TELAAHAN STAF
Kepada : ........................................
Dari : ........................................
Tanggal : .......................................
Nomor : ........................................
Lampiran : ........................................
Hal : ........................................
I. Pokok : .....................................................................................................
Persoalan .....................................................................................................
................................................
II. Pra Anggapan : .....................................................................................................
.....................................................................................................
.....................................................................................................
III. Fakta-fakta : .....................................................................................................
yang
.....................................................................................................
mempengaruh
i .....................................................................................................
......................
.....................................................................................................
: .....................................................................................................
IV. Analisis/
.....................................................................................................
Analisa
...........................................................................
.....................................................................................................
: ...................................................
V. Kesimpulan
.....................................................................................................
: ...........................................
VI. Saran
tandatangan
XXXXXX
Pangkat......
NIP. ..........................