BUKU SUPERVISI

INSTALASI FARMASI
RUMAH SAKIT DAERAH BALUNG
TAHUN 2016
 CATATAN SUPERVISI

HARI/TANGGAL : ...................................................
TEMPAT : ...................................................
SUPERVISOR : ...................................................

CATATAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
SARAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
...............................................................................................................................................
HASIL :
...........................................

Yang Diperiksa Yang Memeriksa

1
Page

NIP./NIPTT. 19600512 199003 2 005 NIP./NIPTT. 19600512 199003

 CATATAN SUPERVISI

HARI/TANGGAL : ...................................................
TEMPAT : ...................................................
SUPERVISOR : ...................................................

CATATAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
SARAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
...............................................................................................................................................
HASIL :
...........................................

Yang Diperiksa Yang Memeriksa

2
Page

NIP./NIPTT. 19600512 199003 2 005 NIP./NIPTT. 19600512 199003

 CATATAN SUPERVISI

HARI/TANGGAL : ...................................................
TEMPAT : ...................................................
SUPERVISOR : ...................................................

CATATAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
SARAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
...............................................................................................................................................
HASIL :
...........................................

Yang Diperiksa Yang Memeriksa

3
Page

NIP./NIPTT. 19600512 199003 2 005 NIP./NIPTT. 19600512 199003

 CATATAN SUPERVISI

HARI/TANGGAL : ...................................................
TEMPAT : ...................................................
SUPERVISOR : ...................................................

CATATAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
SARAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
...............................................................................................................................................
HASIL :
...........................................

Yang Diperiksa Yang Memeriksa

4
Page

NIP./NIPTT. 19600512 199003 2 005 NIP./NIPTT. 19600512 199003

 CATATAN SUPERVISI

HARI/TANGGAL : ...................................................
TEMPAT : ...................................................
SUPERVISOR : ...................................................

CATATAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
SARAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
...............................................................................................................................................
HASIL :
...........................................

Yang Diperiksa Yang Memeriksa

5
Page

NIP./NIPTT. 19600512 199003 2 005 NIP./NIPTT. 19600512 199003

 CATATAN SUPERVISI

HARI/TANGGAL : ...................................................
TEMPAT : ...................................................
SUPERVISOR : ...................................................

CATATAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
SARAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
...............................................................................................................................................
HASIL :
...........................................

Yang Diperiksa Yang Memeriksa

6
Page

NIP./NIPTT. 19600512 199003 2 005 NIP./NIPTT. 19600512 199003

 CATATAN SUPERVISI

HARI/TANGGAL : ...................................................
TEMPAT : ...................................................
SUPERVISOR : ...................................................

CATATAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
SARAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
...............................................................................................................................................
HASIL :
...........................................

Yang Diperiksa Yang Memeriksa

7
Page

NIP./NIPTT. 19600512 199003 2 005 NIP./NIPTT. 19600512 199003

 CATATAN SUPERVISI

HARI/TANGGAL : ...................................................
TEMPAT : ...................................................
SUPERVISOR : ...................................................

CATATAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
SARAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
...............................................................................................................................................
HASIL :
...........................................

Yang Diperiksa Yang Memeriksa

8
Page

NIP./NIPTT. 19600512 199003 2 005 NIP./NIPTT. 19600512 199003

 CATATAN SUPERVISI

HARI/TANGGAL : ...................................................
TEMPAT : ...................................................
SUPERVISOR : ...................................................

CATATAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
SARAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
...............................................................................................................................................
HASIL :
...........................................

Yang Diperiksa Yang Memeriksa

9
Page

NIP./NIPTT. 19600512 199003 2 005 NIP./NIPTT. 19600512 199003

 CATATAN SUPERVISI

HARI/TANGGAL : ...................................................
TEMPAT : ...................................................
SUPERVISOR : ...................................................

CATATAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
SARAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
...............................................................................................................................................
HASIL :
...........................................

Yang Diperiksa Yang Memeriksa

10
Page

NIP./NIPTT. 19600512 199003 2 005 NIP./NIPTT. 19600512 199003

 CATATAN SUPERVISI

HARI/TANGGAL : ...................................................
TEMPAT : ...................................................
SUPERVISOR : ...................................................

CATATAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
SARAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
...............................................................................................................................................
HASIL :
...........................................

Yang Diperiksa Yang Memeriksa

11
Page

NIP./NIPTT. 19600512 199003 2 005 NIP./NIPTT. 19600512 199003

 CATATAN SUPERVISI

HARI/TANGGAL : ...................................................
TEMPAT : ...................................................
SUPERVISOR : ...................................................

CATATAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
SARAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
...............................................................................................................................................
HASIL :
...........................................

Yang Diperiksa Yang Memeriksa

12
Page

NIP./NIPTT. 19600512 199003 2 005 NIP./NIPTT. 19600512 199003

 CATATAN SUPERVISI

HARI/TANGGAL : ...................................................
TEMPAT : ...................................................
SUPERVISOR : ...................................................

CATATAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
SARAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
...............................................................................................................................................
HASIL :
...........................................

Yang Diperiksa Yang Memeriksa

13
Page

NIP./NIPTT. 19600512 199003 2 005 NIP./NIPTT. 19600512 199003

 CATATAN SUPERVISI

HARI/TANGGAL : ...................................................
TEMPAT : ...................................................
SUPERVISOR : ...................................................

CATATAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
SARAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
...............................................................................................................................................
HASIL :
...........................................

Yang Diperiksa Yang Memeriksa

14
Page

NIP./NIPTT. 19600512 199003 2 005 NIP./NIPTT. 19600512 199003

 CATATAN SUPERVISI

HARI/TANGGAL : ...................................................
TEMPAT : ...................................................
SUPERVISOR : ...................................................

CATATAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
SARAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
...............................................................................................................................................
HASIL :
...........................................

Yang Diperiksa Yang Memeriksa

15
Page

NIP./NIPTT. 19600512 199003 2 005 NIP./NIPTT. 19600512 199003

 CATATAN SUPERVISI

HARI/TANGGAL : ...................................................
TEMPAT : ...................................................
SUPERVISOR : ...................................................

CATATAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
SARAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
...............................................................................................................................................
HASIL :
...........................................

Yang Diperiksa Yang Memeriksa

16
Page

NIP./NIPTT. 19600512 199003 2 005 NIP./NIPTT. 19600512 199003

 CATATAN SUPERVISI

HARI/TANGGAL : ...................................................
TEMPAT : ...................................................
SUPERVISOR : ...................................................

CATATAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
SARAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
...............................................................................................................................................
HASIL :
...........................................

Yang Diperiksa Yang Memeriksa

17
Page

NIP./NIPTT. 19600512 199003 2 005 NIP./NIPTT. 19600512 199003

 CATATAN SUPERVISI

HARI/TANGGAL : ...................................................
TEMPAT : ...................................................
SUPERVISOR : ...................................................

CATATAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
SARAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
...............................................................................................................................................
HASIL :
...........................................

Yang Diperiksa Yang Memeriksa

18
Page

NIP./NIPTT. 19600512 199003 2 005 NIP./NIPTT. 19600512 199003

 CATATAN SUPERVISI

HARI/TANGGAL : ...................................................
TEMPAT : ...................................................
SUPERVISOR : ...................................................

CATATAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
SARAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
...............................................................................................................................................
HASIL :
...........................................

Yang Diperiksa Yang Memeriksa

19
Page

NIP./NIPTT. 19600512 199003 2 005 NIP./NIPTT. 19600512 199003

 CATATAN SUPERVISI

HARI/TANGGAL : ...................................................
TEMPAT : ...................................................
SUPERVISOR : ...................................................

CATATAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
SARAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
...............................................................................................................................................
HASIL :
...........................................

Yang Diperiksa Yang Memeriksa

20
Page

NIP./NIPTT. 19600512 199003 2 005 NIP./NIPTT. 19600512 199003

 CATATAN SUPERVISI

HARI/TANGGAL : ...................................................
TEMPAT : ...................................................
SUPERVISOR : ...................................................

CATATAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
SARAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
...............................................................................................................................................
HASIL :
...........................................

Yang Diperiksa Yang Memeriksa

21
Page

NIP./NIPTT. 19600512 199003 2 005 NIP./NIPTT. 19600512 199003

 CATATAN SUPERVISI

HARI/TANGGAL : ...................................................
TEMPAT : ...................................................
SUPERVISOR : ...................................................

CATATAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
SARAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
...............................................................................................................................................
HASIL :
...........................................

Yang Diperiksa Yang Memeriksa

22
Page

NIP./NIPTT. 19600512 199003 2 005 NIP./NIPTT. 19600512 199003

 CATATAN SUPERVISI

HARI/TANGGAL : ...................................................
TEMPAT : ...................................................
SUPERVISOR : ...................................................

CATATAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
SARAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
...............................................................................................................................................
HASIL :
...........................................

Yang Diperiksa Yang Memeriksa

23
Page

NIP./NIPTT. 19600512 199003 2 005 NIP./NIPTT. 19600512 199003

 CATATAN SUPERVISI

HARI/TANGGAL : ...................................................
TEMPAT : ...................................................
SUPERVISOR : ...................................................

CATATAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
SARAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
...............................................................................................................................................
HASIL :
...........................................

Yang Diperiksa Yang Memeriksa

24
Page

NIP./NIPTT. 19600512 199003 2 005 NIP./NIPTT. 19600512 199003

 CATATAN SUPERVISI

HARI/TANGGAL : ...................................................
TEMPAT : ...................................................
SUPERVISOR : ...................................................

CATATAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
SARAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
...............................................................................................................................................
HASIL :
...........................................

Yang Diperiksa Yang Memeriksa

25
Page

NIP./NIPTT. 19600512 199003 2 005 NIP./NIPTT. 19600512 199003

 CATATAN SUPERVISI

HARI/TANGGAL : ...................................................
TEMPAT : ...................................................
SUPERVISOR : ...................................................

CATATAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
SARAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
...............................................................................................................................................
HASIL :
...........................................

Yang Diperiksa Yang Memeriksa

26
Page

NIP./NIPTT. 19600512 199003 2 005 NIP./NIPTT. 19600512 199003

 CATATAN SUPERVISI

HARI/TANGGAL : ...................................................
TEMPAT : ...................................................
SUPERVISOR : ...................................................

CATATAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
SARAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
...............................................................................................................................................
HASIL :
...........................................

Yang Diperiksa Yang Memeriksa

27
Page

NIP./NIPTT. 19600512 199003 2 005 NIP./NIPTT. 19600512 199003

 CATATAN SUPERVISI

HARI/TANGGAL : ...................................................
TEMPAT : ...................................................
SUPERVISOR : ...................................................

CATATAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
SARAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
...............................................................................................................................................
HASIL :
...........................................

Yang Diperiksa Yang Memeriksa

28
Page

NIP./NIPTT. 19600512 199003 2 005 NIP./NIPTT. 19600512 199003

 CATATAN SUPERVISI

HARI/TANGGAL : ...................................................
TEMPAT : ...................................................
SUPERVISOR : ...................................................

CATATAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
SARAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
...............................................................................................................................................
HASIL :
...........................................

Yang Diperiksa Yang Memeriksa

29
Page

NIP./NIPTT. 19600512 199003 2 005 NIP./NIPTT. 19600512 199003

 CATATAN SUPERVISI

HARI/TANGGAL : ...................................................
TEMPAT : ...................................................
SUPERVISOR : ...................................................

CATATAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
SARAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
...............................................................................................................................................
HASIL :
...........................................

Yang Diperiksa Yang Memeriksa

30
Page

NIP./NIPTT. 19600512 199003 2 005 NIP./NIPTT. 19600512 199003

 CATATAN SUPERVISI

HARI/TANGGAL : ...................................................
TEMPAT : ...................................................
SUPERVISOR : ...................................................

CATATAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
SARAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
...............................................................................................................................................
HASIL :
...........................................

Yang Diperiksa Yang Memeriksa

31
Page

NIP./NIPTT. 19600512 199003 2 005 NIP./NIPTT. 19600512 199003

 CATATAN SUPERVISI

HARI/TANGGAL : ...................................................
TEMPAT : ...................................................
SUPERVISOR : ...................................................

CATATAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
SARAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
...............................................................................................................................................
HASIL :
...........................................

Yang Diperiksa Yang Memeriksa

32
Page

NIP./NIPTT. 19600512 199003 2 005 NIP./NIPTT. 19600512 199003

 CATATAN SUPERVISI

HARI/TANGGAL : ...................................................
TEMPAT : ...................................................
SUPERVISOR : ...................................................

CATATAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
SARAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
...............................................................................................................................................
HASIL :
...........................................

Yang Diperiksa Yang Memeriksa

33
Page

NIP./NIPTT. 19600512 199003 2 005 NIP./NIPTT. 19600512 199003

 CATATAN SUPERVISI

HARI/TANGGAL : ...................................................
TEMPAT : ...................................................
SUPERVISOR : ...................................................

CATATAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
SARAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
...............................................................................................................................................
HASIL :
...........................................

Yang Diperiksa Yang Memeriksa

34
Page

NIP./NIPTT. 19600512 199003 2 005 NIP./NIPTT. 19600512 199003

 CATATAN SUPERVISI

HARI/TANGGAL : ...................................................
TEMPAT : ...................................................
SUPERVISOR : ...................................................

CATATAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
SARAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
...............................................................................................................................................
HASIL :
...........................................

Yang Diperiksa Yang Memeriksa

35
Page

NIP./NIPTT. 19600512 199003 2 005 NIP./NIPTT. 19600512 199003

 CATATAN SUPERVISI

HARI/TANGGAL : ...................................................
TEMPAT : ...................................................
SUPERVISOR : ...................................................

CATATAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
SARAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
...............................................................................................................................................
HASIL :
...........................................

Yang Diperiksa Yang Memeriksa

36
Page

NIP./NIPTT. 19600512 199003 2 005 NIP./NIPTT. 19600512 199003

 CATATAN SUPERVISI

HARI/TANGGAL : ...................................................
TEMPAT : ...................................................
SUPERVISOR : ...................................................

CATATAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
SARAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
...............................................................................................................................................
HASIL :
...........................................

Yang Diperiksa Yang Memeriksa

37
Page

NIP./NIPTT. 19600512 199003 2 005 NIP./NIPTT. 19600512 199003

 CATATAN SUPERVISI

HARI/TANGGAL : ...................................................
TEMPAT : ...................................................
SUPERVISOR : ...................................................

CATATAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
SARAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
...............................................................................................................................................
HASIL :
...........................................

Yang Diperiksa Yang Memeriksa

38
Page

NIP./NIPTT. 19600512 199003 2 005 NIP./NIPTT. 19600512 199003

 CATATAN SUPERVISI

HARI/TANGGAL : ...................................................
TEMPAT : ...................................................
SUPERVISOR : ...................................................

CATATAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
SARAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
...............................................................................................................................................
HASIL :
...........................................

Yang Diperiksa Yang Memeriksa

39
Page

NIP./NIPTT. 19600512 199003 2 005 NIP./NIPTT. 19600512 199003

 CATATAN SUPERVISI

HARI/TANGGAL : ...................................................
TEMPAT : ...................................................
SUPERVISOR : ...................................................

CATATAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
SARAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
...............................................................................................................................................
HASIL :
...........................................

Yang Diperiksa Yang Memeriksa

40
Page

NIP./NIPTT. 19600512 199003 2 005 NIP./NIPTT. 19600512 199003

 CATATAN SUPERVISI

HARI/TANGGAL : ...................................................
TEMPAT : ...................................................
SUPERVISOR : ...................................................

CATATAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
SARAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
...............................................................................................................................................
HASIL :
...........................................

Yang Diperiksa Yang Memeriksa

41
Page

NIP./NIPTT. 19600512 199003 2 005 NIP./NIPTT. 19600512 199003

 CATATAN SUPERVISI

HARI/TANGGAL : ...................................................
TEMPAT : ...................................................
SUPERVISOR : ...................................................

CATATAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
SARAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
...............................................................................................................................................
HASIL :
...........................................

Yang Diperiksa Yang Memeriksa

42
Page

NIP./NIPTT. 19600512 199003 2 005 NIP./NIPTT. 19600512 199003

 CATATAN SUPERVISI

HARI/TANGGAL : ...................................................
TEMPAT : ...................................................
SUPERVISOR : ...................................................

CATATAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
SARAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
...............................................................................................................................................
HASIL :
...........................................

Yang Diperiksa Yang Memeriksa

43
Page

NIP./NIPTT. 19600512 199003 2 005 NIP./NIPTT. 19600512 199003

 CATATAN SUPERVISI

HARI/TANGGAL : ...................................................
TEMPAT : ...................................................
SUPERVISOR : ...................................................

CATATAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
SARAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
...............................................................................................................................................
HASIL :
...........................................

Yang Diperiksa Yang Memeriksa

44
Page

NIP./NIPTT. 19600512 199003 2 005 NIP./NIPTT. 19600512 199003

 CATATAN SUPERVISI

HARI/TANGGAL : ...................................................
TEMPAT : ...................................................
SUPERVISOR : ...................................................

CATATAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
SARAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
...............................................................................................................................................
HASIL :
...........................................

Yang Diperiksa Yang Memeriksa

45
Page

NIP./NIPTT. 19600512 199003 2 005 NIP./NIPTT. 19600512 199003

 CATATAN SUPERVISI

HARI/TANGGAL : ...................................................
TEMPAT : ...................................................
SUPERVISOR : ...................................................

CATATAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
SARAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
...............................................................................................................................................
HASIL :
...........................................

Yang Diperiksa Yang Memeriksa

46
Page

NIP./NIPTT. 19600512 199003 2 005 NIP./NIPTT. 19600512 199003

 CATATAN SUPERVISI

HARI/TANGGAL : ...................................................
TEMPAT : ...................................................
SUPERVISOR : ...................................................

CATATAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
SARAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
...............................................................................................................................................
HASIL :
...........................................

Yang Diperiksa Yang Memeriksa

47
Page

NIP./NIPTT. 19600512 199003 2 005 NIP./NIPTT. 19600512 199003

 CATATAN SUPERVISI

HARI/TANGGAL : ...................................................
TEMPAT : ...................................................
SUPERVISOR : ...................................................

CATATAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
SARAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
...............................................................................................................................................
HASIL :
...........................................

Yang Diperiksa Yang Memeriksa

48
Page

NIP./NIPTT. 19600512 199003 2 005 NIP./NIPTT. 19600512 199003

 CATATAN SUPERVISI

HARI/TANGGAL : ...................................................
TEMPAT : ...................................................
SUPERVISOR : ...................................................

CATATAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
SARAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
...............................................................................................................................................
HASIL :
...........................................

Yang Diperiksa Yang Memeriksa

49
Page

NIP./NIPTT. 19600512 199003 2 005 NIP./NIPTT. 19600512 199003

 CATATAN SUPERVISI

HARI/TANGGAL : ...................................................
TEMPAT : ...................................................
SUPERVISOR : ...................................................

CATATAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
SARAN :
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
...............................................................................................................................................
HASIL :
...........................................

Yang Diperiksa Yang Memeriksa

50
Page

NIP./NIPTT. 19600512 199003 2 005 NIP./NIPTT. 19600512 199003

Page 51