Yayasan Pelayanan Kasih Agustinian

Rumah Sakit
FATIMA
Kasih Yang Menyembuhkan

Form Anggaran : Belanja Rutin per tahun

Unit UGD

No Nama Barang SpesifikasiJumlah Satuan Harga Satuan Rp Anggaran

A. Sumber Daya Manusia :

1 - Perawat 14 orang
2 - PJ Shift 6 orang
3 - Perawat Pelaksana 8 orang
4 - Rencana Penambahan Perawat 6 orang
Sub Total
B. Rencana Pelatihan Internal
1 - BHD
Sub Total
C. Rencana Pelatihan Eksternal
1 - BTCLS 2 orang
Sub Total
D. Ruangan
1 Ruang UGD 1 unit
2 Ruang Obat 1 unit
3 Ruang PONEK 1
4 Ruang Isolasi 1
5 Ruang Dekontaminasi 1
Sub Total
E. Perlengkapan Administrasi ATK :
1 - Spidol Boardmaker 12 pcs
2 - Ball-point 24 pcs
3 - Buku Folio 4 buah
4 - Form-form 10 rim
5 - Buku Ekspedisi 5 buah
6 - Tinta Cap SBAR 2 set
7-
8-
Sub Total
F. Rumah Tangga :
1 - Kain Seragam Teknisi 24 stel
2 - Rinso 10 kg
3 - Kain Lap 2 helai
4 - Sapu 2 buah
5 - Serok 2 buah
6 - Baterray 36 buah
7 - Kain Majun 50 kg
8 - Pengharum Ruangan 12 pcs
Sub Total
G. K3 ( Kesehatan Dan keselamatan Kerja )
1 - Apron 7 unit 250,000 1,750,000
2 - Ear-Muff 7 set 100,000 700,000
3 - Googles 7 unit 50,000 350,000
4 - Hand-glove 7 psg 150,000 1,050,000
5 - Safety shoes 7 psg 350,000 2,450,000
6 - Masker Cartridge 7 unit 150,000 1,050,000
7 - Cartridge 14 pcs 50,000 700,000
8 - Helm 7 pcs 50,000 350,000
Sub Total 8,400,000
H. Perabotan
1 - Lemari Alat 1 unit 1,500,000 1,500,000
2 - Lemari Pelengkapan K3 1 unit 500,000 500,000
3 - Meja 1 biro 1 unit 350,000 350,000
4 - Kursi 1 unit 150,000 150,000
 5 - Komputer 1 set 5,000,000 5,000,000
6 - Printer A3 1 set 2,500,000 2,500,000
7 - Meja Panjang 1 unit 1,000,000 1,000,000
Sub Total 11,000,000
Sub Jumlah 19,400,000

Yayasan Pelayanan Kasih Agustinian

Rumah Sakit
FATIMA
Form Anggaran : Belanja Rutin per tahun Kasih Yang Menyembuhkan
Unit : …………………………………

No Nama Barang SpesifikasiJumlah Satuan Harga Satuan Rp Anggaran

I. Spare Part dan Perlengkapan Teknik

INCENERATOR
1 - Limits Switch 5 pcs 35,000 175,000
2 - Relay 8 pcs 50,000 400,000
3 - Pilot Lamp 2 pcs 25,000 50,000
4 - Toggle switch 2 pcs 15,000 30,000
5 - MCCB 1 pcs 750,000 750,000
6 - Stuts 1 pcs 25,000 25,000
7 - Timer 1 pcs 55,000 55,000
8 - Air Aki 10 ltr 5,000 50,000
Sub Total 1,535,000
GENERATOR SET
1 - Accumulator 10 buah 1,750,000 17,500,000
2 - Fuse 4 pcs 5,000 20,000
3 - Radiator Coolant 10 ltr 25,000 250,000
4 - Hose water-pump 1 unit 150,000 150,000
5 - Engine Oil 100 ltr 15,000 1,500,000
6 - Air Aki 10 ltr 5,000 50,000
Sub Total 19,470,000
PANEL INDUK PLN
1 - Arester 1 set 75,000 75,000
2 - Pilot lamp 3 pcs 25,000 75,000
3 - Volt Meter 3 unit 75,000 225,000
4 - MCCB 3 unit 750,000 2,250,000
5 - Change Oper Switch 1 unit 7,500,000 7,500,000
Sub Total 10,125,000
CAPACITOR BANK
1 - NH Fuse 6 pcs 45,000 270,000
2 - CT 1 pcs 150,000 150,000
3 - Display Indicator 1 unit 500,000 500,000
Sub Total 920,000
CENTRAL O2
1 - Manometer 1 unit 3,000,000 3,000,000
2 - Seal Tape 12 roll 3,000 36,000
3 - Pipa Kuningan 1 btg 150,000 150,000
Sub Total 3,186,000
CENTRAL PARABOLA
1 - Modulator 2 unit 750,000 1,500,000
2 - Receiver 2 unit 300,000 600,000
3 - LNB 2 set 150,000 300,000
4 - Booster Induk 1 unit 5,000,000 5,000,000
5 - Kabel RCA 12 set 25,000 300,000
6 - Socket TV 50 pcs 5,000 250,000
7 - Connector Kabel 20 pcs 5,000 100,000
8 - Stop kontak 2 pcs 25,000 50,000
Sub Total 8,100,000
ELEVATOR
1 - Accumulator 5 buah 1,750,000 8,750,000
2 - Olie SAE 10 3 liter 15,000 45,000
 3- Kuas 4 pcs 5,000 20,000
4- Minyak Tanah 2 liter 15,000 30,000
5- Bola Lampu Neon 8 buah 35,000 280,000
6- Olie Mesin SAE 40 20 liter 20,000 400,000
Sub Total 9,525,000
INSTALASI OKSIGEN ,GAS MEDIS, DAN PANEL KONTROL
1 - Manometer 1 buah 3,000,000 3,000,000
2 - Pressure Hose 10 meter 25,000 250,000
3 - Socket Nepple 6 pcs 150,000 900,000
4 - Seal Tape 30 roll 3,000 90,000
5 - Flow Meter 10 unit 1,500,000 15,000,000
6 - Regulator 20 unit 350,000 7,000,000
7 - Ball Valve kuningan 2 unit 150,000 300,000
Sub Total 26,540,000
Sub Jumlah 79,401,000

Yayasan Pelayanan Kasih Agustinian

Rumah Sakit
FATIMA
Form Anggaran : Belanja Rutin per tahun
Kasih Yang Menyembuhkan
Unit : …………………………

No Nama Barang SpesifikasiJumlah Satuan Harga Satuan Rp Anggaran

INSTALASI LISTRIK , PANEL KONTROL

1 - Stuts 20 pcs 25,000 500,000
2 - Pilot Lamp 30 pcs 20,000 600,000
3 - Fuse 6 pcs 5,000 30,000
4 - MCCB 2 buah 750,000 1,500,000
5 - Kabel Tiss 3 bks 50,000 150,000
6 - Isolasi 10 roll 10,000 100,000
7 - Stop kontak 50 buah 25,000 1,250,000
8 - Stecker 20 buah 15,000 300,000
9 - Klem Kabel 20 bks 25,000 500,000
10 - Ducting Kabel 200 btg 45,000 9,000,000
11 - Klem Ducting 5 bks 25,000 125,000
Sub Total 14,055,000
INSTALASI PENERANGAN
1 - Bola Neon 30 buah 25,000 750,000
2 - Bola SL 50 pcs 45,000 2,250,000
3 - Trafo 10 pcs 25,000 250,000
4 - Stater 10 pcs 5,000 50,000
5 - Socket lampu 10 set 25,000 250,000
6 - Saklar 30 buah 25,000 750,000
7 - Fitting 20 buah 15,000 300,000
8 - Sekrup 200 pcs 500 100,000
9 - Spot Light 5 unit 350,000 1,750,000
10 - Down light 5 unit 250,000 1,250,000
11 - Timer 2 unit 75,000 150,000
12 - Cap Lampu 5 unit 150,000 750,000
13 - Lampu pijar 24 pcs 15,000 360,000
Sub Total 8,960,000
INSTALASI AIR BERSIH, RO, POMPA, HEATER
1 - Bearing 20 pcs 45,000 900,000
2 - Water Seal 10 pcs 15,000 150,000
3 - Socket,Fitting RO 10 pcs 5,000 50,000
4 - Automatic Solenoid 5 unit 75,000 375,000
5 - Seal Tape 10 roll 3,000 30,000
6 - Lem 5 klg 35,000 175,000
7 - Accesorie Pipa 500 pcs 5,000 2,500,000
8 - Automatic Pelampung 3 unit 150,000 450,000
9 - Foot Valve 5 unit 50,000 250,000
10 - Resin 200 kg 35,000 7,000,000
 11 - Garam Curai 100 kg 3,000 300,000
12 - Kaporit 60 kg 35,000 2,100,000
13 - Karbon Aktif 400 kg 15,000 6,000,000
14 - Media Mangan 300 kg 45,000 13,500,000
15 - Pompa RO 4 unit 1,500,000 6,000,000
16 - Membran RO 4 pcs 1,250,000 5,000,000
17 - Filter RO 12 unit 125,000 1,500,000
18 - Stop Kran 30 pcs 35,000 1,050,000
19 - Hose 20 meter 5,000 100,000
20 - Klem Pipa 50 pcs 5,000 250,000
21 - Impeller Pompa 2 unit 45,000 90,000
22 - Baut Ikat 20 pcs 3,000 60,000
23 - Water Mur 10 pcs 45,000 450,000
24 - Insulating Varnish 2 tbg 75,000 150,000
25 - Isolasi 20 roll 10,000 200,000
26 - Check Valve 2 pcs 75,000 150,000
27 - Flow Switch 2 pcs 150,000 300,000
28 - Spreyer 2 unit 200,000 400,000
29 - Slang Air RO 20 meter 15,000 300,000
Sub Total 49,780,000
Sub Jumlah 72,795,000

Yayasan Pelayanan Kasih Agustinian

Rumah Sakit
Form Anggaran : Belanja Rutin per tahun
FATIMA
Kasih Yang Menyembuhkan
Unit : ………………………

No Nama Barang SpesifikasiJumlah Satuan Harga Satuan Rp Anggaran

INSTALASI AC, KIPAS, EXHAUST

1 - Compressor 2,5 PK 2 unit 2,500,000 5,000,000
2 - Compressor 2 PK 20 unit 1,750,000 35,000,000
3 - Compressor 1,5 PK 4 unit 1,500,000 6,000,000
4 - Compressor 3/4 PK 2 unit 1,250,000 2,500,000
5 - Compressor 1/2 PK 3 unit 1,000,000 3,000,000
6 - AC 2 unit 10,000,000 20,000,000
7 - Relay 3 pcs 45,000 135,000
8 - Capacitor 3 pcs 55,000 165,000
9 - Freon 12 tbg 850,000 10,200,000
10 - PCB 4 unit 1,250,000 5,000,000
11 - Termister 5 pcs 125,000 625,000
12 - Remote Control 5 pcs 250,000 1,250,000
13 - Msnifold 1 set 350,000 350,000
14 - Lem Aron Alpha 10 pcs 25,000 250,000
15 - Klem 5 bks 15,000 75,000
16 - Fisher 2 kotak 15,000 30,000
17 - Baut Fisher 40 pcs 5,000 200,000
18 - Dyna Bolt 20 pcs 5,000 100,000
19 - Plastik Cleaning Indoor 2 unit 75,000 150,000
20 - Lem Fox 1 kg 35,000 35,000
21 - Accetelyne 1 tbg 1,500,000 1,500,000
22 - Oksigen 1 tbg 175,000 175,000
23 Kawat Las Perak 1 kg 150,000 150,000
24 Borak 5 bks 5,000 25,000
25 Brander Las 1 unit 350,000 350,000
Sub Total 92,265,000
 INSTALASI AIPHONE
1 - UPS 1 unit 3,500,000 3,500,000
2 - Kabel Socket 5 set 150,000 750,000
3 - Terminal Socket 5 set 5,000 25,000
4 - PCB Card 2 set 3,500,000 7,000,000
5 - Kabel Aiphone 5 roll 150,000 750,000
6 - Pesawat telpon 5 unit 350,000 1,750,000
Sub Total 13,775,000

Sub Jumlah 106,040,000

Yayasan Pelayanan Kasih Agustinian

Rumah Sakit
FATIMA
Form Anggaran : Belanja Rutin per tahun Kasih Yang Menyembuhkan
Unit : …………………………………..

No Nama Barang SpesifikasiJumlah Satuan Harga Satuan Rp Anggaran

INSTALASI SOUND SYSTEM

1 - Connector 5 pcs 15,000 75,000
2 - Fuse 8 pcs 5,000 40,000
3 - Pilot Lamp 2 pcs 25,000 50,000
4 - Toggle switch 2 pcs 25,000 50,000
5 - MCCB 1 pcs 500,000 500,000
6 - Stuts 1 pcs 25,000 25,000
7 - Mikrophone 2 set 150,000 300,000
8 - Speaker 2 set 350,000 700,000
9 - Kabel AV 1 roll 200,000 200,000
Sub Total 1,940,000
INSTALASI POWER SUPPLY LISTRIK
1 - Kabel NYY 3 Roll 3,600,000 10,800,000
2 - Kabel NYM 5 Roll 550,000 2,750,000
3 - Kabel NYAF 3 Roll 450,000 1,350,000
4 - Ducting Kabel 20 btg 45,000 900,000
5 - UPS Kapasitas 50 kVA 2 unit 7,500,000 15,000,000
6 - Genset Kapasitas 300 kVA 1 unit 500,000,000 500,000,000
7 - Kabel Instalasi Power Genset 1 set 75,000,000 75,000,000
Sub Total 605,800,000
INSTALASI AC,KIPAS, EXHAUST
 1 - Pipa kapiler 50 meter 125,000 6,250,000
2 - Kipas Ceilling Mounted 4 unit 250,000 1,000,000
3 - Exhaust Fan 15 unit 350,000 5,250,000
Sub Total 12,500,000

INSTALASI PARABOLA
1 - Kabel parabola RG 11 2 roll 500,000 1,000,000
Sub Total 1,000,000

INSTALASI SOUND SYSTEM

1 - Kabel Sound 2 roll 250,000 500,000
2-
Sub Total 500,000

INSTALASI AIPHONE
1 - Kabel aiphone 3 roll 250,000 750,000
2 - Pesawat Telpon 2 unit 250,000 500,000

Sub Total 1,250,000

INSTALASI OKSIGEN, GAS MEDIK

1 - Pipa Tembaga 12 meter 50,000 600,000
Sub Total 600,000
INSTALASI POMPA, AIR BERSIH
1 - Pompa Air 4 unit 3,500,000 14,000,000
2 - Pipa 100 batang 45,000 4,500,000
3 - Tong Air 4 buah 2,000,000 8,000,000
4 - Pipa Galvanis 5 btg 245,000 1,225,000
5 - Filter Tank ( Mangan-Zeolit-Karbon Aktif ) 6 unit 7,500,000 45,000,000
Sub Total 72,725,000

Sub Jumlah 696,315,000

Yayasan Pelayanan Kasih Agustinian

Rumah Sakit
FATIMA
Form Anggaran : Belanja Rutin per tahun Kasih Yang Menyembuhkan
Unit : ………………………….

No Nama Barang SpesifikasiJumlah Satuan Harga Satuan Rp Anggaran

J. Alat Kerja/Inventaris
MEKANIK
1 - Troly 1 unit 1,500,000 1,500,000
2 - Chain Hook 1 unit 450,000 450,000
3 - Kawat Las 30 kg 350,000 10,500,000
4 - Kawat Las S/S 10 kg 450,000 4,500,000
5 - Kawat Las CI 0.5 kg 500,000 250,000
6 - Mata Gerinda Kasar 10 pcs 15,000 150,000
7 - Mata Gerinda Potong 50 pcs 10,000 500,000
8 - Bor Duduk 1 unit 5,000,000 5,000,000
9 - Kunci Rantai 1 unit 150,000 150,000
10 - Paking / O-ring 20 unit 25,000 500,000
11 - Bor Beton 1 unit 1,500,000 1,500,000
12 - Mata Bor Beton 5 pcs 75,000 375,000
13 - Baut 100 pcs 5,000 500,000
14 - Sekrup 200 pcs 500 100,000
15 - Stopper Bed 50 set 35,000 1,750,000
16 - Roda Bed 12 pcs 150,000 1,800,000
17 - Mata Bor Besi 1 set 250,000 250,000
18 - Mata Gergaji Besi 5 pcs 50,000 250,000
19 - Pipe Cutter PVC 1 unit 150,000 150,000
20 - Pipe Cutter GIP 1 unit 1,500,000 1,500,000
21 - Tang Rivet 1 unit 75,000 75,000
22 - Paku Rivet 2 kotak 75,000 150,000
23 - Pillox 10 kaleng 25,000 250,000
24 - Tap 3 set 125,000 375,000
25 - Stang Tap 1 unit 75,000 75,000
26 - Snei 5 set 150,000 750,000
27 - Stang Snei 1 unit 125,000 125,000
28 - Amplas 15 lbr 5,000 75,000
29 - Langsol 1 btg 35,000 35,000
30 - Vaccum Pump AC 1 unit 3,500,000 3,500,000
Sub Total 37,085,000
ELEKTRIK
1 - Multi - Tester Digital AC/DC 1 unit 350,000 350,000
2 - Charger Aki Fast Start 1 unit 2,500,000 2,500,000
3 - Head-Lamp 2 unit 50,000 100,000
4 - Solder Electric 1 unit 50,000 50,000
5 - Solder Cleaner 1 unit 75,000 75,000
6 - Timah Solder 5 roll 75,000 375,000
7 - Tang Skun 1 unit 150,000 150,000
8 - Skun Kabel 50 pcs 5,000 250,000
9 - Kuas 5 pcs 10,000 50,000
10 - Merger 1 unit 5,000,000 5,000,000
11 - Earth Quarth Leakage Tester 1 unit 7,500,000 7,500,000

Sub Total 16,400,000

Sub Jumlah 53,485,000

Grand Total 1,027,436,000

Diketahui Ketapang, .............................

Dibuat oleh
Kepala Divisi
Kepala Unit
Disetujui

Direktur
 Tahun :

Keterangan
 Tahun : ………

Keterangan

Besaran Variatif

Besaran Variatif

Besaran Variatif

Model Variatif
 Tahun : ……..

Keterangan

Ukuran Variatif
Ukuram Variatif

Tahun : ……..

Keterangan
 Tahun : ……..

Keterangan
Ukuran variatif

Tahun : ……..

Keterangan
 Ukuran Variatif

Ukuran Variatif

.........................
t oleh

a Unit