DEPARTEMENT OF EDUCATION

UDAYANA UNIVERSITY
FACULTY OF MEDICINE

ELECTIVE STUDY PROGRAM

Head of Program

: Dr.dr. I W. P. Sutirta Yasa, M.Si

Secretary

: dr P. A. Asri Damayanti, M.Kes

Students Name

: Putu Suryawan (1202005023)

Supervisor

: Prof. Dr. Ketut Tirtayasa, MS, AIF, AIFO, Sp. Erg

Elective Study Program for 2 weeks

SUPERVISORS
SIGN

NO.

DATE

ACTIVITY

1.

19 September 2014

Memilih dosen pembimbing

2.

29 September 2014

Menentukan topik

3.

10 Oktober 2014

Konsultasi topik

4.

15 Oktober 2014

Mencari bahan pustaka

5.

11 November 2014

Menyusun proposal penelitian

6.

16 Januari 2015

Revisi I

7.

23 Januari 2015

Revisi II

8.

27 Januari 2015

Penentuan jadwal ujian

9.

2 Februari 2015

Menghubungi penguji

10.

5 Februari 2015

Ujian proposal penelitian

Denpasar,
Verified by
Head of Program

Dr.dr. I W. P. Sutirta Yasa, M.Si

NIP 19570513 198601 1 001

Secretary,

dr P. A. Asri Damayanti, M.Kes

NIP 19780706 200312 2 002

Elective Study Process Final Assessment

By Supervisor
Title

: Prevalensi dan Gambaran Keluhan Kelelahan Mata pada Penjahit Garmen di Kota
Denpasar

Exam Date/Time
Student Name
Student ID Number
Supervisor
Assessment

: Kamis, 5 Februari 2015

: Putu Suryawan
: 1202005023
: Prof. Dr. Ketut Tirtayasa, MS, AIF, AIFO, Sp. Erg
:

The process are approximately as follows :

No.
1.

Item Assesment
Log Book
Observation :

Range
0-30

2.

- Communication
- Attendance
- Gesture and Posture
Ability to find literature
Total

0-40

3.

Final Result (Score) :

Criteria
:A B
Results Range :
A
B
C
D
E

Score

0-30
0-100

(please circling the criteria)

: 80-100
: 70-79
: 55-69
: 45-54
: 0-44

Supervisor,

Prof. Dr. Ketut Tirtayasa, MS, AIF, AIFO, Sp. Erg

NIP. 19501231 198003 1 015

Elective Study Process Final Assessment

By Evaluator

Title

: Prevalensi dan Gambaran Keluhan Kelelahan Mata pada Penjahit Garmen di Kota
Denpasar

Exam Date/Time
Student Name
Student ID Number
Supervisor

: Kamis, 5 Februari 2015

: Putu Suryawan
: 1202005023
: Prof. Dr. Ketut Tirtayasa, MS, AIF, AIFO, Sp. Erg Assessment
:

The final exam are approximately as follows :

No.
1.
2.
3.
4.
5.

Item Assesment
Quality of material
Students interest and motivation
Critical thinking
Capability fo information searching
Reliability
Total

Final Result (Score) :

Criteria
:A B
Results Range :
A
B
C
D
E

Range
0-60
0-10
0-10
0-10
0-10
0-100

(please circling the criteria)

: 80-100
: 70-79
: 55-69
: 45-54
: 0-44

Evaluator,

Dr. Luh Made Indah Sri Handari Adiputra, S.Psi, M.Erg

NIP. 19680929 199903 2 001

Score