FORM I

FORMULIR INSPEKSI PASAR

( UNTUK PETUGAS )

I. DATA UMUM :

1. NAMA PASAR :
2. ALAMAT PASAR :
3. NAMA PENGELOLA PASAR

: ( PENANNGGUNGJAWAB )
4. JUMLAH KIOS / LOS :
5. JUMLAH PEDAGANG :
6. JUMLAH ASOSIASI/
KELOMPOK PEDAGANG

II. DATA FISIK :

NO VARIABEL UPAYA BOBOT KOMPONEN YANG DINILAI NILAI SCORE

1 2 3 4 5 6
LOKASI
A 5
(N !" M"#$ %"! 5&&)
1. S'$" R' *" " U%% T"+"
2&
R",
2. T-"# +' !'+"# "-" -"' "0
2&
 "" '*""
3. T-"# +' !'+"# "-" -"' "0
2&
 "" #'*'!"#""
4. T-"# +' !'+"# "-" -"' "0
2&
'#"$
5. M'%" "+"$ !""0
2&
", '!"$
B BANGUNAN
PASAR 2&
Nili !"#i!l 2$$$
1 U!%! & 5 B",  " -"  "*", ", 1&&
 $'$ " -'," ' "+  " ",
' !"#
2 P&'(' )%'* 1. P'%"," " '" $'$" -' ,"
4 25
+*'* '+#"" (7,)
2. 87, -'," -'++"$
5
!',#"
3. L'" !77, "+" !7$
15
%%"! 15 %'+'
4. J""# +'%"+ '"%,"
-" '%7+7 ," ,,"$
-'," "," "$" &
% %"! 1& %'+' "+"
-"+"$ +'%7#
5. P'$+ $ -" -" "0" '"0""
' "* +'  $"0 -'," 7" 15
%"#"" -" "0" ","
3 R% '* "'(,) 1. 9'+ !"$ %   %"! 2&  -"
&5
-&'*&l,l ! "$ !"+"
2. P'*"0""" %%"! 1&& !;
3. T'$'- " +7 !'+ -" +'%"+ * *
+" ,"
4. T&!-( -&'%l'
/0' -'*' +' 15
!"''
4.1 T&!-( -&'%l' 1. M'" +'%"+ '"!" (!"
4
/0' -'*' / # 0 1&)
". T"0" #" "+ 4
. R"+" 2
*. K'%," 2
-. T,, 6& *% 2
2. K" #"$ -",, -," +, 4
3. A!"$ '%7+7, (+"!'") +-"#
+'"+ -" #" +-"#
15
' "*   #'-" " -" % -"0
-' $0#"
4. T'%"+ '%"" "0" 15
"," -'," "+" - ,
 (cold chain) '$0
(4<1& &=)
5. T'$'- " +'%"+ '* * "
>
"0" "," -" '"!"+"
6. T'%"+ ** +"," -!',#"
(!" 14):
". S" 6
. A %',"! >
?. S"!  " '%"," ! %"0
(!" 1&) :
". T'+ + 5
. K'%," 5
>. T'%"+ $"%"0 (!" 1&) :
". T'$"0 ($"%"0 "$"0
4
@ #'   ,)
. K'-" " 3
*. T'+ 3
. B'"$ "+", '!"
'"#+ ('#+7) @ +'%"+
'-#""
4.2 T&!-( -&'%l' 3 1. M'" +'%"+ '"!"
/0' -'*' "&)i'* -',": '%#"" "+"
%-"0
-'$0#" -'," +,,
%%"! 6& *% ( !" 2& )
". P' %#""  "+" 1&
. M-"0 -'$0#" 5
*. T,, %%"! 6& *% 5
2. M'" +'"+ -" "0" +"0" 2&
3. T'% "+ $"%"0 (!" 2&) :
". T'$"0 "$"0 -" #', &
. K'-" " 5
*. B'+ + 5
4. T'%"+ * * +"," - !',#"
(!" 2&) :
. D' ," $" &
. A %',"! 14
5. B'"$ '#+7 '!" '"# +
2&
-"
43 T&!-( -&'i ' 3 1. T'%"+ '"" %"#"" (
!" 2& )
!"''
 !('*#i- #i
". T'++ 4
. B"0" T"0" K""+ 3
*. P'%#"" R"+" 3
-. M-"0 -'$0#" 3
'. T,, M%"! 6& *% 3
2. T'%"+ * * +"," - !',#" (!"
2&):
". D'," $" 6
. A %',"! 14
3. T'%"+ * * '"!"+" (!"
2&) :
". K"+ 6
. A%" 4
*. T-"# '#""+ 4
-. M-"0 -'$0#" 6
4. P $" ", - ,  "#"  + # 1&
%'%7+7, "0" %'+"0 -"
"0" %"+", ''-" -"
+-"# '#""+
5. S"!" '%"," !%"0
(!" 1& ):
". T'++ 5
. K'%," 5
6. T'%"+ $"%"0 (!" 1&) :
". T'$"0 "$"0 -" #', &
. K'-" " 2
*. B'++ 2
?. B'"$ '#+7 '!" '"# + 1&
-" +'%"+ '-#""
44 A)& P)"i) 1 1. A-" '%$"0 ", '!"$ 15
-'," "+"$ !""0 "$"
2. P"#  %7! %7+7 $''-" 1&
"-7,/-'!%" '*"#
+'$"0
3. T'$'-" "'" "# #0$$ 1&
#'-""" ',",#+ 0'"
0-
4. T'$'-" "'" #0$$ 7,#" &
% "+ "",
5. T-"# "-" ,'"," " 1&
 6. T'$'-" +'%"+ $"%"0 $'+" 15
"-$ 1& %'+' 15

?. A-" "! -" +"-" %"$# 1&

-" #'!" #'-""" ",
'!"$

>. A-" +""%" ',0"" 1&

. A-"" "'" '$"" " 1&

44 K,'#()%"#i : 4
4 5.1 A(- &5 1. A+" (!" 4&)
". K"+ 2&
. T-"# 7*7 1&
*. T-"# %'"- +'%"+ 1&
'-#" '*+7
2. K'%," "+" *# -"
+-"# %'%,##" 4&
,'"," "
3. A+" -'," #'+  ,, " !'0
1& %'+' -!',#"
'",#"! '+ 2&
4 5.2 Di'+i'* &5 1. K'"-"" -  -  , (!" 4&)
". B'$0 15
. T-"# !'%" 15
*. B'"" +'", 1&
2. P'% #"" - - , ",
$'!"! +'#'" '*#" "
+'"+ -" (!" 4&) :
". B"0" ", #"+ 2&
. K'-" " 2&
3. P'+'% " !"+" -'," &
--, 0"$ !',#,
(*7$)
4 5.3 L'(i &5 1. K'"-"" !"+" (!" ?&) :
". K'-" " 15
. R"+" 15
*. T-"# ! * 15
-. T-"# '+"# 1&
'. M-"0 -'$0#" 15
 2. L"+"K"%" %"- T'%"+ 3&
** -" $''$"
%'%" #'%," #'
$"!" '%","

4 5.4 T'** &5 1. T,, !'" #'%," 4&

$'$ " -'," #'+'+ " ",
'!"#

2. T'-""+ ',"," +"," 2&

3. K "+ -" + -"# ! * 2&
4. P'*"0""" %   %"! 1&& ! ; 2&
4.5.5 V&'(il#i 1 M%"! 2& -" !"$ !"+" 1&&
4 5.6 P&'0' &5 I+'$+"$ '*"0"" *# 1&&
  + # %'!"# #" + ,"$
',7!"0" -" '%'$0"
"0" %"#"" %   %"! 1&& L ;
4 5. Pi'(% &5 K0$$ !7$/#7$ '"! -",,  &
#" -" $''$"
%',,  "#" + ", -""+
-#" -" %'++ $'- "+"
!"$+* +# %',0"!",
"+", "+" $'",," '!"
'"#+.
SANITASI 3&
C
 Nili Mi'i!l 3$$$
Ai) B&)#i0 4 1. A '$0 $'!"! +'$'-" 4&
1 -"!"% %!"0 %%"!
( 4& L+' ''-",",)
2. K"!+"$ " '$0 %'%'0 3&
$""+ #'$'0"+"
3. J""# $%' " '$0 2&
-'," $'+ *#+"# %  %"!
3& *%
4. P'," " '$0 -!"##" 1&
6 !" $'#"!
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 T,il&( ''%" +'$"0 -',"
%!"0 *# (!" 1&)
". T'$"0 5
. J%!"0 *# 5
2. T'$'- " "# -" " '$ 0 1&
-'," %!"0 *# -"
'"$ '+ #
3. T7!'+ -'," !'0' ",$" 1&
4. T'$'- " +'%"+ ** +"," &
-" $"
5. T'$'-" +'%"+ $"%"0 ", 1&
+'++
6. T'$'-" $'+# +"# -'," 1&
!", ''$"" ",
%'%'0 #'$'0"+"
?. L'+"# +7 !'+ %   %"! 1& %'+' 1&
-" '"! %"#"" -"
"0" %"#""
>. 9'+!"$ %%"! 2& -" 1&
!"$ !"+"
. P'*"0""" %   %"! 1&& !; 1&
1&. L"+" #'-" " +-"# !* 1&
%-"0 -'$0#" -',"
#'%," ", *#
P&'*,l0' S!-0 4 1. S'+ " # 7$/!77,/!7$ +'$'- " &
3 +'%"+ $"%"0 "$"0 -"
#',
2. T'%"+ $"%"0 +'"+ -"
(!" 2&) :
". B"0" #'-" " 5
. T-"# %-"0 '#""+ 5
*. K"+ 4
-. T'++ 3
'. M-"0 -'$0#" 3
3. T'$'-" "!"+ ',",#+
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