REKAPITULASI PENILAIAN KINERJA (FORM E)

Masa Penilaian Tanggal : Oktober s/d Desember 2020

KETIDAKHADIRAN
Komulatif FORM B FORM C1 FORM C2 TOTAL %
(DT,PC) KETIDAK Total FORM FORM
NO NAMA FORM B, CAPAIA
LUPA HADIRAN Target B C
IZIN S CUTI TK Capaian Target % Capaian Target % Capaian Target % C1, dan C2 N
ABSEN menit
1 dr. Solihin Wijaya 0 0 0 0 0 0 0 0 28 0,00 37 59 62,71 20 21 95,24 57 108 52,78 - 57,00
2 Eka Akhmad Nuryani, SKM., M.Si. 3 0 0 0 0 0 3 34 56 60,71 17 21 80,95 51 77 66,23 - 51,00
3 drg. Retno G Munthe 0 0 0 0 0 0 0 18 28 64,29 13 36 36,11 6 12 50,00 37 76 48,68 18,00 19,00
4 drg. Andi Tenrisanna 0 0 0 0 0 0 0 22 28 78,57 3 12 25,00 25 40 62,50 22,00 3,00
5 dr. Anindyta Audie Dhea 0 0 0 0 0 0 0 16 28 57,14 6 36 16,67 6 15 40,00 28 79 35,44 16,00 12,00
6 dr. Desika Pujikireni 0 0 7 0 0 0 7 16 28 57,14 0 36 0,00 6 12 50,00 22 76 28,95 16,00 6,00
7 dr. Khairiyyah Suriatmaja 1 28 0 0 0 0 29 16 28 57,14 0 36 0,00 2 12 16,67 18 76 23,68 16,00 2,00
8 dr. Risanti Maulidya 1 0 12 0 0 0 13 16 28 57,14 4 36 11,11 4 12 33,33 24 76 31,58 16,00 8,00
9 dr. Hilaliyah 0 0 0 0 0 0 0 16 28 57,14 4 12 33,33 20 40 50,00 16,00 4,00
10 Viviana Idris, Apt 2 0 13 0 0 0 15 18 28 64,29 7 47 14,89 4 12 33,33 29 87 33,33 18,00 11,00 203 550 36,9091
11 Dina Hariati 1 0 0 0 0 0 1 34 38 89,47 9 12 75,00 43 50 86,00 34,00 9,00
12 Dudy Arya Zulfikar, SE 2 6 0 0 0 0 8 8 32 25,00 4 19 21% 10 12 83,33 22 63 34,92 8,00 14,00
13 Ganda Himawan, S.Kom 1 1 0 0 0 0 2 20 40 50,00 11 22 50% 13 15 86,67 44 77 57,14 20,00 24,00
14 Lili Indiani, S.K.M. 2 0 0 0 0 0 2 11 27 40,74 22 33 67% 17 24 70,83 50 84 59,52 11,00 39,00
15 Mariyam Yachya, S.K.M. 1 0 12 0 0 0 13 6 32 18,75 4 22 18% 8 15 53,33 18 69 26,09 6,00 12,00
16 Muhammad Fauzi, S.K.M 0 11 0 0 0 0 11 8 31 25,81 6 30 20,00 12 15 80,00 26 76 34,21 8,00 18,00
17 Normaidah 0 0 0 0 0 0 0 34 48 70,83 19 36 52,78 5 12 41,67 58 96 60,42 34,00 24,00
18 Sukono 3 1 10 0 0 0 14 16 40 40,00 11 51 21,57 2 9 22,22 29 100 29,00 16,00 13,00 290 615 47,1545
19 Abd. Haris H.Ismail, S.K.M. 2 3 0 0 0 0 5 5 33 15,15 4 30 13% 18 21 85,71 27 84 32,14 5,00 22,00
20 Agustina. AMd.Kep 1 5 12 0 0 0 18 0 20 0,00 0 25 0% 0 12 0,00 0 57 - - -
21 Ayu Wulan Dewi, S.Tr.Kep 2 1 20 0 0 0 23 9 28 32,14 5 33 15% 2 12 16,67 16 73 21,92 9,00 7,00
22 Dini Avianti, S. Kep 1 1 11 0 0 0 13 9 20 45,00 32 39 82% 18 21 85,71 59 80 73,75 9,00 50,00
23 Hanifah Nabilah, Amd. Kep 2 0 0 0 0 0 2 13 28 46,43 9 12 75,00 22 40 55,00 13,00 9,00
24 Nurdiana, Amd. Kep 0 1 12 0 0 0 13 6 28 21,43 15 22 68% 5 12 41,67 26 62 41,94 6,00 20,00
25 Rahmawati, Amd. Kep 1 5 0 0 0 0 6 13 28 46,43 17 22 77% 7 12 58,33 37 62 59,68 13,00 24,00
26 Rushandayani, Amd.Kep 0 0 4 0 0 0 4 6 28 21,43 5 33 15% 8 12 66,67 19 73 26,03 6,00 13,00
27 Sitti Aisyah, S.K.M. 0 2 0 0 0 0 2 4 28 14,29 6 33 18% 11 12 91,67 21 73 28,77 4,00 17,00
28 Soleha Murniasih, Amd.Kep 1 0 10 0 0 0 11 14 28 50,00 14 33 42% 11 12 91,67 39 73 53,42 14,00 25,00
29 Sri Surya N., Amd. Kep 2 0 6 0 0 0 8 6 20 30,00 12 25 48% 7 12 58,33 25 57 43,86 6,00 19,00
30 Winarti, Amd. Kep 5 0 0 0 0 0 5 15 28 53,57 9 22 41% 5 12 41,67 29 62 46,77 15,00 14,00
31 Yenny Salfitriany.S.,S.K.M. 2 3 0 0 0 0 5 6 28 21,43 5 33 15% 11 18 61,11 22 79 27,85 6,00 16,00 320 796 40,201
32 Yuliana, Amd. Kep 0 5 0 0 0 0 5 6 28 21,43 7 33 21% 9 12 75,00 22 73 30,14 6,00 16,00
33 Dewi Mulyanti, Amd Keb 3 4 0 0 0 0 7 7 19 36,84 9 22 41% 8 15 53,33 24 56 42,86 7,00 17,00
34 Elisa Nurya Nainggolan, Amd. Keb 0 0 0 0 0 0 0 9 19 47,37 14 22 64% 12 15 80,00 35 56 62,50 9,00 26,00
35 Febriyanti Finelda, A.Md.Keb 2 1 9 0 0 0 12 7 19 36,84 10 22 45% 11 18 61,11 28 59 47,46 7,00 21,00
36 Kasmaliah, Amd.Keb 1 0 0 0 0 0 1 8 19 42,11 11 22 50% 8 15 53,33 27 56 48,21 8,00 19,00
37 Mira Lufti 1 0 0 0 0 0 1 8 19 42,11 0 30 0% 9 15 60,00 17 64 26,56 8,00 9,00
38 Nasrika, S.Tr.Keb 4 7 7 0 0 0 18 7 19 36,84 10 22 45% 11 18 61,11 28 59 47,46 7,00 21,00
39 Nurhikmah, Amd.Keb 2 10 0 0 0 0 12 6 19 31,58 9 22 41% 7 15 46,67 22 56 39,29 6,00 16,00
40 Nurul Ainun Jariah, Amd. Keb 3 5 0 0 0 0 8 7 19 36,84 14 22 64% 10 15 66,67 31 56 55,36 7,00 24,00
41 Sabrina Siyani, Amd.Keb 2 2 0 0 0 0 4 6 19 31,58 12 22 55% 7 15 46,67 25 56 44,64 6,00 19,00
42 Srianah, Amd.Keb 0 0 0 0 0 0 0 11 19 57,89 13 30 43% 15 21 71,43 39 70 55,71 11,00 28,00
43 Sulastri, Amd. Keb 0 0 6 0 0 0 6 8 19 42,11 5 22 23% 8 15 53,33 21 56 37,50 8,00 13,00
44 Syarifah Serli W, Amd. Keb 4 4 0 0 0 0 8 7 19 36,84 5 12 41,67 12 31 38,71 7,00 5,00
45 Tandariani. 0 0 18 0 0 0 18 0 16 0,00 1 9 11,11 1 25 4,00 - 1,00
46 Versa Deviana A., A.Md.Keb 0 0 12 0 0 0 12 12 19 63,16 19 36 53% 14 18 77,78 45 73 61,64 12,00 33,00
47 Vina Anggraini, Amd.Keb 3 10 25 0 0 0 38 4 16 25,00 9 22 41% 1 12 8,33 14 50 28,00 4,00 10,00
48 Wiwin Widyawati, Amd.Keb 0 0 0 0 0 0 0 10 19 52,63 14 22 64% 9 18 50,00 33 59 55,93 10,00 23,00
49 Annisa, A.Md. AK 2 0 0 0 0 0 2 16 16 100,00 8 12 66,67 24 28 85,71 16,00 8,00
50 Maulida, ST AK 2 0 0 0 0 0 2 14 16 87,50 16 22 73% 8 12 66,67 38 50 76,00 14,00 24,00
51 Ranisti Setia Putri, AMG 3 1 6 0 0 0 10 4 16 25,00 3 30 10% 17 18 94,44 24 64 37,50 4,00 20,00
52 Rimawati Mega Manurung, SKM 0 0 0 0 0 0 0 12 24 50,00 16 21 76,19 28 45 62,22 12,00 16,00
53 Safaruddin 0 0 0 0 0 0 0 16 32 50,00 3 33 9% 12 15 80,00 31 80 38,75 16,00 15,00
54 Mega Susila Wardana, A.Md.KL 1 1 0 0 0 0 2 21 32 65,63 19 21 90,48 40 53 75,47 21,00 19,00
55 Suharniati, S.K.M. 2 2 12 0 0 0 16 4 30 13,33 12 21 57,14 16 51 31,37 4,00 12,00
56 Rizky Arum, S.K.M. 1 1 0 0 0 0 2 17 33 51,52 20 21 95,24 37 54 68,52 17,00 20,00
57 Iffa Mukrimah, A.Md.KG 1 3 12 0 0 0 16 6 11 54,55 13 22 59% 8 9 88,89 27 42 64,29 6,00 21,00
58 Sulaiman ( P.GIGI ) 3 6 0 0 1 0 10 6 11 54,55 4 22 18% 3 9 33,33 13 42 30,95 6,00 7,00
59 Dina Puspitasari, Amd. Far 0 0 6 0 0 0 6 14 16 87,50 8 22 36% 13 15 86,67 35 53 66,04 14,00 21,00
 REKAPITULASI PENILAIAN KINERJA (FORM E)
Masa Penilaian Tanggal : Oktober s/d Desember 2020

KETIDAKHADIRAN
Komulatif FORM B FORM C1 FORM C2 TOTAL %
(DT,PC) KETIDAK Total FORM FORM
NO NAMA FORM B, CAPAIA
LUPA HADIRAN Target B C
IZIN S CUTI TK Capaian Target % Capaian Target % Capaian Target % C1, dan C2 N
ABSEN menit

60 Dio Aulia Putra 2 0 0 0 0 0 2 8 16 50,00 2 6 33,33 10 22 45,45 8,00 2,00

61 Mas'ida, Amd. Far 1 0 9 0 0 0 10 14 16 87,50 7 22 32% 9 15 60,00 30 53 56,60 14,00 16,00
62 Rusgiati, Amd. Farm 2 1 0 0 0 0 3 16 16 100,00 12 22 55% 11 15 73,33 39 53 73,58 16,00 23,00
63 Surahim 0 0 0 0 0 0 0 23 27 85,19 8 9 88,89 31 36 86,11 23,00 8,00
64 Muhammad Syahroni 1 0 0 0 0 0 1 12 16 75,00 4 6 66,67 16 22 72,73 12,00 4,00
65 Rahmadani 3 1 0 1 0 0 5 12 16 75,00 5 6 83,33 17 22 77,27 12,00 5,00
66 Syarwani 1 0 0 0 0 0 1 21 27 77,78 12 22 55% 4 6 66,67 37 55 67,27 21,00 16,00 70 99 70,7071
67 Junaidi 0 0 0 0 0 0 0 20 26 76,92 3 9 33,33 23 35 65,71 20,00 3,00
68 Endi Setiawan 4 0 0 0 0 0 4 19 31 61,29 10 12 83,33 29 43 67,44 19,00 10,00
69 Rido Musharizal Prabowo 0 0 0 0 0 0 0 19 31 61,29 0 22 0% 5 12 41,67 24 65 36,92 19,00 5,00
70 Syafiatul Akma 0 14 0 0 0 0 14 18 31 58,06 5 12 41,67 23 43 53,49 18,00 5,00 76 151 50,3311
90 146 251 1 1 0 489 816 1701 47,97 536 1515 35,38 607 975 62,26 1959 4191 46,74
4191
Mengetahui
Kepala UPT Puskesmas Sidomulyo Ketua Tim Verifikator

dr. Solihin Wijaya Lili Indiani, SKM

NIP. 196604141999031002 NIP 196602181987112002

Evaluasi
Capaian Form B 47,97 %
Capaian Form C1 35,38 %
Capaian Form C2 62,26 %
Capaian Kinerja 46,74 %