4.poli Gigi

KARTU INVENTARIS RUANGAN
KABUPATEN : SIMALUNGUN
PROVINSI : SUMATERA UTARA
SATUAN KERJA : PUSKESMAS SARIBU DOLOK
RUANGAN : RUANG GIGI
Tahun Keadaan Barang
Jumlah
No. No. Seri No. Pembuata No. Kode Harga Beli/ Rusak
Nama Barang/ Jenis Barang Merk/ Model Ukuran Bahan Barang/ Kurang
Urut Pabrik Register n/ Barang Perolehan Baik (B) Berat
Register Baik (KB)
Pembelian (RB)
1 2 3 4 5 6 7 8 9 10 11 12 13
1 Meja 0017 Kayu 1 B
2 Kursi kerja 0003 Besi/ Busa 1 B
3 Lemari Tarik 0002 Kayu 1 B
4 Dental Unit 0001 Besi 1 B
5 Kaca Mulut Frenzy 0001 Stenles 2007 1 KB
6 Sonde Frenzy 0001 Stenles 2007 1 B
7 Pinset Frenzy 0001 Stenles 2007 1 B
0001 s/d
8 Spoon Escapator Large, Medium, Small Frenzy Stenles 2007 1 set B
0003
9 Ekskavator Berujung Dua Besar 0001 2007 1 B
10 Ekskavator Berujung Dua kecil 0001 2007 1 B
11 Spatula Pengaduk Semen Gigi Mecadein 0001 18 Cm Stenles 2007 1 B
12 Tang cabut Insisi push Atas 0001 Stenles 2007 1 B
13 Tang Hechting 0002 Stenles 2007 1 B
14 Tang molar Rahang Atas Anak 0003 Stenles 2007 1 B
15 Dental Toolbein Besar Mecadein 0001 15 Cm Stenles 2007 1 B
16 Dental Toolbein Kecil 0002 15 Cm Stenles 2007 1 B
17 Amalgam Stoper 0001 Stenles 2007 1 B
18 Bulnizer Besar/Kecil 0001 Stenles 2007 1 Set B
19 Syringe 0001 Stenles 2007 1 B
20 Amalgam Pistol 0002 Stenles 2007 1 B
21 klem dental 0001 Stenles 2007 1 B
22 Flagers 0001 Stenles 2007 1 B
23 Nierbeken Kecil 0008 Stenles 1 B
24 Compressor Turbin 0001 1992 1 B
25 Kursi Kerja Whaiting Chair 0009 Besi 2016 1 B
26 2020 B
Dentar chair mounted unit Fortuna premium CAMPURAN 1 Rp 119,500,000
27 Light curing starlight pro Stenles 2020 1 Rp 8,200,000 B
28 Extraction tong for adult -lower Root Stenles 2020 1 Rp 545,940 B
29 Extraction tong for children-upper incisive Stenles 2020 1 Rp 545,940 B
30 Extraction tong for adult -lower incisive Stenles 2020 1 Rp 545,940 B
31 Extraction tong for children-upper Root Stenles 2020 1 Rp 545,940 B
32 Extraction tong for children-upper Molar Stenles 2020 1 Rp 545,940 B
33 Extraction tong for adult -upper Molar Left Stenles 2020 1 Rp 545,940 B
34 Stenles 2020 B
Extraction tong for adult -lower wisdom 1 Rp 545,940
35 Extraction tong for adult -upper incisive Stenles 2020 1 Rp 545,940 B
36 Extraction tong for children-lower Root Stenles 2020 1 Rp 545,940 B
37 Extraction tong for children-lower incisive Stenles 2020 1 Rp 545,940 B
38 Extraction tong for adult -upper premolar Stenles 2020 1 Rp 545,940 B
39 Extraction tong for adult -upper molar right Stenles 2020 1 Rp 545,940 B
40 Extraction tong for adult -upper molar wisdom Stenles 2020 1 B

Rp 545,940
41 Extraction tong for adult - lower premolar Stenles 2020 1 Rp 545,940 B
42 Extraction tong for adult - Bayonet Stenles 2020 1 Rp 545,940 B
43 Extraction tong for adult - lower molar Stenles 2020 1 Rp 545,940 B
44 Stenles 2020 B
Extraction tong for children-lower Molar 1 Rp 545,940
45 Extraction tong for children- upper premolar Stenles 2020 1 Rp 545,940 B
46 Extraction tong for adult - upper Root anterior Stenles 2020 1 Rp 545,940 B
47 Extraction supporting -Mayo hegar needle holder Stenles 2020 1 Rp 406,043 B
48 Extraction supporting - needle holder Stenles 2020 1 Rp 599,681 B
49 Extraction supporting -cryer kanan Stenles 2020 1 Rp 599,681 B
50 Extraction supporting -cryer kiri Stenles 2020 1 Rp 383,864 B
51 Extraction supporting -Bein bengkok kiri Stenles 2020 1 Rp 338,369 B
52 Extraction supporting -Bein bengkok kanan Stenles 2020 1 Rp 338,369 B
53 Extraction supporting -Bein Lurus sedang Stenles 2020 1 Rp 366,803 B
54 Extraction supporting -Bein Lurus Besar Stenles 2020 1 Rp 366,803 B
55 Extraction supporting -Bein Lurus Kecil Stenles 2020 1 Rp 366,803 B
56 Diagnostic set- Excavator kecil Stenles 2020 1 Rp 119,424 B
57 Diagnostic set- Excavator Besar Stenles 2020 1 Rp 119,424 B
58 Diagnostic set- Excavator halfmoon Stenles 2020 1 Rp 51,182 B
59 Diagnostic set- Excavator straight Stenles 2020 1 Rp 51,182 B
60 Diagnostic set- Excavator kecil Stenles 2020 4 Rp 119,424 B
61 Diagnostic set- Excavator Besar Stenles 2020 4 Rp 119,424 B
62 Diagnostic set- Tweezer dreesing Stenles 2020 1 Rp 109,757 B
63 Diagnostic set- mouth mirror handle Stenles 2020 5 Rp 44,073 B
64 Diagnostic set- mouth mirror plane Stenles 2020 5 Rp 354,292 B
65 Conservationset- semen stoper besar Stenles 2020 1 Rp 116,012 B
66 Conservationset- semen stoper kecil Stenles 2020 1 Rp 116,012 B
67 Conservationset- semen spatula Stenles 2020 1 Rp 137,907 B
68 Conservationset- Amalgam carver Stenles 2020 1 Rp 149,280 B
69 Conservationset- Amalgam Pistol Aplicator Stenles 2020 1 Rp 354,292 B
70 Conservationset- Amalgam stopper kecil Stenles 2020 1 Rp 118,856 B
71 Conservationset- Amalgam stopper besar Stenles 2020 1 Rp 118,856 B
72 Conservationset- Plastik filling Stenles 2020 1 Rp 137,907 B
73 Conservationset- Instrument filling Stenles 2020 1 Rp 123,690 B
74 Conservationset- burnisher kecil Stenles 2020 1 Rp 143,309 B
75 Conservationset- burnisher Besar Stenles 2020 1 Rp 143,309 B
76 Conservationset- Matrix Holder/Matrix Retainer Stenles 2020 1 Rp 261,596 B
77 Other instruments -Lip retractor 14 Cm Stenles 2020 1 Rp 421,397 B
78 Other instruments - sonde Paradontal WHO Stenles 2020 5 Rp 167,763 B
79 Other instruments - Pinset anatomis Stenles 2020 5 Rp 120,562 B
80 Other instruments --Korentang/Sponge
Pinset Chirurgis & Dressing Stenles 2020 5 Rp 120,562 B
Other instruments
81 Forcep Stenles 2020 1 Rp 555,323 B
82 Other instruments -Tangue spatula Stenles 2020 1 Rp 220,366 B
83 Other instruments -Tangue Scapel Handle No 3 Stenles 2020 1 Rp 105,207 B
84 Other instruments -Surgical Scissors lurus 10 cm Stenles 2020 1 Rp 277,804 B
85 Other instruments -Surgical ScissorsBengkok 11,5 cm Stenles 2020 1 Rp 277,804 B
86 Other instruments -Arteri clem bengkok Stenles 2020 1 Rp 272,117 B
87 Other instruments -Arteri clem Lurus Stenles 2020 1 Rp 267,283 B
88 Micromotor Box - 1 Lowspeed Stenles 2020 1 Rp 6,400,000 B
89 Scaling device Stenles 2020 1 Rp 7,695,000 B
90 Instrument Cabinet Double door KA 25-02B Besi/Kaca 2020 1 Rp 7,900,000 B
91 Instrument Trolley KA 16-01 BSS CAMPURAN 2020 1 Rp 3,100,000 B
92 Instrument tray medium CAMPURAN 2020 1 Rp 1,155,150 B
93 Atraumatic Restorative Treatment CAMPURAN 2020 1 Rp 1,210,750 B
94 K-Files Ukuran 45-80 CAMPURAN 2020 2 Rp 172,000 B
95 Bur Diamond Set FG CAMPURAN 2020 2 Rp 198,000 B
96 Bur Diamond Set RA CAMPURAN 2020 2 Rp 219,000 B
97 K-Files Ukuran 15-40 CAMPURAN 2020 2 Rp 172,000 B
98 Needle Destroyer CAMPURAN 2020 2 Rp 2,400,000 B
SARIBUDOLOK, APRIL 2021
MENGETAHUI
KEPALA UPT PUSKESMAS PENANGGUNG JAWAB RUANG POLI GIGI
dr. IKBAL JAMBAK drg Bernike isabora Sipayung

NIP.198504292011011012 NIP. 199009172007042002
Keterangan
/ Mutasi dll
14
SD
JKN SILVA
SD
JKN SILVA
DAK
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OLOK, APRIL 2021
GUNG JAWAB RUANG POLI GIGI
nike isabora Sipayung

9009172007042002
PEMERINTAH KABUPATEN SIMALUNGUN
UPT DINAS KESEHATAN
PUSKESMAS SARIBUDOLOK
Jln. Sudirman No 1 Saribudolok Kecamatan Silimakuta Kode Pos: 21167
Telp. 081269071430, Email : Puskesmassaribudolok2017@gmail.com
BERITA ACARA PENYERAHAN BARANG

Nomor : / PUSK.Sdlk / XII /2020
Pada hari ini Rabu,tanggal Dua Puluh Tiga Desember Tahun dua ribu dua puluh,Kami yang
bertanda tangan dibawah ini :
1 Mariani Butar Butar : Pengurus Barang
NIP. 198004252005022002
Untuk selanjutnya dalam Berita Acara ini disebut sebagai PIHAK PERTAMA
2 drg Bernike isabora Sipayung : Penanggung Jawab R Gigi
NIP. 199009172007042002
Untuk selanjutnya dalam Berita Acara ini disebut sebagai PIHAK KEDUA
PIHAK PERTAMA telah menyerahkan Barang kepada PIHAK KEDUA, dan PIHAK KEDUA telah menerima
barang tersebut dalam keadaan BAIK, CUKUP dan LENGKAP yang terdiri dari :
NO NAMA BARANG SATUAN JMLH HARGA SATUAN JMLH HARGA KEADAAN
1 Dentar chair mounted unit UNIT 1 Rp 119,500,000 Rp 119,500,000 BAIK

Fortuna premium
2 Light curing starlight pro UNIT 1 Rp 8,200,000 Rp 8,200,000 BAIK
3 Extraction tong for adult -lower UNIT 1 Rp 545,940 Rp 545,940 BAIK

Root
4 Extraction tong for children- UNIT 1 Rp 545,940 Rp 545,940 BAIK

upper incisive

incisive

upper Root

upper Molar
8 Extraction tong for adult -upper UNIT 1 Rp 545,940 Rp 545,940 BAIK

Molar Left

wisdom
incisive
lower Root
lower incisive
premolar
molar right
molar wisdom
16 Extraction tong for adult - lower UNIT 1 Rp 545,940 Rp 545,940 BAIK
premolar
17 Extraction tong for adult - UNIT 1 Rp 545,940 Rp 545,940 BAIK
Bayonet
18 Extraction tong for adult - lower UNIT 1 Rp 545,940 Rp 545,940 BAIK
molar
lower Molar
upper premolar
21 Extraction tong for adult - upper UNIT 1 Rp 545,940 Rp 545,940 BAIK
Root anterior
22 Extraction supporting -Mayo UNIT 1 Rp 406,043 Rp 406,043 BAIK
hegar needle holder
23 Extraction supporting - needle UNIT 1 Rp 599,681 Rp 599,681 BAIK
holder
24 Extraction supporting -cryer UNIT 1 Rp 599,681 Rp 599,681 BAIK
kanan
25 Extraction supporting -cryer kiri UNIT 1 Rp 383,864 Rp 383,864 BAIK
26 Extraction supporting -Bein UNIT 1 Rp 338,369 Rp 338,369 BAIK

bengkok kiri
bengkok kanan
Lurus sedang
Lurus Besar
Lurus Kecil
31 Diagnostic set- Excavator kecil UNIT 1 Rp 119,424 Rp 119,424 BAIK
32 Diagnostic set- Excavator Besar UNIT 1 Rp 119,424 Rp 119,424 BAIK
33 Diagnostic set- Excavator UNIT 1 Rp 51,182 Rp 51,182 BAIK

halfmoon
34 Diagnostic set- Excavator UNIT 1 Rp 51,182 Rp 51,182 BAIK
straight
35 Diagnostic set- Excavator kecil UNIT 4 Rp 29,856 Rp 119,424 BAIK
36 Diagnostic set- Excavator Besar UNIT 4 Rp 29,856 Rp 119,424 BAIK
37 Diagnostic set- Tweezer UNIT 1 Rp 109,757 Rp 109,757 BAIK

dreesing
38 Diagnostic set- mouth mirror UNIT 5 Rp 8,815 Rp 44,073 BAIK
handle
39 Diagnostic set- mouth mirror UNIT 5 Rp 70,858 Rp 354,292 BAIK
plane
40 Conservationset- semen stoper UNIT 1 Rp 116,012 Rp 116,012 BAIK
besar
41 Conservationset- semen stoper Set 1 Rp 116,012 Rp 116,012 BAIK
kecil
42 Conservationset- semen spatula Unit 1 Rp 137,907 Rp 137,907 BAIK
43 Conservationset- Amalgam UNIT 1 Rp 149,280 Rp 149,280 BAIK

carver
44 Conservationset- Amalgam Unit 1 Rp 354,292 Rp 354,292 BAIK
Pistol Aplicator
stopper kecil

stopper besar
47 Conservationset- Plastik filling UNIT 1 Rp 137,907 Rp 137,907 BAIK
48 Conservationset- Instrument UNIT 1 Rp 123,690 Rp 123,690 BAIK

filling
49 Conservationset- burnisher kecil UNIT 1 Rp 143,309 Rp 143,309 BAIK
50 Conservationset- burnisher UNIT 1 Rp 143,309 Rp 55,000 BAIK

Besar
51 Conservationset- Matrix UNIT 1 Rp 261,596 Rp 261,596 BAIK
Holder/Matrix Retainer
52 Other instruments -Lip retractor UNIT 1 Rp 421,397 Rp 421,397 BAIK
14 Cm
53 Other instruments - sonde UNIT 5 Rp 33,553 Rp 167,763 BAIK
Paradontal WHO
54 Other instruments - Pinset UNIT 5 Rp 24,112 Rp 120,562 BAIK
anatomis
55 Other instruments - Pinset UNIT 5 Rp 24,112 Rp 120,562 BAIK
Chirurgis
56 Other instruments UNIT 1 Rp 555,323 Rp 555,323 BAIK

-Korentang/Sponge & Dressing
Forcep
57 Other instruments -Tangue UNIT 1 Rp 220,366 Rp 220,366 BAIK

spatula
58 Other instruments -Tangue UNIT 1 Rp 105,207 Rp 105,207 BAIK
Scapel Handle No 3
59 Other instruments -Surgical UNIT 1 Rp 277,804 Rp 277,804 BAIK
Scissors lurus 10 cm
60 Other instruments -Surgical UNIT 1 Rp 277,804 Rp 277,804 BAIK
ScissorsBengkok 11,5 cm
61 Other instruments -Arteri clem UNIT 1 Rp 272,117 Rp 272,117 BAIK
bengkok
62 Other instruments -Arteri clem UNIT 1 Rp 267,283 Rp 267,283 BAIK
Lurus
63 Micromotor Box - 1 Lowspeed UNIT 1 Rp 6,400,000 Rp 6,400,000 BAIK
64 UNIT 1 Rp 7,695,000 Rp 7,695,000 BAIK

Scaling device
65 Instrument Cabinet Double door UNIT 1 Rp 7,900,000 Rp 7,900,000 BAIK

KA 25-02B
66 Instrument Trolley KA 16-01 UNIT 1 Rp 3,100,000 Rp 3,100,000 BAIK
BSS
67 Instrument tray medium Unit 1 Rp 1,155,150 Rp 1,155,150 BAIK
68 Atraumatic Restorative Unit 1 Rp 1,210,750 Rp 1,210,750 BAIK

Treatment
69 K-Files Ukuran 45-80 Unit 2 Rp 86,000 Rp 172,000 BAIK
70 Bur Diamond Set FG Unit 2 Rp 99,000 Rp 198,000 BAIK
71 Bur Diamond Set RA Unit 2 Rp 109,500 Rp 219,000 BAIK
72 K-Files Ukuran 15-40 Unit 2 Rp 86,000 Rp 172,000 BAIK
73 Needle Destroyer Unit 2 Rp 1,200,000 Rp 2,400,000 BAIK
Rp 178,188,263
TOTAL
Demikian Berita Acara Penyerahan Barang ini di perbuat dan dilaksanakan dengan sebenarnya untuk dapat di
pergunakan sebagaimana mestinya.
Saribudolok, Dua puluh itga Desember Dua Ribu dua Puluh
Yang menyerahkan Barang: Yang menerima

PIHAK PERTAMA PIHAK KEDUA
Pengurus Barang Penanggung Jawab R Gigi
Mariani Butar Butar drg Bernike isabora Sipayung

NIP. 198004252005022002 NIP. 199009172007042002
Diketahui,
Kepala Puskesmas saribudolok,
dr Ikbal Jambak
NIP. 198504292011011012
Pada hari ini Kamis tanggl tujuh februari tahun dua ribu sembilan belas, kami yang bertandatangan d
PEJABAT PELAKSANA TEKNIS KEGIATAN (PPTK)
BERITA ACARA SERAH TERIMA BARANG

Nomor: /PPTK/IV/2016
Pada hari ini Kamis tanggl tujuh februari tahun dua ribu sembilan belas, kami yang bertandatangan di bawah ini :
dr.JON SAFRI SARAGIH

NIP.198002062009021003
Pejabat
Penyimpan
Barang dan
Pengurus
Barang atas
Kegiatan
Pengadaan
Barang Jasa
dan Belanja
Modal yang
dikelola
Dinas
Kesehatan
Kabupaten
Simalungun
Tahun
Anggaran
2016
100658 2
50329
160 10
16
NIP : 197509122006041006
NIP. 199009172007042002
elas, kami yang bertandatangan di bawah ini :
N (PPTK)
MA BARANG
V/2016
ng bertandatangan di bawah ini :
DINAS KESEHATAN
UPT PUSKESMAS SARIBUDOLOK
Jl. Sudirman No. 1 Saribudolok Kecamatan Silimakuta kode Pos : 21167
JADWAL PEMELIHARAAN BARANG INVENTARIS PUSKESMAS SARIBUDOLOK TAHUN 2021
RUANG : RUANG P.GIGI

BULAN : MARET 2021
Tanggal
NO Nama Barang
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 Meja
2 Kursi kerja
3 Lemari Tarik
4 Dental Unit
5 Kaca Mulut
6 Sonde
7 Pinset
Spoon Escapator Large, Medium,
8
Small
9 Ekskavator Berujung Dua Besar
10 Ekskavator Berujung Dua kecil
11 Spatula Pengaduk Semen Gigi
12 Tang cabut Insisi push Atas
13 Tang Hechting
14 Tang molar Rahang Atas Anak
15 Dental Toolbein Besar
16 Dental Toolbein Kecil
17 Amalgam Stoper
18 Bulnizer Besar/Kecil
19 Syringe
20 Amalgam Pistol
21 klem dental
22 Flagers
23 Nierbeken Kecil
24 Compressor
25 Kursi Kerja
Dentar chair mounted unit Fortuna
26
premium
27 Light curing starlight pro
Extraction tong for adult -lower
28
Root
Extraction tong for children-upper
29
incisive
30
incisive
31
Root
32
Molar
Extraction tong for adult -upper
33
Molar Left
34
wisdom
35
incisive
Extraction tong for children-lower
36
Root
37
incisive
38
premolar
39
molar right
40
molar wisdom
Extraction tong for adult - lower
41
premolar
42 Extraction tong for adult - Bayonet
43
molar
44
Molar
Extraction tong for children- upper
45
premolar
Extraction tong for adult - upper
46
Root anterior
Extraction supporting -Mayo hegar
47
needle holder
Extraction supporting - needle
48
holder
49 Extraction supporting -cryer kanan
50 Extraction supporting -cryer kiri
Extraction supporting -Bein
51
bengkok kiri
52
bengkok kanan
Extraction supporting -Bein Lurus
53
sedang
54
Besar
55
Kecil
56 Diagnostic set- Excavator kecil
57 Diagnostic set- Excavator Besar
58 Diagnostic set- Excavator halfmoon
59 Diagnostic set- Excavator straight
62 Diagnostic set- Tweezer dreesing
Diagnostic set- mouth mirror
63
handle
64 Diagnostic set- mouth mirror plane
Conservationset- semen stoper
65
besar
66 Conservationset- semen stoper kecil

67 Conservationset- semen spatula
68 Conservationset- Amalgam carver
Conservationset- Amalgam Pistol
69
Aplicator
Conservationset- Amalgam stopper
70
kecil
71
besar
72 Conservationset- Plastik filling
73 Conservationset- Instrument filling
74 Conservationset- burnisher kecil
75 Conservationset- burnisher Besar
Conservationset- Matrix
76
Other instruments -Lip retractor 14
77
Cm
Other instruments - sonde
78
Paradontal WHO
79 Other instruments - Pinset anatomis
Other instruments - Pinset

80
Chirurgis
Other instruments
81 -Korentang/Sponge & Dressing
Forcep
82 Other instruments -Tangue spatula
Other instruments -Tangue Scapel
83
Handle No 3
Other instruments -Surgical
84
85
Other instruments -Arteri clem
86
bengkok
87
Lurus
88 Micromotor Box - 1 Lowspeed
89 Scaling device
Instrument Cabinet Double door
90
KA 25-02B
91 Instrument Trolley KA 16-01 BSS

92 Instrument tray medium
93 Atraumatic Restorative Treatment
94 K-Files Ukuran 45-80
95 Bur Diamond Set FG
96 Bur Diamond Set RA
98 Needle Destroyer
Saribudolok, MARET2021
Keterangan : Koordinator, Penanggung Jawab Ruangan
1. Mencuci Alat Setelah digunakan

2. Mensterilkan Alat Setelah dikeringkan
3. Membersihkan Mebulair
MARIANI BUTAR BUTAR drg Bernike isabora Sipayung
NIP.198004252005022002 NIP. 199009172007042002
DINAS KESEHATAN

BULAN : APRIL 2021
Tanggal
NO Nama Barang
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
1 Meja
2 Kursi kerja
3 Lemari Tarik
4 Dental Unit
5 Kaca Mulut
6 Sonde
7 Pinset
8
Small
13 Tang Hechting
17 Amalgam Stoper
19 Syringe
20 Amalgam Pistol
21 klem dental
22 Flagers
23 Nierbeken Kecil
24 Compressor
25 Kursi Kerja
26
premium
28
Root
29
incisive
30
incisive
31
Root
32
Molar
33
Molar Left
34
wisdom
35
incisive
36
Root
37
incisive
38
premolar
39
molar right
40
molar wisdom
41
premolar
43
molar
44
Molar
45
premolar
46
Root anterior
47
needle holder
48
holder
51
bengkok kiri
52
bengkok kanan
53
sedang
54
Besar
55
Kecil
63
handle
65
besar

69
Aplicator
70
kecil
71
besar
76
77
Cm
78
Paradontal WHO

80
Chirurgis
Other instruments
Forcep
83
Handle No 3
84
85
86
bengkok
87
Lurus
89 Scaling device
90
KA 25-02B

98 Needle Destroyer
Saribudolok, APRIL 2021

NIP.198004252005022002 NIP. 199009172007042002
DINAS KESEHATAN

BULAN : MEI 2021
Tanggal
NO Nama Barang
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 Meja
2 Kursi kerja
3 Lemari Tarik
4 Dental Unit
5 Kaca Mulut
6 Sonde
7 Pinset
8
Small
13 Tang Hechting
17 Amalgam Stoper
19 Syringe
20 Amalgam Pistol
21 klem dental
22 Flagers
23 Nierbeken Kecil
24 Compressor
25 Kursi Kerja
26
premium
28
Root
29
incisive
30
incisive
31
Root
32
Molar
33
Molar Left
34
wisdom
35
incisive
36
Root
37
incisive
38
premolar
39
molar right
40
molar wisdom
41
premolar
43
molar
44
Molar
45
premolar
46
Root anterior
47
needle holder
48
holder
51
bengkok kiri
52
bengkok kanan
53
sedang
54
Besar
55
Kecil
63
handle
65
besar

69
Aplicator
70
kecil
71
besar
76
77
Cm
78
Paradontal WHO

80
Chirurgis
Other instruments
Forcep
83
Handle No 3
84
85
86
bengkok
87
Lurus
89 Scaling device
90
KA 25-02B

98 Needle Destroyer
Saribudolok, MEI 2021

NIP.198004252005022002 NIP. 199009172007042002
DINAS KESEHATAN

BULAN : Juni 2021
Tanggal
NO Nama Barang
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
1 Meja
2 Kursi kerja
3 Lemari Tarik
4 Dental Unit
5 Kaca Mulut
6 Sonde
7 Pinset
8
Small
13 Tang Hechting
17 Amalgam Stoper
19 Syringe
20 Amalgam Pistol
21 klem dental
22 Flagers
23 Nierbeken Kecil
24 Compressor
25 Kursi Kerja
26
premium
28
Root
29
incisive
30
incisive
31
Root
32
Molar
33
Molar Left
34
wisdom
35
incisive
36
Root
37
incisive
38
premolar
39
molar right
40
molar wisdom
41
premolar
43
molar
44
Molar
45
premolar
46
Root anterior
47
needle holder
48
holder
51
bengkok kiri
52
bengkok kanan
53
sedang
54
Besar
55
Kecil
63
handle
65
besar

69
Aplicator
70
kecil
71
besar
76
77
Cm
78
Paradontal WHO

80
Chirurgis
Other instruments
Forcep
83
Handle No 3
84
85
86
bengkok
87
Lurus
89 Scaling device
90
KA 25-02B

98 Needle Destroyer
Saribudolok, Juni 2021

NIP.198004252005022002 NIP. 199009172007042002
DINAS KESEHATAN

BULAN : Juli 2021
Tanggal
NO Nama Barang
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 Meja
2 Kursi kerja
3 Lemari Tarik
4 Dental Unit
5 Kaca Mulut
6 Sonde
7 Pinset
8
Small
13 Tang Hechting
17 Amalgam Stoper
19 Syringe
20 Amalgam Pistol
21 klem dental
22 Flagers
23 Nierbeken Kecil
24 Compressor
25 Kursi Kerja
26
premium
28
Root
29
incisive
30
incisive
31
Root
32
Molar
33
Molar Left
34
wisdom
35
incisive
36
Root
37
incisive
38
premolar
39
molar right
40
molar wisdom
41
premolar
43
molar
44
Molar
45
premolar
46
Root anterior
47
needle holder
48
holder
51
bengkok kiri
52
bengkok kanan
53
sedang
54
Besar
55
Kecil
63
handle
65
besar

69
Aplicator
70
kecil
71
besar
76
77
Cm
78
Paradontal WHO

80
Chirurgis
Other instruments
Forcep
83
Handle No 3
84
85
86
bengkok
87
Lurus
89 Scaling device
90
KA 25-02B

98 Needle Destroyer
Saribudolok, Juli 2021

NIP.198004252005022002 NIP. 199009172007042002
DINAS KESEHATAN

BULAN : AGUSTUS 2021
Tanggal
NO Nama Barang
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 Meja
2 Kursi kerja
3 Lemari Tarik
4 Dental Unit
5 Kaca Mulut
6 Sonde
7 Pinset
8
Small
13 Tang Hechting
17 Amalgam Stoper
19 Syringe
20 Amalgam Pistol
21 klem dental
22 Flagers
23 Nierbeken Kecil
24 Compressor
25 Kursi Kerja
26
premium
28
Root
29
incisive
30
incisive
31
Root
32
Molar
33
Molar Left
34
wisdom
35
incisive
36
Root
37
incisive
38
premolar
39
molar right
40
molar wisdom
41
premolar
43
molar
44
Molar
45
premolar
46
Root anterior
47
needle holder
48
holder
51
bengkok kiri
52
bengkok kanan
53
sedang
54
Besar
55
Kecil
63
handle
65
besar

69
Aplicator
70
kecil
71
besar
76
77
Cm
78
Paradontal WHO

80
Chirurgis
Other instruments
Forcep
83
Handle No 3
84
85
86
bengkok
87
Lurus
89 Scaling device
90
KA 25-02B

98 Needle Destroyer
Saribudolok, Agustus 2021

NIP.198004252005022002 NIP. 199009172007042002
DINAS KESEHATAN

BULAN : SEPTEMBER 2021
Tanggal
NO Nama Barang
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
1 Meja
2 Kursi kerja
3 Lemari Tarik
4 Dental Unit
5 Kaca Mulut
6 Sonde
7 Pinset
8
Small
13 Tang Hechting
17 Amalgam Stoper
19 Syringe
20 Amalgam Pistol
21 klem dental
22 Flagers
23 Nierbeken Kecil
24 Compressor
25 Kursi Kerja
26
premium
28
Root
29
incisive
30
incisive
31
Root
32
Molar
33
Molar Left
34
wisdom
35
incisive
36
Root
37
incisive
38
premolar
39
molar right
40
molar wisdom
41
premolar
43
molar
44
Molar
45
premolar
46
Root anterior
47
needle holder
48
holder
51
bengkok kiri
52
bengkok kanan
53
sedang
54
Besar
55
Kecil
63
handle
65
besar

69
Aplicator
70
kecil
71
besar
76
77
Cm
78
Paradontal WHO

80
Chirurgis
Other instruments
Forcep
83
Handle No 3
84
85
86
bengkok
87
Lurus
89 Scaling device
90
KA 25-02B

98 Needle Destroyer
Saribudolok, September 2021

NIP.198004252005022002 NIP. 199009172007042002
DINAS KESEHATAN

BULAN : OKTOBER 2021
Tanggal
NO Nama Barang
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 Meja
2 Kursi kerja
3 Lemari Tarik
4 Dental Unit
5 Kaca Mulut
6 Sonde
7 Pinset
8
Small
13 Tang Hechting
17 Amalgam Stoper
19 Syringe
20 Amalgam Pistol
21 klem dental
22 Flagers
23 Nierbeken Kecil
24 Compressor
25 Kursi Kerja
26
premium
28
Root
29
incisive
30
incisive
31
Root
32
Molar
33
Molar Left
34
wisdom
35
incisive
36
Root
37
incisive
38
premolar
39
molar right
40
molar wisdom
41
premolar
43
molar
44
Molar
45
premolar
46
Root anterior
47
needle holder
48
holder
51
bengkok kiri
52
bengkok kanan
53
sedang
54
Besar
55
Kecil
63
handle
65
besar

69
Aplicator
70
kecil
71
besar
76
77
Cm
78
Paradontal WHO

80
Chirurgis
Other instruments
Forcep
83
Handle No 3
84
85
86
bengkok
87
Lurus
89 Scaling device
90
KA 25-02B

98 Needle Destroyer
Saribudolok, Oktober 2021

NIP.198004252005022002 NIP. 199009172007042002
DINAS KESEHATAN

BULAN : NOVEMBER 2021
Tanggal
NO Nama Barang
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
1 Meja
2 Kursi kerja
3 Lemari Tarik
4 Dental Unit
5 Kaca Mulut
6 Sonde
7 Pinset
8
Small
13 Tang Hechting
17 Amalgam Stoper
19 Syringe
20 Amalgam Pistol
21 klem dental
22 Flagers
23 Nierbeken Kecil
24 Compressor
25 Kursi Kerja
26
premium
28
Root
29
incisive
30
incisive
31
Root
32
Molar
33
Molar Left
34
wisdom
35
incisive
36
Root
37
incisive
38
premolar
39
molar right
40
molar wisdom
41
premolar
43
molar
44
Molar
45
premolar
46
Root anterior
47
needle holder
48
holder
51
bengkok kiri
52
bengkok kanan
53
sedang
54
Besar
55
Kecil
63
handle
65
besar

69
Aplicator
70
kecil
71
besar
76
77
Cm
78
Paradontal WHO

80
Chirurgis
Other instruments
Forcep
83
Handle No 3
84
85
86
bengkok
87
Lurus
89 Scaling device
90
KA 25-02B

98 Needle Destroyer
Saribudolok, November 2021

NIP.198004252005022002 NIP. 199009172007042002
DINAS KESEHATAN

BULAN : DESEMBER 2021
Tanggal
NO Nama Barang
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 Meja
2 Kursi kerja
3 Lemari Tarik
4 Dental Unit
5 Kaca Mulut
6 Sonde
7 Pinset
8
Small
13 Tang Hechting
17 Amalgam Stoper
19 Syringe
20 Amalgam Pistol
21 klem dental
22 Flagers
23 Nierbeken Kecil
24 Compressor
25 Kursi Kerja
26
premium
28
Root
29
incisive
30
incisive
31
Root
32
Molar
33
Molar Left
34
wisdom
35
incisive
36
Root
37
incisive
38
premolar
39
molar right
40
molar wisdom
41
premolar
43
molar
44
Molar
45
premolar
46
Root anterior
47
needle holder
48
holder
51
bengkok kiri
52
bengkok kanan
53
sedang
54
Besar
55
Kecil
63
handle
65
besar

69
Aplicator
70
kecil
71
besar
76
77
Cm
78
Paradontal WHO

80
Chirurgis
Other instruments
Forcep
83
Handle No 3
84
85
86
bengkok
87
Lurus
89 Scaling device
90
KA 25-02B

98 Needle Destroyer
Saribudolok, Desember 2021

NIP.198004252005022002 NIP. 199009172007042002

4.poli Gigi

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KARTU INVENTARIS RUANGAN

25 Kursi Kerja Whaiting Chair 0009 Besi 2016 1 B

40 Extraction tong for adult -upper molar wisdom Stenles 2020 1 B

dr. IKBAL JAMBAK drg Bernike isabora Sipayung

GUNG JAWAB RUANG POLI GIGI

nike isabora Sipayung

BERITA ACARA PENYERAHAN BARANG

NO NAMA BARANG SATUAN JMLH HARGA SATUAN JMLH HARGA KEADAAN

1 Dentar chair mounted unit UNIT 1 Rp 119,500,000 Rp 119,500,000 BAIK

2 Light curing starlight pro UNIT 1 Rp 8,200,000 Rp 8,200,000 BAIK

3 Extraction tong for adult -lower UNIT 1 Rp 545,940 Rp 545,940 BAIK

4 Extraction tong for children- UNIT 1 Rp 545,940 Rp 545,940 BAIK

5 Extraction tong for adult -lower UNIT 1 Rp 545,940 Rp 545,940 BAIK

6 Extraction tong for children- UNIT 1 Rp 545,940 Rp 545,940 BAIK

7 Extraction tong for children- UNIT 1 Rp 545,940 Rp 545,940 BAIK

8 Extraction tong for adult -upper UNIT 1 Rp 545,940 Rp 545,940 BAIK

9 Extraction tong for adult -lower UNIT 1 Rp 545,940 Rp 545,940 BAIK

26 Extraction supporting -Bein UNIT 1 Rp 338,369 Rp 338,369 BAIK

32 Diagnostic set- Excavator Besar UNIT 1 Rp 119,424 Rp 119,424 BAIK

33 Diagnostic set- Excavator UNIT 1 Rp 51,182 Rp 51,182 BAIK

36 Diagnostic set- Excavator Besar UNIT 4 Rp 29,856 Rp 119,424 BAIK

37 Diagnostic set- Tweezer UNIT 1 Rp 109,757 Rp 109,757 BAIK

43 Conservationset- Amalgam UNIT 1 Rp 149,280 Rp 149,280 BAIK

46 Conservationset- Amalgam UNIT 1 Rp 118,856 Rp 118,856 BAIK

47 Conservationset- Plastik filling UNIT 1 Rp 137,907 Rp 137,907 BAIK

48 Conservationset- Instrument UNIT 1 Rp 123,690 Rp 123,690 BAIK

50 Conservationset- burnisher UNIT 1 Rp 143,309 Rp 55,000 BAIK

56 Other instruments UNIT 1 Rp 555,323 Rp 555,323 BAIK

57 Other instruments -Tangue UNIT 1 Rp 220,366 Rp 220,366 BAIK

64 UNIT 1 Rp 7,695,000 Rp 7,695,000 BAIK

65 Instrument Cabinet Double door UNIT 1 Rp 7,900,000 Rp 7,900,000 BAIK

68 Atraumatic Restorative Unit 1 Rp 1,210,750 Rp 1,210,750 BAIK

70 Bur Diamond Set FG Unit 2 Rp 99,000 Rp 198,000 BAIK

71 Bur Diamond Set RA Unit 2 Rp 109,500 Rp 219,000 BAIK

72 K-Files Ukuran 15-40 Unit 2 Rp 86,000 Rp 172,000 BAIK

73 Needle Destroyer Unit 2 Rp 1,200,000 Rp 2,400,000 BAIK

Yang menyerahkan Barang: Yang menerima

Mariani Butar Butar drg Bernike isabora Sipayung

PEJABAT PELAKSANA TEKNIS KEGIATAN (PPTK)

BERITA ACARA SERAH TERIMA BARANG

dr.JON SAFRI SARAGIH

JADWAL PEMELIHARAAN BARANG INVENTARIS PUSKESMAS SARIBUDOLOK TAHUN 2021

RUANG : RUANG P.GIGI

66 Conservationset- semen stoper kecil

79 Other instruments - Pinset anatomis

Other instruments - Pinset

91 Instrument Trolley KA 16-01 BSS

1. Mencuci Alat Setelah digunakan

JADWAL PEMELIHARAAN BARANG INVENTARIS PUSKESMAS SARIBUDOLOK TAHUN 2021

RUANG : RUANG P.GIGI

66 Conservationset- semen stoper kecil

79 Other instruments - Pinset anatomis

Other instruments - Pinset

91 Instrument Trolley KA 16-01 BSS

1. Mencuci Alat Setelah digunakan

JADWAL PEMELIHARAAN BARANG INVENTARIS PUSKESMAS SARIBUDOLOK TAHUN 2021

RUANG : RUANG P.GIGI

66 Conservationset- semen stoper kecil

79 Other instruments - Pinset anatomis

Other instruments - Pinset

91 Instrument Trolley KA 16-01 BSS

1. Mencuci Alat Setelah digunakan