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PEMERINTAH KABUPATEN BANYUWANGI

DINAS KESEHATAN
UPTD PUSKESMAS SINGOJURUH
Jl Raya Gendoh No. 91 Telp. (0333)631747 Singojuruh 68464
Email:pkmsingojuruh@yahoo.com.id

HASIL AUDIT PENGELOLA KEUANGAN


BENDAHARA PENGELUARAN

Nama Bendahara : Ahmad Kundori. S. Kep. Ns Tanggal :………………………….

DILAKSANAKAN
NO KEGIATAN
YA TIDAK

1. BKU

2. Laporan Penutupan Kas

3. Buku Bantu pengeluaran

4. Buku Kas Tunai

5. Buku Rincian Obyek belanja

HASIL AUDIT :
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Singojuruh,…………………………………..

Kepala Puskesmas Singojuruh

SUPRIYADI BINTORO, S. Kep


NIP. 19630816 198410 1 008
PEMERINTAH KABUPATEN BANYUWANGI
DINAS KESEHATAN
UPTD PUSKESMAS SINGOJURUH
Jl Raya Gendoh No. 91 Telp. (0333)631747 Singojuruh 68464
Email:pkmsingojuruh@yahoo.com.id

HASIL AUDIT PENGELOLA KEUANGAN


BENDAHARA PENERIMAAN

Nama Bendahara : Miswanto Tanggal :………………………….

DILAKSANAKAN
NO KEGIATAN
YA TIDAK

1. BKU

2. Laporan Penutupan Kas

3. Buku Bantu penerimaan

4. Register Penutupan Kas

5. LKK

HASIL AUDIT :
......................................................................................................................................................................
......................................................................................................................................................................
......................................................................................................................................................................
......................................................................................................................................................................
......................................................................................................................................................................
......................................................................................................................................................................

Singojuruh,…………………………………..

Kepala Puskesmas Singojuruh

SUPRIYADI BINTORO, S. Kep


NIP. 19630816 198410 1 008
PEMERINTAH KABUPATEN BANYUWANGI
DINAS KESEHATAN
UPTD PUSKESMAS SINGOJURUH
Jl Raya Gendoh No. 91 Telp. (0333)631747 Singojuruh 68464
Email:pkmsingojuruh@yahoo.com.id

HASIL AUDIT PENGELOLA KEUANGAN


BENDAHARA JKN

Nama Bendahara : Suhadi Tanggal :………………………….

DILAKSANAKAN
NO KEGIATAN
YA TIDAK

1. BKU

2. Laporan Realisasi atas penggunaan dana kapitasi JKN

3. Surat Pernyataan Tanggung Jawab

4. Laporan pertanggungjawaban Bendahara JKN

5. Rekap Per Kode Rekening

HASIL AUDIT :
......................................................................................................................................................................
......................................................................................................................................................................
......................................................................................................................................................................
......................................................................................................................................................................
......................................................................................................................................................................
......................................................................................................................................................................

Singojuruh,…………………………………..

Kepala Puskesmas Singojuruh

SUPRIYADI BINTORO, S. Kep


NIP. 19630816 198410 1 008

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