KEMENTERIAN AGAMA REPUBLIK INDONESIA

DIREKTORAT JENDERAL PENDIDIKAN ISLAM

Jalan Lapangan Banteng Barat No 3-4 Jakarta Pusat
Telepon (021) 3851220 Fax (021) 2316261

INSTRUMEN
PENDAMPINGAN PENGELOLAAN BMN PADA SATKER PENDIDIKAN ISLAM
TAHUN ANGGARAN 2022
Provinsi : ....................................................................................................................................

Kabupaten/Kota : ....................................................................................................................................

Nama Satker : ....................................................................................................................................

Alamat : ....................................................................................................................................

Telepon/Phone Office : ........................................... e-mail : ...............................................................

A. PERSONIL PENGELOLA PROGRAM PENDIDIKAN ISLAM

Jabatan Nama/NIP No. HP e-mail

Kuasa Pengguna Anggaran/

Barang
NIP.
Kepala Biro PK
(PTKIN)
NIP.
Koordinator
(terkait pengelolaan BMN)
NIP.
Subkoordinator
(terkait pengelolaan BMN)
NIP.

Kepala Bagian Tata Usaha

NIP.

Bendahara Pengeluaran
NIP.
1. 1. 1.
NIP.
Operator/Pengelola BMN
2. 2. 2.
NIP.
B. EVALUASI PENGELOLAAN DAN PENATAUSAHAAN BARANG MILIK NEGARA (BMN)
TAHUN 2022

1. Apakah tanah yang dimiliki/digunakan Satker Saudara sudah bersertifikat?

Luas Rincian Permasalahan
No Tanah No Sertifikat
(m2)
1. 1.
Tanah bersertifikat Pemerintah
1 Republik Indonesia 2. 2.
Cq. Kementerian Agama RI 3. 3.
1. 1.

2 Tanah bersertifikat wakaf 2. 2.

3. 3.
1. 1.

3 Tanah bersertifikat lain 2. 2.

3. 3.
1. 1.

4 Tanah blm bersertifikat 2. 2.

3. 3.

2. Apakah Satker Saudara memiliki BMN yang bersengketa?

Pihak Tahun Upaya Penyelesaian yg
No Jenis BMN Rincian Permasalahan Sudah dilakukan
Bersengketa Sengketa

3. Apakah Satker Saudara memiliki BMN yang dimanfaatkan oleh pihak lain?
Jangka Waktu
No Jenis BMN Bentuk Pemanfaatan Pihak Yg Memanfaatkan Pemanfaatan

3
4. Apakah Satker Saudara memiliki Konstruksi Dalam Pengerjaan (KDP)?
Status KDP Pengerjaan Sumber
No Kondisi KDP Peruntukan KDP Tindak lanjut KDP
(mangkrak/berlanjut) (%) pendanaan

5. Bagaima kondisi gudang penyimpanan BMN di Satker Saudara?

Kondisi
Luas
No Uraian Kurang Tidak Ket
(M2) Baik
Baik Baik
1 Luas Gudang

2 Kondisi Bangunan Gudang

3 Kebersihan Gudang

4 Kerapihan Penataan Barang di Gudang

5 Keamanan Gudang

6 Pencahayaan Gudang
➢ Jika belum memiliki gudang penyimpanan BMN, apa kendalanya?
........................................................................................................................................................................
........................................................................................................................................................................
........................................................................................................................................................................

6. Apakah seluruh BMN di Satker Saudara telah ditetapkan Status Penggunaannya (PSP)?
...............................................................................................................................................
➢ Jika belum di-PSP-kan apa kendalanya?
.........................................................................................................................................
.........................................................................................................................................
.........................................................................................................................................

7. Apakah Satker Saudara memiliki BMN dalam kondisi rusak berat yang belum diusulkan
penghapusannya?
...............................................................................................................................................
➢ Jika ada apa kendalanya?
.........................................................................................................................................
.........................................................................................................................................
.........................................................................................................................................
8. Apakah BMN berupa Laptop, Note Book dan kendaraan yang ada di Satker Saudara telah
dibuatkan SIP (Surat Ijin Pemakaian)?
...............................................................................................................................................
➢ Jika belum dibuatkan SIP, apa kendalanya?
.........................................................................................................................................
.........................................................................................................................................
.........................................................................................................................................

9. Apakah Satker Saudara sudah memiliki petugas penyimpan dokumen BMN?

...............................................................................................................................................
➢ Jika sudah, apakah sudah ditetapkan dalam Surat Keputusan?
.........................................................................................................................................
.........................................................................................................................................
.........................................................................................................................................

10. Apakah Satker Saudara memiliki tempat penyimpanan khusus dokumen kepemilikan BMN?
...............................................................................................................................................
➢ Jika belum apa kendalanya?
.........................................................................................................................................
.........................................................................................................................................
.........................................................................................................................................

11. Peraturan Pemerintah Nomor 27 Tahun 2014 tentang Pengelolaan BMN/BMD, menyebutkan
bahwa “Pengguna Barang melakukan Inventarisasi BMN/BMD paling sedikit 1 (satu) kali
dalam 5 (lima) tahun”.
Apakah Satker Saudara sudah melakukan Inventarisasi BMN?
...............................................................................................................................................
➢ Jika sudah, apakah sudah disusun laporan hasil inventarisasinya?
.........................................................................................................................................
.........................................................................................................................................
.........................................................................................................................................

12. Dalam rangka pengamanan BMN dan mempermudah pengawasan BMN, apakah seluruh
barang inventaris (BMN) sudah diberikan label/barcode?
...............................................................................................................................................
➢ Jika belum apa kendalanya?
.........................................................................................................................................
.........................................................................................................................................
.........................................................................................................................................

13. Dalam rangka pengamanan BMN berupa Tanah dan Bangunan, apakah seluruh Tanah dan
Bangunan di Satker Saudara sudah diberikan Pagar/Patok/Papan Nama?
...............................................................................................................................................
➢ Jika belum apa kendalanya?
...............................................................................................................................................
...............................................................................................................................................
...............................................................................................................................................
14. Apakah Satker Saudara sudah membuat Daftar Barang Ruangan (DBR)/ Daftar Inventaris
Ruangan (DIR) untuk masing-masing ruangan?
...............................................................................................................................................
➢ Apakah DBR/DIR tersebut sudah sesuai dengan ruangan yang ada?
.........................................................................................................................................
.........................................................................................................................................
.........................................................................................................................................

15. Dalam pengelolaan barang persediaan, apakah setiap barang persediaan yang masuk dan
keluar sudah dilakukan pencatatan dan dibuatkan Bon Barang Keluar atau BAST?
...............................................................................................................................................
➢ Jika belum apa kendalanya?
.........................................................................................................................................
.........................................................................................................................................
.........................................................................................................................................

16. Apakah Satker Saudara melakukan stock opname terhadap barang-barang persedian secara
periodik?
...............................................................................................................................................
➢ Jika iya, dalam periode berapa lama?
.........................................................................................................................................
.........................................................................................................................................
.........................................................................................................................................

17. Apakah satker saudara telah memilliki tempat penyimpanan untuk barang persediaan (ATK)?
...............................................................................................................................................
➢ Jika ada apa jenis tempat penyimpanannya?
.........................................................................................................................................
.........................................................................................................................................
.........................................................................................................................................

18. Secara keseluruhan, apakah kendala yang Saudara alami dalam pengelolaan BMN?
.............................................................................................................................................
.............................................................................................................................................
.............................................................................................................................................
.............................................................................................................................................
.............................................................................................................................................
C. SARAN UNTUK MENINGKATKAN PENGELOLAAN BMN
Saran Saudara guna meningkatkan peran serta dalam pengelolaan BMN yang lebih baik lagi?

Satker/lingkungan Saudara :
.............................................................................................................................................
.............................................................................................................................................
.............................................................................................................................................

Wilayah :
.............................................................................................................................................
.............................................................................................................................................
.............................................................................................................................................

Pusat :
.............................................................................................................................................
.............................................................................................................................................
.............................................................................................................................................

…………………, ……………………… 2022

Petugas Monev
Kepala Satker

___________________________ ___________________________
NIP. NIP.

No Data Yang dilampirkan Checklist

1 Fotocopy Sertifikat Tanah

2 Fotocopy Surat Ijin Pemakaian (S.I.P)

3 Fotocopy SK Petugas Penyimpan BMN

4 Fotocopy SK Penetapan Sewa BMN (Jika ada)

5 Fotocopy Laporan Inventarisasi BMN (Jika ada)

6 Fotocopy BON/BAST barangper sediaan (Sampel)

7 Neraca Simak BMN terakhir

8 Dokumentasi