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BADAN PENDIDIKAN DAN PELATIHAN PERAWAT INDONESIA

DEWAN PENGURUS PUSAT


PERSATUAN PERAWAT NASIONAL INDONESIA
Alamat : Jln. Lenteng Agung Raya No. 64 RT 06 / RW 04 Jakarta Selatan
BP3I
Email : kp3i2014@gmail.com, Phone : 0852 8511 0645

FR-APL-02 ASESMEN MANDIRI

Nama Peserta : Tanggal/Waktu :

Nama Asesor : Tempat :

Pada bagian ini, anda diminta untuk menilai diri sendiri terhadap unit (unit-unit) kompetensi yang akan diujikan.

1. Pelajari seluruh standar Kriteria Unjuk Kerja (KUK), batasan variabel, panduan penilaian dan aspek kritis serta yakinkan bahwa
anda sudah benar-benar memahami seluruh isinya.
2. Laksanakan penilaian mandiri dengan mempelajari dan menilai kemampuan yang anda miliki secara obyektif terhadap seluruh
daftar pertanyaan yang ada, serta tentukan apakah sudah kompeten (K) atau belum kompeten (BK).
3. Siapkan bukti-bukti yang anda anggap relevan terhadap unit kompetensi, serta ‘matching’-kan setiap bukti yang ada terhadap
setiap elemen/KUK, konteks variable, pengetahuan dan keterampilan yang dipersyaratkan serta aspek kritis
4. Asesor dan asesi menandatangi form asesmen mandiri

Unit Kompetensi :
Nomor : ………………………………………………....

Judul : ...................................................................

Elemen Kompetensi : 1. Mengkaji kebutuhan dan kesiapan belajar

Daftar Pertanyaan Penilaian Bukti-bukti Pendukung


Komponen Asesmen Mandiri (Asesmen Mandiri/Self Assessment) BK KODE V A C S
K
Kriteria Unjuk Kerja : Indikator Unjuk Kerja

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BADAN PENDIDIKAN DAN PELATIHAN PERAWAT INDONESIA
DEWAN PENGURUS PUSAT
PERSATUAN PERAWAT NASIONAL INDONESIA
Alamat : Jln. Lenteng Agung Raya No. 64 RT 06 / RW 04 Jakarta Selatan
BP3I
Email : kp3i2014@gmail.com, Phone : 0852 8511 0645

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Elemen Kompetensi : 2. Merumuskan Tujuan & Kriteria Hasil

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BADAN PENDIDIKAN DAN PELATIHAN PERAWAT INDONESIA
DEWAN PENGURUS PUSAT
PERSATUAN PERAWAT NASIONAL INDONESIA
Alamat : Jln. Lenteng Agung Raya No. 64 RT 06 / RW 04 Jakarta Selatan
BP3I
Email : kp3i2014@gmail.com, Phone : 0852 8511 0645

Penilaian Bukti – Bukti Pendukung


Komponen Asesmen Mandiri
Daftar Pertanyaan
(Asesmen Mandiri atau Self Assessment) BK KODE V A C S
K
Kriteria Unjuk Kerja:
Indikator Unjuk Kerja

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BADAN PENDIDIKAN DAN PELATIHAN PERAWAT INDONESIA
DEWAN PENGURUS PUSAT
PERSATUAN PERAWAT NASIONAL INDONESIA
Alamat : Jln. Lenteng Agung Raya No. 64 RT 06 / RW 04 Jakarta Selatan
BP3I
Email : kp3i2014@gmail.com, Phone : 0852 8511 0645

Elemen Kompetensi : 3. Mengembangkan Rencana Strategi Pembelajaran

Penilaian Bukti-bukti Pendukung


Komponen Asesmen Mandiri
Daftar Pertanyaan
(Asesmen Mandiri/Self Assessment) BK KODE V A C S
Kriteria Unjuk Kerja: Indikator Unjuk Kerja: K

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BADAN PENDIDIKAN DAN PELATIHAN PERAWAT INDONESIA
DEWAN PENGURUS PUSAT
PERSATUAN PERAWAT NASIONAL INDONESIA
Alamat : Jln. Lenteng Agung Raya No. 64 RT 06 / RW 04 Jakarta Selatan
BP3I
Email : kp3i2014@gmail.com, Phone : 0852 8511 0645

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BADAN PENDIDIKAN DAN PELATIHAN PERAWAT INDONESIA
DEWAN PENGURUS PUSAT
PERSATUAN PERAWAT NASIONAL INDONESIA
Alamat : Jln. Lenteng Agung Raya No. 64 RT 06 / RW 04 Jakarta Selatan
BP3I
Email : kp3i2014@gmail.com, Phone : 0852 8511 0645

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Elemen Kompetensi : 4. Mendokumentasikan Rencana Pembelajaran Ke Dalam Format Yang Ada

Penilaian Bukti-bukti Pendukung


KOMPONEN ASESMEN MANDIRI
Daftar Pertanyaan
(Asesmen Mandiri/Self Assessment) KOD
K BK V A C S
Kriteria Unjuk Indikator Unjuk Kerja: E
Kerja:
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BADAN PENDIDIKAN DAN PELATIHAN PERAWAT INDONESIA
DEWAN PENGURUS PUSAT
PERSATUAN PERAWAT NASIONAL INDONESIA
Alamat : Jln. Lenteng Agung Raya No. 64 RT 06 / RW 04 Jakarta Selatan
BP3I
Email : kp3i2014@gmail.com, Phone : 0852 8511 0645

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Rekomendasi Asesor : Peserta :

Nama

Tanda tangan/

Tanggal

Catatan : Asesor :

Nama

No. Reg.

Tanda tangan/

Tanggal

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