INSTRUMEN MONITORING / VERIFIKASI

PELAKSANAAN TUGAS KEPALA SEKOLAH

I. IDENTITAS SEKOLAH
1. Nama Sekolah : ......................................................................................
2. Nomor Statistik Sekolah : ......................................................................................
3. Alamat Sekolah : ......................................................................................
4. Tahun Pelajaran : ......................................................................................
5. Jumlah Kelas/Rombel : ......................................................................................
6. Jumlah Siswa
- Kelas 1 :.... Siswa.......... rombel
- Kelas II :.... Siswa.......... rombel
- Kelas III :.... Siswa.......... rombel
- Kelas IV :.... Siswa.......... rombel
- Kelas V :.... Siswa.......... rombel
- Kelas VI :.... Siswa ......... rombel

7. Jumlah Tenaga Kependidikan

- Guru PNS :.... orang
- T. Adm :.... orang
- Laboran :.... orang
- Pustakawan :.... orang
- GTT :.... orang
- TTT :.... orang

II.IDENTITAS KEPALA SEKOLAH

1. Nama : ..................................................................................
2. NIP/Karpeg : .................................................................................
3. Tempat, tanggal lahir : ..................................................................................
4. Pangkat/Golongan ruang : ..................................................................................
5. Jabatan Guru : ..................................................................................
6. Bertugas di sekolah ini TMT :
Nomor SK : .............................................................
Tanggal SK: ............................................................
7. Tugas sebelumnya : ..................................................................................
8. Alamat Rumah : ..................................................................................

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III. MANAGEMEN KEPEGAWAIAN
1. Struktur Organisasi
..............................................................................................................................
2. Perincian Tugas Kepala Sekolah
..............................................................................................................................
3. Pembagian Tugas dalam Kegiatan PBM
..............................................................................................................................
4. Bukti Fisik pelaksanaan kegiatan guru dalam PBM
..............................................................................................................................
5. Kegiatan Guru dalam kegiatan ekstra kurikuler
..............................................................................................................................
6. Visi, Misi dan Strategi
..............................................................................................................................
7. Bukti fisik supervise kelas
..............................................................................................................................

IV. PERANGKAT TATA USAHA KEPEGAWAIAN

1. Buku Induk PNS
..............................................................................................................................
2. Bukti Cuti PNS
..............................................................................................................................
3. Buku Catatan Tugas Belajar / Penataran / Latihan
..............................................................................................................................
4. Daftar Hadir PNS
..............................................................................................................................
5. Buku Izin meninggalkan Kantor
..............................................................................................................................

V. TATA NASKAH KEPEGAWAIAN

1. Kartu Induk Pegawai
..............................................................................................................................
2. Daftar Riwayat Hidup
..............................................................................................................................
3. Daftar Penilain Pelaksanaan Pekerjaan (DP3)
..............................................................................................................................
4. Laporan Bulan
..............................................................................................................................
5. Formasi Pegawai
..............................................................................................................................
6. Daftar Urut Kepangkatan
..............................................................................................................................

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VI. MANAGEMEN PROGRAM PENGAJARAN
1. Jadwal Pelajaran di Sekolah Dasar
.........................................................................................................................
2. Daftar Pembagian tugas mengajar bagi guru
.........................................................................................................................
3. Daftar pemeriksaan persiapan mengajar
.........................................................................................................................
4. Daftar penyelesaian kasus di sekolah
.........................................................................................................................
5. Daftar hasil evaluasi belajar tahap akhir
.........................................................................................................................
6. Rekapitulasi kenaikan kelas/kelulusan
.........................................................................................................................
7. Daftar penyerahan STTB
.........................................................................................................................
8. Rekapitulasi pelaksanaan supervise kelas
.........................................................................................................................
9. Hubungan kemasyarakatan
.........................................................................................................................
10. Laporan hasil belajar SD
.........................................................................................................................

VII. MANAGEMEN SARANA DAN PRASARANA

1. Buku pemeriksaan barang
.........................................................................................................................
2. Kartu inventaris gedung
.........................................................................................................................
3. Kartu Inventaris ruangan
.........................................................................................................................
4. Kartu Inventaris lahan tanah
.........................................................................................................................
5. Kartu inventaris kendaraan
.........................................................................................................................
6. Kartu inventaris barang lainnya
.........................................................................................................................
7. Daftar usul pengadaan barang
...................................................................................................

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VIII. MANAGEMEN KESISWAAN
1. Penerimaan siswa baru
...............................................................................................................................
2. Penyusunan data pribadi siswa
...............................................................................................................................
3. Keadaan siswa awal tahun
...............................................................................................................................
4. Kehadiran siswa
...............................................................................................................................
5. Mutasi siswa
...............................................................................................................................
6. Pelaksanaan evaluasi UN dan Ujian Sekolah
...............................................................................................................................
7. Buku Induk
...............................................................................................................................
8. Buku kenaikan kelas
...............................................................................................................................

IX. MANAGEMEN KEUANGAN

1. RKAS
...............................................................................................................................
2. Buku kas pembantu
...............................................................................................................................
3. Buku kas umum
...............................................................................................................................
4. Buku Bank
...............................................................................................................................
5. Buku rekening
...............................................................................................................................
6. Buku Pajak
...............................................................................................................................

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 BERITA ACARA PEMERIKSAAN KAS

Pada hari in.....................tanggal..................................................Bulan...........................tahun dua ribu

........................................yang bertanda tangan di bawah ini:
1. Nama : .................................................................
NIP : .................................................................
Jabatan : ................................................................
2. Nama : ................................................................
NIP : ................................................................
Jabatan : ................................................................

telah mengadakan Pemeriksaan Kas yang dipegang oleh :

Nama : .....................................................
NIP : .....................................................
Jabatan : .....................................................

Yang telah diberi tugas oleh atasan langsungnya untuk pengurusan uang

Berdasarkan hasil Pemeriksaan Kas serta bukti-bukti yang berada dalam pengurusan itu, kami
menemui kenyataan sebagai berikut:
a. Uang kertas dan uang logam Rp ..............................................
b. Saldo Bank Rp ..............................................
c. Surat/barang berharga yang dijanjikan Rp ..............................................
Jumlah Rp ..............................................
Saldo Kas menurut BKU, Register dll Perbedaan Rp ..............................................
Positif/Negatif Rp ..............................................

Mengetahui
Kepala SDN ............................... Bendahara Petugas Verifikasi:

1. ..................... ............. ( )

............................. .....................................
NIP NIP

2. ...................................( )

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 REGISTER PENUTUPAN KAS

Tanggal Penutupan Kas : ........................................................................

Nama Penutup Kas : ........................................................................
Tanggal Penutupan Kas bulan lalu : ........................................................................

Jumlah total penerimaan (Debet) sejak Jumlah total : Rp .........................................

pengeluaran (Kredit) sejak : Rp .........................................
Saldo Buku pada tanggal Saldo Kas Opname : Rp .........................................
tanggal ........................................................

terdiri dari
1. Uang kertas
a. Rp 100.000,oo ......... lembar = Rp. .......................................
b. Rp 50.000,oo ......... lembar = Rp. .......................................
c. Rp 20.000,00 ......... lembar = Rp. .......................................
d. Rp 10.000,oo ......... lembar = Rp. .......................................
f. Rp 5.000,oo ......... lembar = Rp. .......................................
g. Rp 1.000,oo ......... lembar = Rp. .......................................

2. Uang logam

a. Rp 1.000,oo ......... keping = Rp. .......................................

b. Rp 500,oo ......... keping = Rp. .......................................
c. Rp 100,00 ......... keping = Rp. .......................................
d. Rp 50,oo ......... keping = Rp. .......................................

3. Kertas berharga dan bagian kas yang diijinkan

SPMU/Wesel, Cek, Materai dll sebesar : = Rp...........................
Total uang(1+2+3) = Rp...........................
Selisih Perbedaan positif/negative = Rp...........................

Penjelasan perbedaan : Perbedaan ada pada saldo buku bank

Mengetahui
Bendahara, Petugas Verifikasi
Kepala Sekolah

1.........................................
NIP
.......................................... .......................................... 2..........................................
. . .
NIP NIP NIP

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X. KESIMPULAN

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

XI. SARAN

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

XII. TANGGAPAN

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

Tanggal,........................................

Mengetahui:
Kepala...................................... Petugas Verifikasi:

1. ..............................................( )
NIP

................................................. 2 ...............................................( )
NIP NIP