BERITA ACARA

MUSYAWARAH PENGGALIAN GAGASAN

DUSUN GURAH I DESA GURAH KECAMATAN GURAH
KABUPATEN KEDIRI

Pada hari ini Senin tanggal Tiga bulan Februari tahun Dua Ribu Dua Puluh,
bertempat di Balai Desa Gurah yang dihadiri oleh beberapa unsur, sebagaimana daftar hadir
terlampir dalam rangka melaksanakan musyawarah Dusun I guna penyusunan RPJMDesa.

Musyawarah Dusun dimaksud untuk menggali gagasan usulan kegiatan dalam rangka
penjaringan masalah, penyebab masalah dan potensi sebagai dasar penyusunan RPJM Desa
dengan menggunakan tiga alat kajian meliputi Sketsa Desa, Kalender Musim dan Diagram
Kelembagaan.

Materi atau Topik

1. Pembahasan Review RPJM Desa tahun Sebelumnya.

2. Menggali usulan – usulan terbaru dari Dusun Gurah I, sesuai kenyataan dan kondisi
yang ada.

Setelah diadakan pembahasan melalui musyawarah mufakat maka dihasilkan beberapa

kesepakatan hal-hal sebagai berikut:
1. Usulan rencana kegiatan pembangunan Desa dan daftar gagasan dusun / kelompok sebagaimana
terlampir
2. Daftar masalah, penyebab masalah dan potensi di wilayah Dusun sebagaimana format
terlampir

Demikian Berita Acara ini dibuat dengan sebenar-benarnya, untuk dapat digunakan
sebagaimanamestinya.

Mengetahui, Desa Gurah tanggal 3 Februari 2020

Kepala Desa Gurah Ketua Tim Penyusun RPJM Desa

H. S U Y O N O H. ALI ERFAN, SH

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 NOTULEN (DIISI PROSES MUSYAWARAH)
MUSYAWARAH ...............................
HARI/TANGGAL :...................................

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...............................,................................. 2020.
Notulen

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 LAMPIRAN BERITA ACARA
HASIL KEPUTUSAN MUSYAWARAH ...............................

JIKA ADA

1....................................................................................................
2....................................................................................................
3...................................................................................................

Mengetahui, Desa ....................... tanggal ......................

Kepala Desa ......................... Ketua Tim Penyusun

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

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 DAFTAR HADIR PESERTA MUSYAWARAH
PENGGALIAN GAGASAN
MEMBAHAS PENYUSUNAN RPJMDESA
Dusun :.........................................
Desa :..........................................
Hari / Tanggal : ........................................
NO. NAMA L/P UNSUR ALAMAT RT/RW TANDA TANGAN

Mengetahui, Desa ....................... tanggal ......................

Kepala Desa ......................... Ketua Tim Penyusunan RJPMDesa

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

4
 DAFTAR GAGASAN DUSUN / KELOMPOK

Dusun : Gurah I
Desa : Gurah
Kecamatan : Gurah
Kabupaten : Kediri

Penerima Manfaat
Gagasan Kegiatan Prakiraan
No Lokasi Kegiatan Satuan
Volume
LK PR A-RTM

Tutup Gorong -
1 JL. PGA RT 001 RW 001 2x1 meter
Gorong
189 254 38

2 Paving Plesterisasi JL. PGA RT 001 RW 001 100 x 3 meter

189 254 38
Perbaikan Jalan Depan Yolanda RT 001 RW
3 1 kgt
Depan Yolanda 001
189 254 38

4 Pengecatan RT 001 RW 001 1 kgt

189 254 38

5 Penghijauan / Pot RT 001 RW 001 50 unit

189 254 38
Pavingisasi Gang Bu
6 RT 001 RW 001 50 x 3 meter
Endik
189 254 38
Tutup Gorong -
7 Depan Masjid RT 001 RW 001 3x1 meter
Gorong
189 254 38
Pengadaan Tiang
8 RT 001 RW 001 70 unit
Umbul - umbul
189 254 38

9 Pavingisasi Jl. Veteran VI RT 002 RW 001 100 x 3 meter

29 36 15
Jalan Masjid Nurul Ula Jl.
10 Poskamling 1 unit
Veteran VI RT 002 RW 001
29 36 15

11 Tempat Sampah RT 002 RW 001 50 unit

29 36 15

12 Saluran Air / Got I Jl. Veteran II RT 004 RW 001 200 x 3 meter

29 43 21
Jl. Karang Taruna dan Jl.
13 Saluran Air / Got II 200 x 3 meter
Veteran III RT 004 RW 001
29 43 21
Perbaikan Atap /
14 Jl. Veteran II RT 004 RW 001 1 kgt
Seng Kereta Jenazah
29 43 21
Jl. Veteran III RT 004 RW
15 Pavingisasi 200 x 3 meter
001
29 43 21

16 Pos Kamling Jl. Veteran II RT 004 RW 001 1 unit

29 43 21

17 Tiang Bendera RT 004 RW 001 70 unit

29 43 21

18 Tiang Lampu Jalan RT 004 RW 001 14 unit

29 43 21

19 Tempat Sampah RT 004 RW 001 50 unit

29 43 21

20 Umbul - umbul RT 004 RW 001 70 unit

29 43 21
Hotmik Mulai Dari
21 Gedung Bioskop RT 005 RW 001 500 x 3 meter 34 57 43
Sampai Masjid Al -

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 Istiqomah

Pembuatan
22 Poskamling Yang RT 005 RW 001 1 unit 34 57 43
Bisa Dipindah
Pengerukan Aliran
23 RT 005 RW 001 1 kgt 34 57 43
Sungai
Pendataan Kembali
24 Warga Yang Berhak RT 005 RW 001 1 kgt 34 57 43
Menerima Bantuan
Bantuan Tiang
25 RT 005 RW 001 70 unit 34 57 43
Bendera

26 Umbul - umbul RT 005 RW 001 70 unit 34 57 43

27 Tempat Sampah RT 005 RW 001 50 unit 34 57 43

Alat Komunikasi /
28 RT 005 RW 001 5 unit 34 57 43
HT

Audio Untuk
29 RT 005 RW 001 4 unit 34 57 43
Kegiatan Warga

30 Drainase RT 001 RW 002 100 x 1 meter

93 116 33
Perbaikan WC Jl. Karang Taruna RT 001 RW
31 1 unit
Umum 002
93 116 33

32 Tiang Bendera RT 001 RW 002 70 unit

93 116 33
Perbaikan Pos
33 RT 001 RW 002 1 unit
Kamling
93 116 33
Gapuro Depan Timur Pasar Gurah RT 002
34 3x3 meter
Masjid Ke Timur RW 002
178 182 36
Drainase Masjid Ke Jl. Karang Taruna I RT 002
35 150 x 1 meter
Timur RW 002
178 182 36
Pavingisasi Gang Jl. Karang Taruna I RT 002
36 150 x 3 meter
Gudang Gunawan RW 002
178 182 36
Lampu Penerangan
Jl. Karang Taruna I RT 002
37 Jalan Depan Masjid 17 unit
RW 002
Ke Timur 178 182 36

38 Umbul - umbul RT 003 RW 002 70 unit

95 104 57

39 Tiang Bendera RT 003 RW 002 70 unit

95 104 57

40 Bambu RT 003 RW 002 70 unit

95 104 57

41 Bendera RT 003 RW 002 70 unit

95 104 57

42 Umpak Bendera RT 003 RW 002 70 unit

95 104 57
Umpak Umbul -
43 RT 003 RW 002 70 unit
umbul
95 104 57

44 Taman I RT 003 RW 002 6x7 meter

95 104 57

45 Taman II RT 003 RW 002 6x7 meter

95 104 57

46 Lampu Hias RT 003 RW 002 50 unit

95 104 57

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 Pavingisasi Barat
47 RT 003 RW 002 100 x 1,5 meter
Pasar
95 104 57
Got Depan Rumah
48 RT 003 RW 002 100 x 1 meter
Warga Barat Pasar
95 104 57
Gapuro Masuk Barat
49 RT 003 RW 002 1,5 x 3 meter
Pasar
95 104 57

50 Poskamling RT 003 RW 002 1 unit

95 104 57

51 Resapan Air Hujan RT 004 RW 002 50 x 2 meter 70 44 34

52 Pot Bunga RT 004 RW 002 50 unit 70 44 34

53 Perbaikan RT 004 RW 002 70 44 34

Mengetahui, Desa Gurah tanggal 3 Februari 2020

Kepala Desa Gurah Ketua Tim Penyusun RPJM Desa

H. S U Y O N O H. ALI ERFAN, SH

Keterangan :
A-RTM : Anggota Rumah Tangga Miskin

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 DAFTAR GAGASAN DUSUN / KELOMPOK

Dusun : ...................................
Desa : ...................................
Kecamatan : ...................................
Kabupaten : Kediri

A. BIDANG PEMBANGUNAN DESA

Penerima Manfaat
No. Laki-
Gagasan Kegiatan Lokasi Kegiatan Vol. Satuan Perempuan A-RTM
laki
1 2 3 4 5 6 7 8

1 Pemeliharaan jalan
2 Rehabilitasi gedung posyandu
3

Mengetahui, Desa ....................... tanggal ......................

Kepala Desa ......................... Ketua Tim Penyusun RPJM Desa

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

Keterangan :
A-RTM : Anggota Rumah Tangga Miskin

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 DAFTAR GAGASAN DUSUN / KELOMPOK

Dusun : ...................................
Desa : ...................................
Kecamatan : ...................................
Kabupaten : Kediri

B. BIDANG PEMBINAAN DESA

Penerima Manfaat
No. Laki-
Gagasan Kegiatan Lokasi Kegiatan Vol. Satuan Perempuan A-RTM
laki
1 2 3 4 5 6 7 8

1 Pembinaan PKK
2 Pembinaan Siskampling
3

Mengetahui, Desa ....................... tanggal ......................

Kepala Desa ......................... Ketua Tim Penyusun RPJM Desa

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

Keterangan :
A-RTM : Anggota Rumah Tangga Miskin

9
 DAFTAR GAGASAN DUSUN / KELOMPOK

Dusun : ...................................
Desa : ...................................
Kecamatan : ...................................
Kabupaten : Kediri

C. BIDANG PEMBERDAYAAN MASYARAKAT DESA

Penerima Manfaat
No. Laki-
Gagasan Kegiatan Lokasi Kegiatan Vol. Satuan Perempuan A-RTM
laki
1 2 3 4 5 6 7 8

1 Pelatihan tata boga

2 Pelatihan KPM
3

Mengetahui, Desa ....................... tanggal ......................

Kepala Desa ......................... Ketua Tim Penyusun RPJM Desa

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

Keterangan :
A-RTM : Anggota Rumah Tangga Miskin

10
 DAFTAR GAGASAN DUSUN / KELOMPOK

Dusun : ...................................
Desa : ...................................
Kecamatan : ...................................
Kabupaten : Kediri

D. BIDANG PENANGGULANGAN BENCANA, KEADAAN DARURAT DAN KEADAAN MENDESAK DESA

Penerima Manfaat
No. Laki-
Gagasan Kegiatan Lokasi Kegiatan Vol. Satuan Perempuan A-RTM
laki
1 2 3 4 5 6 7 8

1 Pelatihan kebencanaan
2 Pelatihan tanggap darurat
3

Mengetahui, Desa ....................... tanggal ......................

Kepala Desa ......................... Ketua Tim Penyusun RPJM Desa

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

Keterangan :
A-RTM : Anggota Rumah Tangga Miskin

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