KEMENTERIAN AGAMA REPUBLIK INDONESIA

KANTOR KEMENTERIAN AGAMA KABUPATEN PROBOLINGGO

Jl. K.H. Hasan Genggang No. 235 Kab. Probolinggo, Jawa Timur
Telp. / Fax. (0335) 421232 
 
 
INSTRUMEN KINERJA KEPALA MADRASAH TAHUN 2023

1. Nama Madrasah : ........................................................................................................................................

2. Alamat Madrasah : ........................................................................................................................................
3. Nama Kepala : ........................................................................................................................................
4. NIP. : ........................................................................................................................................
7. NRG : ............................................................. NUPTK .......................................
8. Sertifikasi /Jumlah JTM : ........................................................................................................................................
9. Pendidikan : ........................................................................................................................................
10. Pengawas Pembina : ........................................................................................................................................
11. NIP. : ........................................................................................................................................
12. Hari/Tanggal Pelaksanaan : ........................................................................................................................................

Analisa
No Komponen Indikator Tidak
Ada Skor Catatan
Ada
I Dokumen Manajerial Program Kerja Kapala madrasah 4
Sertifikat PKB Kepala madrasah 4
SK Kepala RA/Madrasah 4
Struktur Organisasi dan Uraian Tugas 3
SK Tim Pengembang Madrasah 4
Evaluasi Diri RA/Madrasah ( EDRA/M ) 4
Rencana Kerja Jangka Menengah ( RKJM ) 4
Rencana Kerja Tahunan ( RKT ) 4
Rencana Kerja Anggaran (RKARA/M) 4
Laporan Keuangan (LPJ) 4
Dokumen 1 KOSP / KTSP 4
Laporan Penilaian Kinerja Guru 4
II Supervisi Program/Perencanaan Supervisi 4
Pelaksanaan Supervisi/Intrumen Supervisi 4
Laporan Supervisi/Tindak lanjut 2
III Kewirausahaan Dokumen Kemitraan / Kerjasama 4
Nilai 95
Predikat Sangat Baik
Ket : Skor menggunakan skal : 1 - 4
Probolinggo, .........................................
Pengawas/Monever, Kepala Madrasah

................................. ............................................
Nip .......................... Nip ......................................

Catatan :
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 KEMENTERIAN AGAMA REPUBLIK INDONESIA
KANTOR KEMENTERIAN AGAMA KABUPATEN PROBOLINGGO
Jl. K.H. Hasan Genggang No. 235 Kab. Probolinggo, Jawa Timur
Telp. / Fax. (0335) 421232 
 
 
INSTRUMEN KINERJAI GURU PROFESIONAL TAHUN 2023

1. Nama Madrasah : ..........................................................................................................................

2. Alamat Madrasah : ..........................................................................................................................
3. Nama Kepala : ..........................................................................................................................
4. NIP. : ..........................................................................................................................
5. Nama Guru : ..........................................................................................................................
6. NIP. : ..........................................................................................................................
7. NRG : ...................................................... NUPTK ..............................................
8. Sertifikasi /Jumlah JTM : ..........................................................................................................................
9. Pendidikan : ..........................................................................................................................
10. Pengawas Pembina : ..........................................................................................................................
11. NIP. : ..........................................................................................................................
12. Hari/Tanggal Pelaksanaan : ..........................................................................................................................

Analisa
No Komponen Indikator
Ada Tdk Ada Skor Catatan
SK Pembagian Tugas mengajar 4
Jadwal Pelajaran 4
Jumlah Jam/Minggu 4
I Dokumen Administrasi Daftar Hadir Siswa 4
Jurnal harian 4
Daftar Hadir Guru 4
Kalender Pendidikan/RPE/RHE 4
Program Tahunan 4
Program Semester 4
Dokumen KKM /KKTP 4
II Dokumen Pembelajaran
Silabus / ATP 4
RPP / Modul Ajar 3
Jurnal Mengajar 4
Program Kerja Waka/ekstra/wali
kelas/tugas tambahan lainnya
2
Buku Penilaian Sikap (KI 1 dan KI 2) 4
Buku Penilaian Pengetahuan/Formatif 4
Buku Penilaian Keterampilan/Sumatif 4
III Dokumen Penilaian Dokumen Analisis Hasil Belajar 4
Program Tindak Lanjut Analisis Belajar
(Pengayaan & Remedial)
3
Kisi-Kisi Soal/Pedoman Penskoran 4
Bank Soal 4
Nilai 100
Predikat Sangat Baik
Ket : Skor menggunakan skal : 1 - 4

Mengetahui, Probolinggo, .........................................

Pengawas/Monever, Guru Mata Pelajaran Kepala Madrasah

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