumusan 100 12 bulan -

4 Merencanakan tindakan keperawatan sederhana pada keluarga 0.02 2.88 144 rumusan 100 12 bulan -

5 Melaksanakan tindakan keperawatan,tindakan Keperawatan Dasar Kategori I 0.002 1.2 600 tindakan 100 12 bulan -

6 Melaksanakan tindakan keperawatan,tindakan Keperawatan Dasar Kategori II 0.003 1.8 600 tindakan 100 12 bulan -

7 Melaksanakan tindakan keperawatan,tindakan Keperawatan Dasar Kategori III 0.005 2.5 500 tindakan 100 12 bulan -

8 Melaksanakan tindakan keperawatan,tindakan Keperawatan Dasar Kategori IV 0.007 1.75 250 tindakan 100 12 bulan -

9 Tindakan Keperawatan Komplek Kategori I 0.003 0.6 200 tindakan 100 12 bulan -

10 Tindakan Keperawatan Komplek Kategori II 0.004 0.8 200 tindakan 100 12 bulan -

11 Menyusun penyuluhan dengan metode sederhana 0.01 0.24 24 laporan 100 12 bulan -

12 Melakukan penyulahn kesehatan pada kelompok 0.01 0.24 24 tindakan 100 12 bulan -

13 Menerima konsultasi evaluasi keperawatan sederhana pada kelompok 0.002 0.2 100 tindakan 100 12 bulan -

14 Melakukan Penyuluhan kepada Masyarakat 0.01 0.24 24 kegiatan 100 12 bulan -

14.874 Brebes,2 Januari 2014


Pejabat Penilai, Pegawai Negeri Sipil Yang Dinilai

Daroti, SE SITI SAROH, AMK


19620629 198403 2 007 19790603 201409 2 003

Catatan :
* AK Bagi PNS yang memangku jabatan fungsional tertentu
10/keg

10

10

10

10

10

10

10

10

10
10

10

10

10

10

10
PENILAIAN CAPAIAN SASARAN KERJA
PEGAWAI NEGERI SIPIL
Jangka Waktu Penilaian 2 Januari s.d. 31 Desember 2014
TARGET REALISASI NILAI
PENGHITUNG
NO I. Kegiatan Tugas Jabatan AK Kual/Mu Biay AK Kual/Mu CAPAIAN
Kuant/ Output Waktu Kuant/ Output Waktu Biaya AN
tu a tu SKP
1 2 3 4 5 6 7 8 9 10 11 12 13 14
1 Melaksanakan Pengkajian keperawatan berupa pengkajian dasar pada Kelompok 0.144 144 laporan 100 12 bulan - 0.13 130 laporan 76 12 bulan - 242.28 80.76

2 Menerima Konsultasi Pengkajian keperawatan berupa pengkajian dasar 0.12 120 laporan 100 12 bulan - 0.11 110 laporan 76 12 bulan - 243.67 81.22

3 Melaksanakan analisis data untuk merumuskan dianogsa keperawatan analisis sederhana pada keluarga 2.16 144 rumusan 100 12 bulan - 1.95 130 rumusan 76 12 bulan - 242.28 80.76

4 Merencanakan tindakan keperawatan sederhana pada keluarga 2.88 144 rumusan 100 12 bulan - 2.6 130 rumusan 76 12 bulan - 242.28 80.76

5 Melaksanakan tindakan keperawatan,tindakan Keperawatan Dasar Kategori I 1.2 600 tindakan 100 12 bulan - 1.06 530 tindakan 76 12 bulan - 240.33 80.11

6 Melaksanakan tindakan keperawatan,tindakan Keperawatan Dasar Kategori II 1.8 600 tindakan 100 12 bulan - 1.5 500 tindakan 76 12 bulan - 235.33 78.44

7 Melaksanakan tindakan keperawatan,tindakan Keperawatan Dasar Kategori III 2.5 500 tindakan 100 12 bulan - 2.5 500 tindakan 76 12 bulan - 252.00 84.00

8 Melaksanakan tindakan keperawatan,tindakan Keperawatan Dasar Kategori IV 1.75 250 tindakan 100 12 bulan - 1.68 240 tindakan 76 12 bulan - 248.00 82.67

9 Tindakan Keperawatan Komplek Kategori I 0.6 200 tindakan 100 12 bulan - 0.51 170 tindakan 76 12 bulan - 237.00 79.00

10 Tindakan Keperawatan Komplek Kategori II 0.8 200 tindakan 100 12 bulan - 0.68 170 tindakan 76 1 bulan - 169.33 56.44

11 Menyusun penyuluhan dengan metode sederhana 0.24 24 laporan 100 12 bulan - 0.24 24 laporan 76 12 bulan - 252.00 84.00

12 Melakukan penyulahn kesehatan pada kelompok 0.24 24 tindakan 100 12 bulan - 0.24 24 tindakan 76 12 bulan - 252.00 84.00

13 Menerima konsultasi evaluasi keperawatan sederhana pada kelompok 0.2 100 tindakan 100 12 bulan - 0.2 100 tindakan 76 12 bulan - 252.00 84.00

14 Melakukan Penyuluhan kepada Masyarakat 0.24 24 kegiatan 100 12 bulan - 0.24 24 kegiatan 76 12 bulan - 252.00 84.00

II. TUGAS TAMBAHAN DAN KREATIVITAS/UNSUR PENUNJANG :

1 (tugas tambahan)
(tugas tambahan)
2 (kreatifitas)
(kreatifitas)

80.01
Nilai Capaian SKP
(Baik)
BREBES, 31 Desember 2014
Pejabat Penilai,

Daroti, SE
19620629 198403 2 007
PENILAIAN CAPAIAN SASARAN KERJA
PEGAWAI NEGERI SIPIL

Jangka Waktu Penilaian …. Januari s.d. 31 Desember 20…..


TARGET REALISASI NILAI
PENGHITUNG
NO I. Kegiatan Tugas Jabatan AK Kual/Mu Biay AK Kual/Mu CAPAIAN
Kuant/ Output Waktu Kuant/ Output Waktu Biaya AN
tu a tu SKP
1 2 3 4 5 6 7 8 9 10 11 12 13 14
1 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
2 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
3 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
4 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
5 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
6 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
7 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
8 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
9 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
10 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
11 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
12 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
13 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
14 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
15 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
16 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
17 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
18 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
19 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
20 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
21 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
22 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
23 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
24 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
25 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
26 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
27 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
28 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
29 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
30 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
31 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
32 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
33 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
34 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
35 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
36 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
37 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
38 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
39 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
40 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
II. TUGAS TAMBAHAN DAN KREATIVITAS/UNSUR PENUNJANG :
1 (tugas tambahan)
(tugas tambahan)
2 (kreatifitas)
(kreatifitas)

#DIV/0!
Nilai Capaian SKP
#DIV/0!

…….., 31 Desember 20…..


Pejabat Penilai,

0
0

PENILAIAN CAPAIAN SASARAN KERJA


PEGAWAI NEGERI SIPIL

Jangka Waktu Penilaian …. Januari s.d. 31 Desember 20…..


TARGET REALISASI NILAI
PENGHITUNG
NO I. Kegiatan Tugas Jabatan AK Kual/Mu Biay AK Kual/Mu CAPAIAN
Kuant/ Output Waktu Kuant/ Output Waktu Biaya AN
tu a tu SKP
1 2 3 4 5 6 7 8 9 10 11 12 13 14
1 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
2 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
3 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
4 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
5 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
6 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
7 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
8 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
9 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
10 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
11 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
12 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
13 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
14 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
15 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
16 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
17 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
18 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
19 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
20 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
21 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
22 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
23 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
24 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
25 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
26 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
27 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
28 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
29 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
30 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
31 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
32 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
33 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
34 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
35 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
36 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
37 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
38 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
39 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
40 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
II. TUGAS TAMBAHAN DAN KREATIVITAS/UNSUR PENUNJANG :
1 (tugas tambahan)
(tugas tambahan)
2 (kreatifitas)
(kreatifitas)

#DIV/0!
Nilai Capaian SKP
#DIV/0!

…….., 31 Desember 20…..


Pejabat Penilai,

0
0

PENILAIAN CAPAIAN SASARAN KERJA


PEGAWAI NEGERI SIPIL

Jangka Waktu Penilaian …. Januari s.d. 31 Desember 20…..


TARGET REALISASI NILAI
PENGHITUNG
NO I. Kegiatan Tugas Jabatan AK Kual/Mu Biay AK Kual/Mu CAPAIAN
Kuant/ Output Waktu Kuant/ Output Waktu Biaya AN
tu a tu SKP
1 2 3 4 5 6 7 8 9 10 11 12 13 14
1 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
2 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
3 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
4 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
5 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
6 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
7 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
8 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
9 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
10 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
11 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
12 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
13 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
14 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
15 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
16 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
17 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
18 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
19 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
20 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
21 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
22 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
23 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
24 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
25 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
26 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
27 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
28 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
29 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
30 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
31 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
32 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
33 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
34 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
35 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
36 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
37 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
38 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
39 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
40 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
II. TUGAS TAMBAHAN DAN KREATIVITAS/UNSUR PENUNJANG :
1 (tugas tambahan)
(tugas tambahan)
2 (kreatifitas)
(kreatifitas)

#DIV/0!
Nilai Capaian SKP
#DIV/0!

…….., 31 Desember 20…..


Pejabat Penilai,

0
23 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
24 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
25 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
26 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
27 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
28 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
29 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
30 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
31 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
32 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
33 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
34 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
35 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
36 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
37 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
38 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
39 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
40 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
II. TUGAS TAMBAHAN DAN KREATIVITAS/UNSUR PENUNJANG :
1 (tugas tambahan)
(tugas tambahan)
2 (kreatifitas)
(kreatifitas)

#DIV/0!
Nilai Capaian SKP
#DIV/0!

…….., 31 Desember 20…..


Pejabat Penilai,

0
0

PENILAIAN CAPAIAN SASARAN KERJA


PEGAWAI NEGERI SIPIL

Jangka Waktu Penilaian …. Januari s.d. 31 Desember 20…..


TARGET REALISASI NILAI
PENGHITUNG
NO I. Kegiatan Tugas Jabatan AK Kual/Mu Biay AK Kual/Mu CAPAIAN
Kuant/ Output Waktu Kuant/ Output Waktu Biaya AN
tu a tu SKP
1 2 3 4 5 6 7 8 9 10 11 12 13 14
1 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
2 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
3 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
4 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
5 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
6 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
7 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
8 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
9 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
10 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
11 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
12 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
13 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
14 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
15 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
16 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
17 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
18 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
19 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
20 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
21 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
22 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
23 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
24 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
25 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
26 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
27 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
28 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
29 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
30 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
31 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
32 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
33 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
34 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
35 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
36 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
37 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
38 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
39 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
40 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
II. TUGAS TAMBAHAN DAN KREATIVITAS/UNSUR PENUNJANG :
1 (tugas tambahan)
(tugas tambahan)
2 (kreatifitas)
(kreatifitas)

#DIV/0!
Nilai Capaian SKP
#DIV/0!

…….., 31 Desember 20…..


Pejabat Penilai,

0
23 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
24 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
25 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
26 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
27 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
28 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
29 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
30 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
31 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
32 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
33 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
34 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
35 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
36 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
37 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
38 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
39 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
40 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
II. TUGAS TAMBAHAN DAN KREATIVITAS/UNSUR PENUNJANG :
1 (tugas tambahan)
(tugas tambahan)
2 (kreatifitas)
(kreatifitas)

#DIV/0!
Nilai Capaian SKP
#DIV/0!

…….., 31 Desember 20…..


Pejabat Penilai,

0
0
PENILAIAN CAPAIAN SASARAN KERJA
PEGAWAI NEGERI SIPIL

Jangka Waktu Penilaian …. Januari s.d. 31 Desember 20…..


TARGET REALISASI NILAI
PENGHITUNG
NO I. Kegiatan Tugas Jabatan AK Kual/Mu Biay AK Kual/Mu CAPAIAN
Kuant/ Output Waktu Kuant/ Output Waktu Biaya AN
tu a tu SKP
1 2 3 4 5 6 7 8 9 10 11 12 13 14
1 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
2 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
3 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
4 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
5 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
6 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
7 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
8 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
9 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
10 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
11 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
12 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
13 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
14 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
15 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
16 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
17 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
18 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
19 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
20 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
21 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
22 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
23 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
24 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
25 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
26 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
27 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
28 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
29 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
30 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
31 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
32 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
33 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
34 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
35 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
36 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
37 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
38 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
39 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
40 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
II. TUGAS TAMBAHAN DAN KREATIVITAS/UNSUR PENUNJANG :
1 (tugas tambahan)
(tugas tambahan)
2 (kreatifitas)
(kreatifitas)

#DIV/0!
Nilai Capaian SKP
Nilai Capaian SKP
#DIV/0!

…….., 31 Desember 20…..


Pejabat Penilai,

0
0

PENILAIAN CAPAIAN SASARAN KERJA


PEGAWAI NEGERI SIPIL

Jangka Waktu Penilaian …. Januari s.d. 31 Desember 20…..


TARGET REALISASI NILAI
PENGHITUNG
NO I. Kegiatan Tugas Jabatan AK AK CAPAIAN
AN
SKP
NILAI
PENGHITUNG
NO I. Kegiatan Tugas Jabatan AK Kual/Mu Biay AK Kual/Mu CAPAIAN
Kuant/ Output Waktu Kuant/ Output Waktu Biaya AN
tu a tu SKP
1 2 3 4 5 6 7 8 9 10 11 12 13 14
1 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
2 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
3 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
4 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
5 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
6 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
7 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
8 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
9 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
10 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
11 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
12 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
13 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
14 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
15 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
16 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
17 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
18 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
19 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
20 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
21 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
22 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
23 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
24 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
25 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
26 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
27 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
28 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
29 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
30 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
31 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
32 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
33 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
34 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
35 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
36 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
37 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
38 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
39 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
40 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
II. TUGAS TAMBAHAN DAN KREATIVITAS/UNSUR PENUNJANG :
1 (tugas tambahan)
(tugas tambahan)
2 (kreatifitas)
(kreatifitas)

#DIV/0!
Nilai Capaian SKP
#DIV/0!

…….., 31 Desember 20…..


Pejabat Penilai,

0
0

PENILAIAN CAPAIAN SASARAN KERJA


PEGAWAI NEGERI SIPIL

Jangka Waktu Penilaian …. Januari s.d. 31 Desember 20…..


TARGET REALISASI NILAI
PENGHITUNG
NO I. Kegiatan Tugas Jabatan AK Kual/Mu Biay AK Kual/Mu CAPAIAN
Kuant/ Output Waktu Kuant/ Output Waktu Biaya AN
tu a tu SKP
1 2 3 4 5 6 7 8 9 10 11 12 13 14
1 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
2 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
3 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
4 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
5 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
6 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
7 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
8 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
9 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
10 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
11 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
12 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
13 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
14 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
15 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
16 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
17 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
18 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
19 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
20 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
21 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
22 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
23 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
24 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
25 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
26 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
27 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
28 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
29 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
30 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
31 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
32 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
33 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
34 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
35 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
36 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
37 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
38 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
39 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
40 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
II. TUGAS TAMBAHAN DAN KREATIVITAS/UNSUR PENUNJANG :
1 (tugas tambahan)
(tugas tambahan)
2 (kreatifitas)
(kreatifitas)

#DIV/0!
Nilai Capaian SKP
#DIV/0!

…….., 31 Desember 20…..


Pejabat Penilai,

0
0
PENILAIAN CAPAIAN SASARAN KERJA
PEGAWAI NEGERI SIPIL

Jangka Waktu Penilaian …. Januari s.d. 31 Desember 20…..


TARGET REALISASI NILAI
PENGHITUNG
NO I. Kegiatan Tugas Jabatan AK Kual/Mu Biay AK Kual/Mu CAPAIAN
Kuant/ Output Waktu Kuant/ Output Waktu Biaya AN
tu a tu SKP
1 2 3 4 5 6 7 8 9 10 11 12 13 14
1 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
2 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
3 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
4 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
5 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
6 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
7 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
8 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
9 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
10 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
11 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
12 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
13 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
14 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
15 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
16 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
17 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
18 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
19 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
20 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
21 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
22 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
23 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
24 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
25 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
26 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
27 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
28 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
29 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
30 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
31 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
32 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
33 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
34 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
35 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
36 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
37 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
38 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
39 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
40 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
II. TUGAS TAMBAHAN DAN KREATIVITAS/UNSUR PENUNJANG :
1 (tugas tambahan)
(tugas tambahan)
2 (kreatifitas)
(kreatifitas)

#DIV/0!
Nilai Capaian SKP
#DIV/0!

…….., 31 Desember 20…..


Pejabat Penilai,

0
0
PENILAIAN CAPAIAN SASARAN KERJA
PEGAWAI NEGERI SIPIL

Jangka Waktu Penilaian …. Januari s.d. 31 Desember 20…..


TARGET REALISASI NILAI
PENGHITUNG
NO I. Kegiatan Tugas Jabatan AK Kual/Mu Biay AK Kual/Mu CAPAIAN
Kuant/ Output Waktu Kuant/ Output Waktu Biaya AN
tu a tu SKP
1 2 3 4 5 6 7 8 9 10 11 12 13 14
1 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
2 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
3 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
4 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
5 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
6 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
7 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
8 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
9 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
10 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
11 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
12 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
13 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
14 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
15 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
16 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
17 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
18 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
19 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
20 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
21 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
22 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
23 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
24 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
25 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
26 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
27 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
28 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
29 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
30 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
31 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
32 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
33 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
34 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
35 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
36 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
37 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
38 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
39 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
40 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
II. TUGAS TAMBAHAN DAN KREATIVITAS/UNSUR PENUNJANG :
1 (tugas tambahan)
(tugas tambahan)
2 (kreatifitas)
(kreatifitas)

#DIV/0!
Nilai Capaian SKP
#DIV/0!

…….., 31 Desember 20…..


Pejabat Penilai,

0
0
PENILAIAN CAPAIAN SASARAN KERJA
PEGAWAI NEGERI SIPIL

Jangka Waktu Penilaian …. Januari s.d. 31 Desember 20…..


TARGET REALISASI NILAI
PENGHITUNG
NO I. Kegiatan Tugas Jabatan AK Kual/Mu Biay AK Kual/Mu CAPAIAN
Kuant/ Output Waktu Kuant/ Output Waktu Biaya AN
tu a tu SKP
1 2 3 4 5 6 7 8 9 10 11 12 13 14
1 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
2 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
3 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
4 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
5 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
6 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
7 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
8 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
9 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
10 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
11 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
12 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
13 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
14 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
15 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
16 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
17 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
18 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
19 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
20 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
21 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
22 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
23 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
24 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
25 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
26 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
27 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
28 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
29 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
30 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
31 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
32 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
33 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
34 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
35 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
36 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
37 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
38 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
39 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
40 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
II. TUGAS TAMBAHAN DAN KREATIVITAS/UNSUR PENUNJANG :
1 (tugas tambahan)
(tugas tambahan)
2 (kreatifitas)
(kreatifitas)

#DIV/0!
Nilai Capaian SKP
#DIV/0!

…….., 31 Desember 20…..


Pejabat Penilai,

0
0
PENILAIAN CAPAIAN SASARAN KERJA
PEGAWAI NEGERI SIPIL

Jangka Waktu Penilaian …. Januari s.d. 31 Desember 20…..


TARGET REALISASI NILAI
PENGHITUNG
NO I. Kegiatan Tugas Jabatan AK Kual/Mu Biay AK Kual/Mu CAPAIAN
Kuant/ Output Waktu Kuant/ Output Waktu Biaya AN
tu a tu SKP
1 2 3 4 5 6 7 8 9 10 11 12 13 14
1 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
2 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
3 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
4 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
5 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
6 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
7 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
8 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
9 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
10 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
11 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
12 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
13 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
14 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
15 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
16 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
17 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
18 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
19 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
20 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
21 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
22 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
23 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
24 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
25 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
26 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
27 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
28 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
29 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
30 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
31 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
32 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
33 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
34 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
35 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
36 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
37 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
38 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
39 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
40 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
II. TUGAS TAMBAHAN DAN KREATIVITAS/UNSUR PENUNJANG :
1 (tugas tambahan)
(tugas tambahan)
2 (kreatifitas)
(kreatifitas)

#DIV/0!
Nilai Capaian SKP
#DIV/0!

…….., 31 Desember 20…..


Pejabat Penilai,

0
0
PENILAIAN CAPAIAN SASARAN KERJA
PEGAWAI NEGERI SIPIL

Jangka Waktu Penilaian …. Januari s.d. 31 Desember 20…..


TARGET REALISASI NILAI
PENGHITUNG
NO I. Kegiatan Tugas Jabatan AK Kual/Mu Biay AK Kual/Mu CAPAIAN
Kuant/ Output Waktu Kuant/ Output Waktu Biaya AN
tu a tu SKP
1 2 3 4 5 6 7 8 9 10 11 12 13 14
1 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
2 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
3 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
4 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
5 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
6 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
7 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
8 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
9 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
10 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
11 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
12 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
13 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
14 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
15 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
16 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
17 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
18 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
19 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
20 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
21 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
22 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
23 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
24 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
25 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
26 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
27 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
28 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
29 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
30 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
31 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
32 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
33 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
34 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
35 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
36 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
37 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
38 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
39 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
40 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
II. TUGAS TAMBAHAN DAN KREATIVITAS/UNSUR PENUNJANG :
1 (tugas tambahan)
(tugas tambahan)
2 (kreatifitas)
(kreatifitas)

#DIV/0!
Nilai Capaian SKP
#DIV/0!

…….., 31 Desember 20…..


Pejabat Penilai,

0
0

PENILAIAN CAPAIAN SASARAN KERJA


PEGAWAI NEGERI SIPIL
Jangka Waktu Penilaian …. Januari s.d. 31 Desember 20…..
TARGET REALISASI NILAI
PENGHITUNG
NO I. Kegiatan Tugas Jabatan AK Kual/Mu Biay AK Kual/Mu CAPAIAN
Kuant/ Output Waktu Kuant/ Output Waktu Biaya AN
tu a tu SKP
1 2 3 4 5 6 7 8 9 10 11 12 13 14
1 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
2 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
3 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
4 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
5 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
6 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
7 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
8 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
9 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
10 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
11 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
12 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
13 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
14 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
15 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
16 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
17 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
18 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
19 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
20 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
21 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
22 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
23 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
24 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
25 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
26 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
27 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
28 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
29 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
30 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
31 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
32 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
33 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
34 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
35 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
36 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
37 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
38 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
39 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
40 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
II. TUGAS TAMBAHAN DAN KREATIVITAS/UNSUR PENUNJANG :
1 (tugas tambahan)
(tugas tambahan)
2 (kreatifitas)
(kreatifitas)

#DIV/0!
Nilai Capaian SKP
#DIV/0!

…….., 31 Desember 20…..


Pejabat Penilai,

0
0

PENILAIAN CAPAIAN SASARAN KERJA


PEGAWAI NEGERI SIPIL

Jangka Waktu Penilaian …. Januari s.d. 31 Desember 20…..


TARGET REALISASI NILAI
PENGHITUNG
NO I. Kegiatan Tugas Jabatan AK Kual/Mu Biay AK Kual/Mu CAPAIAN
Kuant/ Output Waktu Kuant/ Output Waktu Biaya AN
tu a tu SKP
1 2 3 4 5 6 7 8 9 10 11 12 13 14
1 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
2 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
3 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
4 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
5 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
6 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
7 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
8 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
9 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
10 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
11 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
12 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
13 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
14 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
15 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
16 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
17 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
18 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
19 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
20 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
21 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
22 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
23 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
24 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
25 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
26 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
27 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
28 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
29 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
30 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
31 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
32 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
33 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
34 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
35 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
36 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
37 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
38 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
39 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
40 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
II. TUGAS TAMBAHAN DAN KREATIVITAS/UNSUR PENUNJANG :
1 (tugas tambahan)
(tugas tambahan)
2 (kreatifitas)
(kreatifitas)

#DIV/0!
Nilai Capaian SKP
#DIV/0!

…….., 31 Desember 20…..


Pejabat Penilai,

0
0
PENILAIAN CAPAIAN SASARAN KERJA
PEGAWAI NEGERI SIPIL

Jangka Waktu Penilaian …. Januari s.d. 31 Desember 20…..


TARGET REALISASI NILAI
PENGHITUNG
NO I. Kegiatan Tugas Jabatan AK Kual/Mu Biay AK Kual/Mu CAPAIAN
Kuant/ Output Waktu Kuant/ Output Waktu Biaya AN
tu a tu SKP
1 2 3 4 5 6 7 8 9 10 11 12 13 14
1 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
2 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
3 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
4 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
5 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
6 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
7 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
8 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
9 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
10 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
11 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
12 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
13 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
14 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
15 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
16 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
17 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
18 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
19 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
20 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
21 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
22 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
23 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
24 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
25 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
26 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
27 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
28 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
29 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
30 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
31 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
32 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
33 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
34 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
35 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
36 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
37 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
38 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
39 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
40 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
II. TUGAS TAMBAHAN DAN KREATIVITAS/UNSUR PENUNJANG :
1 (tugas tambahan)
(tugas tambahan)
2 (kreatifitas)
(kreatifitas)

#DIV/0!
Nilai Capaian SKP
#DIV/0!

…….., 31 Desember 20…..


Pejabat Penilai,

0
0
PENILAIAN CAPAIAN SASARAN KERJA
PEGAWAI NEGERI SIPIL

Jangka Waktu Penilaian …. Januari s.d. 31 Desember 20…..


TARGET REALISASI NILAI
PENGHITUNG
NO I. Kegiatan Tugas Jabatan AK Kual/Mu Biay AK Kual/Mu CAPAIAN
Kuant/ Output Waktu Kuant/ Output Waktu Biaya AN
tu a tu SKP
1 2 3 4 5 6 7 8 9 10 11 12 13 14
1 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
2 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
3 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
4 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
5 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
6 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
7 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
8 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
9 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
10 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
11 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
12 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
13 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
14 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
15 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
16 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
17 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
18 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
19 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
20 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
21 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
22 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
23 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
24 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
25 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
26 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
27 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
28 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
29 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
30 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
31 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
32 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
33 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
34 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
35 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
36 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
37 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
38 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
39 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
40 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
II. TUGAS TAMBAHAN DAN KREATIVITAS/UNSUR PENUNJANG :
1 (tugas tambahan)
(tugas tambahan)
2 (kreatifitas)
(kreatifitas)

#DIV/0!
Nilai Capaian SKP
#DIV/0!

…….., 31 Desember 20…..


Pejabat Penilai,

0
0
PENILAIAN CAPAIAN SASARAN KERJA
PEGAWAI NEGERI SIPIL

Jangka Waktu Penilaian …. Januari s.d. 31 Desember 20…..


TARGET REALISASI NILAI
PENGHITUNG
NO I. Kegiatan Tugas Jabatan AK Kual/Mu Biay AK Kual/Mu CAPAIAN
Kuant/ Output Waktu Kuant/ Output Waktu Biaya AN
tu a tu SKP
1 2 3 4 5 6 7 8 9 10 11 12 13 14
1 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
2 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
3 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
4 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
5 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
6 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
7 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
8 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
9 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
10 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
11 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
12 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
13 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
14 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
15 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
16 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
17 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
18 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
19 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
20 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
21 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
22 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
23 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
24 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
25 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
26 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
27 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
28 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
29 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
30 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
31 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
32 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
33 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
34 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
35 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
36 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
37 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
38 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
39 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
40 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
II. TUGAS TAMBAHAN DAN KREATIVITAS/UNSUR PENUNJANG :
1 (tugas tambahan)
(tugas tambahan)
2 (kreatifitas)
(kreatifitas)

#DIV/0!
Nilai Capaian SKP
#DIV/0!

…….., 31 Desember 20…..


Pejabat Penilai,

0
0
PENILAIAN CAPAIAN SASARAN KERJA
PEGAWAI NEGERI SIPIL

Jangka Waktu Penilaian …. Januari s.d. 31 Desember 20…..


TARGET REALISASI NILAI
PENGHITUNG
NO I. Kegiatan Tugas Jabatan AK Kual/Mu Biay AK Kual/Mu CAPAIAN
Kuant/ Output Waktu Kuant/ Output Waktu Biaya AN
tu a tu SKP
1 2 3 4 5 6 7 8 9 10 11 12 13 14
1 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
2 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
3 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
4 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
5 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
6 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
7 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
8 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
9 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
10 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
11 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
12 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
13 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
14 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
15 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
16 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
17 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
18 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
19 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
20 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
21 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
22 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
23 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
24 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
25 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
26 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
27 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
28 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
29 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
30 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
31 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
32 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
33 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
34 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
35 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
36 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
37 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
38 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
39 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
40 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
II. TUGAS TAMBAHAN DAN KREATIVITAS/UNSUR PENUNJANG :
1 (tugas tambahan)
(tugas tambahan)
2 (kreatifitas)
(kreatifitas)

#DIV/0!
Nilai Capaian SKP
#DIV/0!

…….., 31 Desember 20…..


Pejabat Penilai,

0
0
PENILAIAN CAPAIAN SASARAN KERJA
PEGAWAI NEGERI SIPIL

Jangka Waktu Penilaian …. Januari s.d. 31 Desember 20…..


TARGET REALISASI NILAI
PENGHITUNG
NO I. Kegiatan Tugas Jabatan AK Kual/Mu Biay AK Kual/Mu CAPAIAN
Kuant/ Output Waktu Kuant/ Output Waktu Biaya AN
tu a tu SKP
1 2 3 4 5 6 7 8 9 10 11 12 13 14
1 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
2 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
3 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
4 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
5 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
6 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
7 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
8 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
9 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
10 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
11 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
12 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
13 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
14 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
15 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
16 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
17 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
18 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
19 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
20 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
21 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
22 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
23 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
24 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
25 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
26 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
27 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
28 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
29 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
30 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
31 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
32 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
33 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
34 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
35 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
36 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
37 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
38 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
39 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
40 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
II. TUGAS TAMBAHAN DAN KREATIVITAS/UNSUR PENUNJANG :
1 (tugas tambahan)
(tugas tambahan)
2 (kreatifitas)
(kreatifitas)

#DIV/0!
Nilai Capaian SKP
#DIV/0!

…….., 31 Desember 20…..


Pejabat Penilai,

0
0
PENILAIAN CAPAIAN SASARAN KERJA
PEGAWAI NEGERI SIPIL

Jangka Waktu Penilaian …. Januari s.d. 31 Desember 20…..


TARGET REALISASI NILAI
PENGHITUNG
NO I. Kegiatan Tugas Jabatan AK Kual/Mu Biay AK Kual/Mu CAPAIAN
Kuant/ Output Waktu Kuant/ Output Waktu Biaya AN
tu a tu SKP
1 2 3 4 5 6 7 8 9 10 11 12 13 14
1 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
2 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
3 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
4 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
5 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
6 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
7 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
8 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
9 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
10 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
11 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
12 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
13 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
14 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
15 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
16 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
17 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
18 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
19 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
20 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
21 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
22 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
23 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
24 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
25 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
26 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
27 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
28 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
29 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
30 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
31 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
32 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
33 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
34 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
35 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
36 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
37 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
38 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
39 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
40 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
II. TUGAS TAMBAHAN DAN KREATIVITAS/UNSUR PENUNJANG :
1 (tugas tambahan)
(tugas tambahan)
2 (kreatifitas)
(kreatifitas)
#DIV/0!
Nilai Capaian SKP
#DIV/0!

…….., 31 Desember 20…..


Pejabat Penilai,

0
0

PENILAIAN CAPAIAN SASARAN KERJA


PEGAWAI NEGERI SIPIL

Jangka Waktu Penilaian …. Januari s.d. 31 Desember 20…..


TARGET REALISASI NILAI
PENGHITUNG
NO I. Kegiatan Tugas Jabatan AK Kual/Mu Biay AK Kual/Mu CAPAIAN
Kuant/ Output Waktu Kuant/ Output Waktu Biaya AN
tu a tu SKP
1 2 3 4 5 6 7 8 9 10 11 12 13 14
1 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
2 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
3 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
4 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
5 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
6 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
7 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
8 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
9 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
10 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
11 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
12 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
13 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
14 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
15 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
16 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
17 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
18 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
19 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
20 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
21 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
22 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
23 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
24 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
25 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
26 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
27 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
28 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
29 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
30 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
31 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
32 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
33 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
34 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
35 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
36 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
37 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
38 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
39 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
40 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
II. TUGAS TAMBAHAN DAN KREATIVITAS/UNSUR PENUNJANG :
1 (tugas tambahan)
(tugas tambahan)
2 (kreatifitas)
(kreatifitas)

#DIV/0!
Nilai Capaian SKP
#DIV/0!

…….., 31 Desember 20…..


Pejabat Penilai,
0
0

PENILAIAN CAPAIAN SASARAN KERJA


PEGAWAI NEGERI SIPIL

Jangka Waktu Penilaian …. Januari s.d. 31 Desember 20…..


TARGET REALISASI NILAI
PENGHITUNG
NO I. Kegiatan Tugas Jabatan AK Kual/Mu Biay AK Kual/Mu CAPAIAN
Kuant/ Output Waktu Kuant/ Output Waktu Biaya AN
tu a tu SKP
1 2 3 4 5 6 7 8 9 10 11 12 13 14
1 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
2 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
3 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
4 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
5 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
6 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
7 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
8 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
9 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
10 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
11 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
12 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
13 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
14 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
15 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
16 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
17 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
18 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
19 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
20 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
21 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
22 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
23 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
24 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
25 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
26 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
27 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
28 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
29 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
30 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
31 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
32 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
33 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
34 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
35 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
36 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
37 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
38 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
39 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
40 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
II. TUGAS TAMBAHAN DAN KREATIVITAS/UNSUR PENUNJANG :
1 (tugas tambahan)
(tugas tambahan)
2 (kreatifitas)
(kreatifitas)

#DIV/0!
Nilai Capaian SKP
#DIV/0!

…….., 31 Desember 20…..


Pejabat Penilai,

0
0
PENILAIAN CAPAIAN SASARAN KERJA
PEGAWAI NEGERI SIPIL

Jangka Waktu Penilaian …. Januari s.d. 31 Desember 20…..


TARGET REALISASI NILAI
PENGHITUNG
NO I. Kegiatan Tugas Jabatan AK Kual/Mu Biay AK Kual/Mu CAPAIAN
Kuant/ Output Waktu Kuant/ Output Waktu Biaya AN
tu a tu SKP
1 2 3 4 5 6 7 8 9 10 11 12 13 14
1 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
2 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
3 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
4 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
5 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
6 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
7 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
8 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
9 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
10 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
11 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
12 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
13 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
14 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
15 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
16 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
17 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
18 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
19 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
20 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
21 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
22 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
23 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
24 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
25 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
26 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
27 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
28 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
29 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
30 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
31 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
32 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
33 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
34 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
35 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
36 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
37 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
38 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
39 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
40 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
II. TUGAS TAMBAHAN DAN KREATIVITAS/UNSUR PENUNJANG :
1 (tugas tambahan)
(tugas tambahan)
2 (kreatifitas)
(kreatifitas)

#DIV/0!
Nilai Capaian SKP
#DIV/0!

…….., 31 Desember 20…..


Pejabat Penilai,

0
0
PENILAIAN CAPAIAN SASARAN KERJA
PEGAWAI NEGERI SIPIL

Jangka Waktu Penilaian …. Januari s.d. 31 Desember 20…..


TARGET REALISASI NILAI
PENGHITUNG
NO I. Kegiatan Tugas Jabatan AK Kual/Mu Biay AK Kual/Mu CAPAIAN
Kuant/ Output Waktu Kuant/ Output Waktu Biaya AN
tu a tu SKP
1 2 3 4 5 6 7 8 9 10 11 12 13 14
1 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
2 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
3 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
4 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
5 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
6 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
7 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
8 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
9 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
10 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
11 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
12 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
13 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
14 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
15 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
16 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
17 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
18 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
19 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
20 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
21 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
22 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
23 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
24 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
25 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
26 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
27 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
28 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
29 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
30 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
31 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
32 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
33 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
34 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
35 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
36 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
37 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
38 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
39 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
40 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
II. TUGAS TAMBAHAN DAN KREATIVITAS/UNSUR PENUNJANG :
1 (tugas tambahan)
(tugas tambahan)
2 (kreatifitas)
(kreatifitas)

#DIV/0!
Nilai Capaian SKP
#DIV/0!

…….., 31 Desember 20…..


Pejabat Penilai,

0
0
PENILAIAN CAPAIAN SASARAN KERJA
PEGAWAI NEGERI SIPIL

Jangka Waktu Penilaian …. Januari s.d. 31 Desember 20…..


TARGET REALISASI NILAI
PENGHITUNG
NO I. Kegiatan Tugas Jabatan AK Kual/Mu Biay AK Kual/Mu CAPAIAN
Kuant/ Output Waktu Kuant/ Output Waktu Biaya AN
tu a tu SKP
1 2 3 4 5 6 7 8 9 10 11 12 13 14
1 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
2 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
3 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
4 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
5 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
6 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
7 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
8 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
9 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
10 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
11 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
12 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
13 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
14 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
15 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
16 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
17 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
18 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
19 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
20 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
21 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
22 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
23 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
24 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
25 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
26 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
27 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
28 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
29 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
30 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
31 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
32 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
33 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
34 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
35 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
36 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
37 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
38 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
39 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
40 0 0 0 0 0 0 0 0 0 0 0 0.00 0.00
II. TUGAS TAMBAHAN DAN KREATIVITAS/UNSUR PENUNJANG :
1 (tugas tambahan)
(tugas tambahan)
2 (kreatifitas)
(kreatifitas)

#DIV/0!
Nilai Capaian SKP
#DIV/0!

…….., 31 Desember 20…..


Pejabat Penilai,

0
0
persen waktu persen biaya kuantitas kualitas waktu biaya RW<24 RW>24 RB<24 RB>24

1 80.75925926 0 #VALUE! 90.2777778 76 76 #VALUE! 76 100 #VALUE! #VALUE! 242.2777778 0.0000 #VALUE! 242.277778 242.2778 242.277778

1 81.22222222 0 #VALUE! 91.6666667 76 76 #VALUE! 76 100 #VALUE! #VALUE! 243.6666667 0.0000 #VALUE! 243.666667 243.6667 243.666667

1 80.75925926 0 #VALUE! 90.2777778 76 76 #VALUE! 76 100 #VALUE! #VALUE! 242.2777778 0.0000 #VALUE! 242.277778 242.2778 242.277778

1 80.75925926 0 #VALUE! 90.2777778 76 76 #VALUE! 76 100 #VALUE! #VALUE! 242.2777778 0.0000 #VALUE! 242.277778 242.2778 242.277778

1 80.11111111 0 #VALUE! 88.3333333 76 76 #VALUE! 76 100 #VALUE! #VALUE! 240.3333333 0.0000 #VALUE! 240.333333 240.3333 240.333333

1 78.44444444 0 #VALUE! 83.3333333 76 76 #VALUE! 76 100 #VALUE! #VALUE! 235.3333333 0.0000 #VALUE! 235.333333 235.3333 235.333333

1 84 0 #VALUE! 100 76 76 #VALUE! 76 100 #VALUE! #VALUE! 252 0 #VALUE! 252 252 252

1 82.66666667 0 #VALUE! 96 76 76 #VALUE! 76 100 #VALUE! #VALUE! 248 0 #VALUE! 248 248 248

1 79 0 #VALUE! 85 76 76 #VALUE! 76 100 #VALUE! #VALUE! 237 0 #VALUE! 237 237 237

1 56.44444444 91.6666666667 #VALUE! 85 76 8.3333333333 #VALUE! 167.66666667 8.3333333333 #VALUE! #VALUE! 169.3333333 91.6666667 #VALUE! 328.666667 169.3333 328.666667

1 84 0 #VALUE! 100 76 76 #VALUE! 76 100 #VALUE! #VALUE! 252 0 #VALUE! 252 252 252

1 84 0 #VALUE! 100 76 76 #VALUE! 76 100 #VALUE! #VALUE! 252 0 #VALUE! 252 252 252

1 84 0 #VALUE! 100 76 76 #VALUE! 76 100 #VALUE! #VALUE! 252 0.0000 #VALUE! 252 252 252

1 84 0 #VALUE! 100 76 76 #VALUE! 76 100 #VALUE! #VALUE! 252 0.0000 #VALUE! 252 252 252

0 0 #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!

0 0 #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!

(1.76*G8-N8)/G8)*100) (76-((((1.76*G8-N8)/G8)*100)-100))
(1.76*I8-P8)/I8)*100) (76-((((1.76*I8-P8)/I8)*100)-100))

#REF!

14
UNSUR YANG DINILAI Jumlah
4. 6. TANGGAPAN PEJABAT PENILAI
a. Sasaran Kerja
ATAS KEBERATAN
Pegawai (SKP) 80.01 x 60% 48.01

1. Orientasi Pelayanan 76 (Baik)


TIDAK ADA

2. Integritas 76 (Baik)

3. Komitmen 76 (Baik)

4. Disiplin 76 (Baik)

b. Perilaku Kerja 5. Kerjasama 76 (Baik)

6. Kepemimpinan - -
Tanggal, 5 Januari 2015
7. Jumlah 380

8. Nilai rata – rata 76.00 (Baik)


7. KEPUTUSAN ATASAN PEJABAT
PENILAI ATAS KEBERATAN
9. Nilai Perilaku Kerja 76.00 x 40% 30.40

78.41
TIDAK ADA

NILAI PRESTASI KERJA (Baik)

5. KEBERATAN DARI PEGAWAI NEGERI


SIPIL YANG DINILAI (APABILA ADA)

TIDAK ADA

Tanggal, 5 Januari 2015 Tanggal, 6 Januari 2015


8. REKOMENDASI

PENILAIAN PRESTASI KERJA


PEGAWAI NEGERI SIPIL

PEMERINTAH KABUPATEN BREBES JANGKA WAKTU PENILAIAN


DINAS KESEHATAN KABUPATEN BREBES BULAN : Januari s/d Desember 2014
1.
YANG DINILAI

a. N a m a SITI SAROH, AMK

b. N I P 19790603 201409 2 003


9. DIBUAT TANGGAL, 31 DESEMBER 2014
PEJABAT PENILAI c. Pangkat, Golongan ruang, TMT Pengatur - II / c

d. Jabatan/Pekerjaan Perawat Puskesmas Ketanggungan

e. Unit Organisasi Puskesmas Ketanggungan


Daroti, SE
19620629 198403 2 007 2.
PEJABAT PENILAI

a. N a m a Daroti, SE
10. DITERIMA TANGGAL, 2 JANUARI 2015
PEGAWAI NEGERI SIPIL YANG DINILAI b. N I P 19620629 198403 2 007

c. Pangkat, Golongan ruang, TMT Penata/IIIc

d. Jabatan/Pekerjaan KASUBAG Kepegawaian


SITI SAROH, AMK
19790603 201409 2 003 e. Unit Organisasi Dinas Kesehatan Kabupaten Brebes.

3.
ATASAN PEJABAT PENILAI
11.DITERIMA TANGGAL, 5 JANUARI 2015
ATASAN PEJABAT PENILAI a. N a m a Dra. Julining Pirula Dewi

b. N I P 10650712 199203 2 007

c. Pangkat, Golongan ruang, TMT Pembiba TK I - IV/b


Dra. Julining Pirula Dewi
10650712 199203 2 007 d. Jabatan/Pekerjaan Sekretaris Dinas Kesehatan Kabupaten Brebes

e. Unit Organisasi Dinas kesehatan Kabupaten Brebes