LAPORAN HASIL PENGAWASAN PEMILU

Nomor: ..../LHP/PM.01/MANDIRAJA/............................................/02/2024

I. Data Pengawas:
1. Tahapan yang diawasi : Persiapan Pemungutan Suara dan Penghitungan
Suara Pemilu 2024
2. Nama Pelaksana Tugas : Naufal Fazal Muttaqin
Pengawasan
3. Jabatan : Pengawas TPS 07
Desa Mandiraja Wetan
Kecamatan Mandiraja
Kabupaten Banjarnegara
Provinsi Jawa Tengah
4. Nomor Surat Perintah : 051/PM.00/JT-01.08/02/2024
Tugas
5. Alamat : Jl. Pemuda No. 05 Mandiraja

II. Kegiatan Pengawasan

1 Kegiatan
.
a. Bentuk : Pengawasan Langsung
b. Tujuan : Memastikan proses persiapan pemungutan di
Tingkat TPS sesuai dengan peraturan perundang-
undangan.
c. Sasaran : Petugas Kelompok Penyelenggara Pemungutan Suara
(KPPS)
d. Waktu dan Tempat : Hari : Rabu
Tanggal : 14 Februari 2024
Jam : 07.00 WIB
Tempat : TPS 07 (SDN 2 Mandiraja Wetan)

III. Uraian Singkat Hasil Pengawasan

1. Pengawasan persiapan pemungutan suara pada TPS 07 Desa Mandiraja
Wetan Kecamatan Mandiraja Kabupaten Banjarnegara yang berlokasi di SDN
2 Mandiraja Wetan pada pukul 07.00 WIB
2. Bahwa KPPS dalam persiapan pemungutan suara telah mengumumkan dan
menempelkan Salinan DPT, DPTb, daftar Pasangan Calon, dan DCT anggota
DPR, DCT anggota DPD, DCT anggota DPRD Provinsi, dan DCT anggota DPRD
Kabupaten/Kota di TPS dan telah/belum* menyerahkan salinan DPT dan
DPTb kepada saksi yang hadir dan pengawas TPS;
 3. Bahwa Ketua KPPS menyiapkan TPS dengan ukuran Panjang 14 meter dan
lebar 12 meter dengan mempertimbangkan kemudahan pemilih dalam
memberikan suara serta memperhatikan alur pemberian suara oleh pemilih;
4. Bahwa Ketua KPPS memastikan TPS pada hari Rabu 14 Februari 2024 telah
siap;
5. Bahwa PPS memberikan kepada KPPS perlengkapan pemungutan suara,
dukungan perlengkapan lainnya, dan perlengkapan pemungutan suara
lainnya pada hari Selasa, 13 Februari 2024 Selasa, 13 Februari 2024 (satu
hari sebelum hari dan tanggal pemungutan suara) pada pukul 16.05 WIB
serta mengecek kelengkapan pemungutan suara, dukungan perlengkapan
lainnya, dan perlengkapan pemungutan suara lainnya; (data terlampir);
6. Bahwa Ketua KPPS memberikan penjelasan kepada anggota KPPS terkait tata
cara pelaksanaan pemungutan dan penghitungan suara di TPS serta membagi
tugas KPPS sesuai Keputusan KPU pada hari Selasa, 13 Februari 2024 (satu
hari sebelum hari dan tanggal pemungutan suara)

IV. Informasi Dugaan Pelanggaran

1. Peristiwa
a. Peristiwa : .......................................................................................
.......................................................................................
...........................................................................

b. Tempat Kejadian : ...................................................................................

c. Waktu Kejadian : ...................................................................................

d. Pelaku : ...................................................................................

e. Alamat : ...................................................................................

2. Saksi-Saksi
1) Nama : .......................................................................
Alamat : .......................................................................
2) Nama : .......................................................................
Alamat : .......................................................................
3. Alat Bukti:
a. .........................................................................................................
b. ........................................................................................................
c. .........................................................................................................
4. Barang Bukti:
a. .........................................................................................................
b. .........................................................................................................
c. .........................................................................................................
5. Uraian Singkat Dugaan Pelanggaran:
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6. Fakta dan Keterangan:
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7. Analisa:
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V. Informasi Potensi Sengketa

1. Peristiwa:
a. Peserta Pemilu : ……………………………………………….
b. Tempat Kejadian : ……………………………………………….
c. Waktu Kejadian : ……………………………………………….
 2. Obyek Sengketa:
a. Bentuk objek sengketa : ……………………………………………….…………
…………………………………….
b. Identitas objek sengketa : ……………………………………………….…………
…………………………………….
c. Hari/Tanggal dikeluarkan : ……………………………………………….
d. Kerugian langsung : ……………………………………………….…………
…………………………………….

3. Uraian Singkat Potensi Sengketa:

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Banjarnegara, 14 Februari 2024

Pengawas Pemilu,

Nama TANDA TANGAN

Naufal Fazal Muttaqin

VI. Dokumentasi