PEMERINTAH KOTA PEKANBARU

DINAS KESEHATAN
Jalan Melur No. 103 Telepon (0761) 23213

Nomor :
Lembar ke :

SURAT PERINTAH PERJALANAN DINAS

(SPPD)

1. Pejabat yang memberi Perintah : Plt. KEPALA DINAS KESEHATAN KOTA PEKANBARU

2. Nama/NIP Pegawai yang diperintah

: Betrina, SST / 196705271990032005
mengadakan Perjalanan Dinas
3. a. Jabatan : Pranata Laboratorium Kesehatan Muda

b. Pangkat/Golongan : Pembina / IV a

4. Perjalanan Dinas yang diperintahkan : Dari : PUSKESMAS SAIL

5. Transportasi yang digunakan : Darat

6. Perjalanan Dinas yang direncanakan : Tanggal / Tempat :

1. 29 Oktober 2018 /
2. 31 Oktober 2018 / SLB

7. Maksud mengadakan Perjalanan : Kegiatan Imunisasi MR

8. Perhitungan Biaya Perjalanan : Atas beban : DANA BOK DAK NON FISIK TA 2018
Kode Rekening :1.01.02.1.01.02.01.16.09.5.2.2.31.01

9. Keterangan :

Pekanbaru, 2018
Plt. Kepala Dinas,

dr. Zaini Rizaldy S.

NIP 197208102002121005
KETERANGAN

I. DARI PEJABAT YANG MEMBERI PERINTAH :

Tempat Berangkat Kembali
Kedudukan
Pegawai yang
Tanggal Tanda tangan Tanggal Tanda tangan
diberi Perintah

PUSKESMAS SAIL 29,31/ 29,31/

10/2018 10/2018

dr. Zaini Rizaldy S. dr. Zaini Rizaldy S.

NIP 197208102002121005 NIP 197208102002121005

II. DARI PEJABAT DI DAERAH PENUGASAN YANG DIKUNJUNGI :

Tempat Kedudukan Berangkat Kembali
Pegawai yang diberi
Perintah Tanggal Tanda tangan Tanggal Tanda tangan

TK 29/10/2018 29/10/2018

SLB 31/10/2018 31/10/2018

Plt. Kepala Dinas,

dr. Zaini Rizaldy S.

Pembina
NIP 197208102002121005
 LAPORAN PERJALANAN DINAS

KEPADA YTH : Plt. Kepala Dinas Kesehatan

DARI : Betrina, SST

TANGGAL : 29 Oktober 2018

PERIHAL : Kegiatan Imunisasi MR

I. DASAR
a. SPT NO :.................................................................
b. DPA NO : 1.02.1.02.01.16.09

II. WAKTU DAN TEMPAT

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III. HASIL PELAKSANAAN KEGIATAN

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Demikian Laporan ini disampaikan kepada Bapak untuk dapat menjadi Periksa.

Pekanbaru, 2018
Yang Melapor,

............................................
 LAPORAN PERJALANAN DINAS

KEPADA YTH : Plt. Kepala Dinas Kesehatan

DARI : Betrina, SST

TANGGAL : 31 Oktober 2018

PERIHAL : Kegiatan Imunisasi MR

I. DASAR
a. SPT NO :.................................................................
b. DPA NO : 1.02.1.02.01.16.09

II. WAKTU DAN TEMPAT

............................................................................................................................. ...........................
...................................................................................................................................................

III. HASIL PELAKSANAAN KEGIATAN

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............................................................................................................................. ...................
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............................................................................................................................. ...................
..........................................................................................................................................
............................................................................................................................. ...................
..........................................................................................................................................

Demikian Laporan ini disampaikan kepada Bapak untuk dapat menjadi Periksa.

Pekanbaru, 2018
Yang Melapor,

............................................