Catatan :
……………………………………………………………………………………..
……………………………………………………………………………………..
……………………………………………………………………………………..
……………………………………………………………………………………..
A. Identitas Guru
Nama : ............................................
NIP : ................................................................
Pangkat/jabatan : ................................................................
Mata Pelajaran : ................................................................
B. Jadwal Supervisi
Hari / tanggal : ................................................................
Waktu : ................................................................
Kelas : ................................................................
D. Nilai Akhir :
E. Ketercapaian :
A = 91% -100: Sangat Baik
B = 81% - 90% : Baik
C = 71% - 80% : Cukup Kriteria =
D = ≤70% : Kurang
........................................ ........................................
NIP. NIP.
Mengetahui
Kepala Sekolah