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<div align='center'><img style='max-height:100px;'

src='../images/garuda.png'><br><br>
<strong>PENILAIAN PRESTASI KERJA<br />
PEGAWAI NEGERI SIPIL</strong></div>
<br>
<div align='right'><strong>JANGKA WAKTU PENILAIAN</strong><br />
01 Januari 2021 s/d 30 Juni 2021</strong></div>
<table width='100%' border='1'>
<tr>
<td><strong>1.</strong></td>
<td colspan='5'><strong>YANG DINILAI</strong></td>
</tr>
<tr>
<td></td>
<td width='120px'>Nama</td>
<td colspan='4'> TIWUK PUJI RAHAYU, S.KM., M.Kes.</td>
</tr>
<tr>
<td></td>
<td>NIP.</td>
<td colspan='4'>19820131 200501 2 005</td>
</tr>
<tr>
<td></td>
<td>Pangkat/Gol. Ruang</td>
<td colspan='4'>Penata (III/c)</td>
</tr>
<tr>
<td></td>
<td>Jabatan</td>
<td colspan='4'>Penyuluh Kesehatan Masyarakat Ahli Muda</td>
</tr>
<tr>
<td></td>
<td>Unit Kerja</td>
<td colspan='4'>DINAS KESEHATAN - SEKRETARIS - SUB BAGIAN UMUM</td>
</tr>
<tr>
<td><strong>2.</strong></td>
<td colspan='5'><strong>PEJABAT PENILAI </strong></td>
</tr>
<tr>
<td></td>
<td>Nama</td>
<td colspan='4'>drg. RAYA MULYASARI </td>
</tr>
<tr>
<td></td>
<td>NIP.</td>
<td colspan='4'>19750427 200312 2 007</td>
</tr>
<tr>
<td></td>
<td>Pangkat/Gol. Ruang</td>
<td colspan='4'>Pembina Tingkat I (IV/b)</td>
</tr><tr>
<td></td>
<td>Jabatan</td>
<td colspan='4'>Dokter Gigi </td>
</tr><tr>
<td></td>
<td>Unit Kerja</td>
<td colspan='4'>DINAS KESEHATAN - UPT PUSKESMAS PESANTREN I</td>
</tr>

<tr>
<td><strong>3.</strong></td>
<td colspan='5'><strong>ATASAN PEJABAT PENILAI </strong></td>
</tr>
<tr>
<td></td>
<td>Nama</td>
<td colspan='4'>- DWI SUNARYATI SKM.,MM.</td>
</tr>
<tr>
<td></td>
<td>NIP.</td>
<td colspan='4'>19690301 199203 2 011</td>
</tr>
<tr>
<td></td>
<td>Pangkat/Gol. Ruang</td>
<td colspan='4'>Pembina (IV/a)</td>
</tr><tr>
<td></td>
<td>Jabatan</td>
<td colspan='4'>Kepala Bidang Pada Bidang Pelayanan Dan Sumber Daya
Kesehatan</td>
</tr><tr>
<td></td>
<td>Unit Kerja</td>
<td colspan='4'>DINAS KESEHATAN - BIDANG PELAYANAN DAN SUMBER DAYA
KESEHATAN</td>
</tr>

<tr>
<td><strong>4.</strong></td>
<td colspan='4'><strong>UNSUR YANG DINILAI</strong></td>
<td><div align='center'><strong>JUMLAH</strong></div></td>
</tr>
<tr><td></td>
<td><strong>Sasaran Kerja PNS (SKP)</strong></td><td
colspan='3'><center><strong>92 x
60%</strong></center></td><td><center><strong>55.2</strong></center></td>
</tr>
<tr>
<td></td>
<td><strong>Perilaku Kerja</strong></td>
<td>1. Orientasi Pelayanan</td>
<td><center>85</center></td>
<td><center>Baik</center></td>
<td></td>
</tr>
<tr>
<td></td>
<td></td>
<td>2. Integritas</td>
<td><center>81</center></td>
<td><center>Baik</center></td>
<td></td>
</tr>
<tr>
<td></td>
<td></td>
<td>3. Komitmen</td>
<td><center>82</center></td>
<td><center>Baik</center></td>
<td></td>
</tr>
<tr>
<td></td>
<td></td>
<td>4. Disiplin</td>
<td><center>82</center></td>
<td><center>Baik</center></td>
<td></td>
</tr>
<tr>
<td></td>
<td></td>
<td>5. Kerjasama</td>
<td><center>82</center></td>
<td><center>Baik</center></td>
<td></td>
</tr>
<tr>
<td></td>
<td></td>
<td>6. Kepemimpinan</td>
<td><center>-</center></td>
<td><center>-</center></td>
<td></td>
</tr>
<tr>
<td></td>
<td></td>
<td>7. Jumlah</td>
<td><center>412</center></td>
<td></td>
<td></td>
</tr>
<tr>
<td></td>
<td></td>
<td>8. Nilai Rata-rata</td>
<td><center>82.4</center></td>
<td><center>Baik</center></td>
<td></td>
</tr>
<tr>
<td></td>
<td></td>
<td><p><strong>9. Nilai Perilaku Kerja</strong></td>
<td colspan='2'><center><strong>82.4 x 40%</strong></center></td>
<td><center><strong>32.96 </strong></center></td>
</tr>
<tr>
<td colspan='5'><center><strong>Nilai Prestasi Kerja</strong></center></td>
<td><center><strong>88.16 <br> Baik</strong></center></td>
</tr>

</table>

<div style='page-break-before:always;'>
<table width='100%' border='1'>
<tr>
<td width='5'><strong>5.</strong></td>
<td colspan='5'><strong>KEBERATAN DARI PEGAWAI NEGERI SIPIL YANG DINILAI
(APABILA ADA)</strong>
<br>
<br>
<br>
<br>
<br>
<br>
<div align=right>Tanggal, ..................................</div>
</td>
</tr>
<tr>
<td width='5'><strong>6.</strong></td>
<td colspan='5' ><strong>TANGGAPAN PEJABAT PENILAI ATAS KEBERATAN</strong>
<br>
<br>
<br>
<br>
<br>
<br>
<div align=right>Tanggal, ..................................</div>
</td>
</tr>
<tr>
<td width='5'><strong>7.</strong></td>
<td colspan='5' ><strong>KEPUTUSAN ATASAN PEJABAT PENILAI ATAS
KEBERATAN</strong>
<br>
<br>
<br>
<br>
<br>
<br>
<div align=right>Tanggal, ..................................</div>
</td>
</tr>
<tr>
<td width='5'><strong>8.</strong></td>
<td colspan='5' ><strong>REKOMENDASI</strong> <br><br>
<br>
<br>
<br>
<br>
<br>
<br>
</td>
</tr>
<tr>
<td colspan='3'></td>
<td colspan='3' width='50%'><strong>9. DIBUAT TANGGAL, 01 Juli
2021</strong><br>
&nbsp;&nbsp;&nbsp;&nbsp;PEJABAT PENILAI
<br>
<br>
<br>
<br>
<br>
<br>
&nbsp;&nbsp;&nbsp;&nbsp;(drg. RAYA MULYASARI )
<br>&nbsp;&nbsp;&nbsp;&nbsp;NIP. 19750427 200312 2 007</td>
</tr>

<tr>
<td colspan='3'><strong>10. DITERIMA TANGGAL, 02 Juli 2021</strong><br>
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;PEGAWAI NEGERI SIPIL YANG DINILAI
<br>
<br>
<br>
<br>
<br>
<br>
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;( TIWUK PUJI RAHAYU, S.KM., M.Kes. ) <br>
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;NIP. 19820131 200501 2 005
</td>
<td colspan='3'></td>
</tr>

<tr>
<td colspan='3'</td>
<td colspan='3'><strong>11. DITERIMA TANGGAL, 05 Juli 2021</strong><br>
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;ATASAN PEJABAT YANG MENILAI
<br>
<br>
<br>
<br>
<br>
<br>
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;(- DWI SUNARYATI SKM.,MM. )
<br>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;NIP. 19690301 199203 2 011</td>
</tr>

</table>
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