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1/129
NO
1 MDGS 12 MDGS 2
3 MDGS 3
SUB TOTAL
1 SCORE
1 PPI 1
2 PPI 2
3 PPI 3
4 PPI 4
5 PPI 5
6 PPI 5.1
7 PPI 68 PPI 7
9 PPI 7.1
10 PPI 7.1.1
11 PPI 7.2
12 PPI 7.3
13 PPI 7.4
14 PPI 7.5
15 PPI 8
16 PPI 9
17 PPI 10
18 PPI 10.1
19 PPI 11
SUB TOTAL
2 SCORE
1 SKP 1
2 SKP 2
3 SKP 3
4 SKP 4
5 SKP 5
6 SKP 6
7 SKP NoteSUB TOTAL
3 SCORE
1 APK 1
2 APK 1.1
ELEMENPENILAIAN
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2/129
3 APK 1.1.1
4 APK 1.1.2
5 APK 1.1.3
6 APK 1.2
7 APK 1.3
8 APK 1.4
9 APK 2
10 APK 2.1
11 APK 3
12 APK 3.1
13 APK 3.2
14 APK 3.2.1
15 APK 3.3
16 APK 3.417 APK 3.5
18 APK 4
19 APK 4.1
20 APK 4.2
21 APK 4.3
22 APK 4.4
23 APK 5
SUB TOTAL
7/24/2019 Check List Dokumen Instrumen Akreditasi RS 2012
3/129
4 SCORE
1 PPK 1
2 PPK 2
3 PPK 2.1
4 PPK 3
5 PPK 4
6 PPK 57 PPK 6
SUB TOTAL
5 SCORE
1 PAB 1
2 PAB 2
3 PAB 3
4 PAB 4
5 PAB 56 PAB 5.1
7 PAB 5.2
8 PAB 5.3
9 PAB 6
10 PAB 7
11 PAB 7.1
12 PAB 7.2
13 PAB 7.3
14 PAB 7.4
SUB TOTAL
6 SCORE
1 PP 1
2 PP 2
3 PP 2.1
4 PP 2.2
5 PP 2.3
6 PP 2.4
7 PP 3
8 PP 3.1
9 PP 3.210 PP 3.3
11 PP 3.4
12 PP 3.5
13 PP 3.6
14 PP 3.7
15 PP 3.8
16 PP 3.9
17 PP 4
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4/129
18 PP 4.1
19 PP 5
20 PP 6
21 PP 7
22 PP 7.1
SUB TOTAL
7 SCORE1 MKI 1
2 MKI 2
3 MKI 3
4 MKI 4
5 MKI 5
6 MKI 6
7 MKI 7
8 MKI 8
9 MKI 9
10 MKI 10
11 MKI 1112 MKI 12
13 MKI 13
14 MKI 14
15 MKI 15
16 MKI 16
17 MKI 17
18 MKI 18
19 MKI 19
20 MKI 19.1
21 MKI 19.1.1
22 MKI 19.2
23 MKI 19.3
24 MKI 19.4
25 MKI 20
26 MKI 20.1
27 MKI 20.2
28 MKI 21
SUB TOTAL
8 SCORE
1 AP 1
2 AP 1.13 AP 1.2
4 AP 1.3
5 AP 1.3.1
6 AP 1.4
7 AP 1.4.1
8 AP 1.5
9 AP 1.5.1
10 AP 1.6
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11 AP 1.7
12 AP 1.8
13 AP 1.9
14 AP 1.10
15 AP 1.11
16 AP 2
17 AP 318 AP 4
19 AP 4.1
20 AP 5
21 AP 5.1
22 AP 5.2
23 AP 5.3
24 AP 5.3.1
25 AP 5.4
26 AP 5.5
27 AP 5.6
28 AP 5.729 AP 5.8
30 AP 5.9
31 AP 5.9.1
32 AP 5.10
33 AP 5.11
34 AP 6
35 AP 6.1
36 AP 6.2
37 AP 6.3
38 AP 6.4
39 AP 6.5
40 AP 6.6
41 AP 6.7
42 AP 6.8
43 AP 6.9
44 AP 6.10
SUB TOTAL
9 SCORE
1 MFK 1
2 MFK 2
3 MFK 34 MFK 3.1
5 MFK 4
6 MFK 4.1
7 MFK 4.2
8 MFK 5
9 MFK 6
10 MFK 6.1
11 MFK 7
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6/129
12 MFK 7.1
13 MFK 7.2
14 MFK 7.3
15 MFK 8
16 MFK 8.1
17 MFK 8.2
18 MFK 919 MFK 9.1
20 MFK 9.2
21 MFK 10
22 MFK 10.1
23 MFK 10.2
24 MFK 11
25 MFK 11.1
26 MFK 11.2
27 MFK 11.3
SUB TOTAL
10 SCORE1 MPO 1
2 MPO 1.1
3 MPO 2
4 MPO 2.1
5 MPO 2.2
6 MPO 3
7 MPO 3.1
8 MPO 3.2
9 MPO 3.3
10 MPO 4
11 MPO 4.1
12 MPO 4.2
13 MPO 4.3
14 MPO 5
15 MPO 5.1
16 MPO 5.2
17 MPO 6
18 MPO 6.1
19 MPO 6.2
20 MPO 7
21 MPO 7.1SUB TOTAL
11 SCORE
1 PMKP 1
2 PMKP 1.1
3 PMKP 1.2
4 PMKP 1.3
5 PMKP 1.4
6 PMKP 1.5
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7/129
7 PMKP 2
8 PMKP 2.1
9 PMKP 3
10 PMKP 3.1
11 PMKP 3.2
12 PMKP 3.3
13 PMKP 414 PMKP 4.1
15 PMKP 4.2
16 PMKP 5
17 PMKP 5.1
18 PMKP 6
19 PMKP 7
20 PMKP 8
21 PMKP 9
22 PMKP 10
23 PMKP 11
SUB TOTAL12 SCORE
1 TKP 1
2 TKP 1.1
3 TKP 1.2
4 TKP 1.3
5 TKP 1.4
6 TKP 1.5
7 TKP 2
8 TKP 3
9 TKP 3.1
10 TKP 3.2
11 TKP 3.2.1
12 TKP 3.3
13 TKP 3.3.1
14 TKP 3.3.2
15 TKP 3.4
16 TKP 3.5
17 TKP 4
18 TKP 5
19 TKP 5.1
20 TKP 5.1.121 TKP 5.2
22 TKP 5.3
23 TKP 5.4
24 TKP 5.5
25 TKP 6
26 TKP 6.1
27 TKP 6.2
SUB TOTAL
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8/129
13 SCORE
1 HPK 1
2 HPK 1.1
3 HPK 1.1.1
4 HPK 1.2
5 HPK 1.3
6 HPK 1.47 HPK 1.5
8 HPK 1.6
9 HPK 2
10 HPK 2.1
12 HPK 2.1.1
13 HPK 2.2
14 HPK 2.3
15 HPK 2.4
16 HPK 2.5
17 HPK 3
18 HPK 419 HPK 5
20 HPK 6
21 HPK 6.1
22 HPK 6.2
23 HPK 6.3
24 HPK 6.4
25 HPK 6.4.1
26 HPK 7
27 HPK 7.1
28 HPK 8
29 HPK 9
30 HPK 10
31 HPK 11
SUB TOTAL
14 SCORE
1 KPS 1
2 KPS 1.1
3 KPS 2
4 KPS 3
5 KPS 4
6 KPS 57 KPS 6
8 KPS 6.1
9 KPS 7
10 KPS 8
11 KPS 8.1
12 KPS 8.2
13 KPS 8.3
14 KPS 8.4
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9/129
15 KPS 9
16 KPS 9.1
17 KPS 10
18 KPS 11
19 KPS 12
20 KPS 13
21 KPS 1422 KPS 15
23 KPS 16
24 KPS 17
SUB TOTAL
15 SCORE
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10/129
EVALUASI PENYELESAIAN DOKUMEN AKREDITASI
RS. AL IRSYAD SURABAYA
TAHUN 2015
DOKUMEN ACUAN KEBI!AKAN PEDOMAN"PANDUAN SPO DAN PRO#RAM KER!A
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11/129
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12/129
Reg!"#$ te%t"%g &e!"'"%"% "%e#te#$ ($ RS
Reg!"#$ P"%("% &e!"'"%"% "%e#te#$ )te*+"#, #e("#$ +o(e*"t-("!"+
Reg!"#$ &e!"'"%"% "%e#te#$
Reg!"#$ &e!"'"%"% "%e#te#$Reg!"#$ &e+/e*$"% $%o*+"#$ ("% &e*#et"% t$%(","% ,e(o,te*"%
Reg!"#$ &e!"'"%"% "%e#te#$
Reg!"#$ &e+/e*$"% "%e#te#$
Reg!"#$ &e!"'"%"% "%e#te#$ +o%$to*$%g &"#" "%e#te#$
Reg!"#$ &e!"'"%"% /e("
P*o#e(* /e(" ("% te%t"%g !"&o*"%%'"
P*o#e(* +o%$to*$%g &"#" /e("
Reg!"#$ &e!"'"%"% /e("
PMK 519-Me%,e#-Pe*-III-2011 Te%t"%g Pe(o+"% Pe%'e!e%gg"*""% Pe!"'"%"% A%e#te#$o!og$("% Te*"&$ I%te%#$ ($ RS
Reg!"#$ &e!"'"%"% "%e#te#$ Ke/$","% P"%("% P*o#e(* te%t"%g "#"% &"#$e% '"%g#e*"g"+ ($ #e!* *+" #",$t T Ke&"!"-P Pe!"'"%"% A%e#te#$
A"% M"%"! Ko%#$! Ke(o,te*"% I%(o%e#$" te%t"%g &e*#et"% t$%(","% ,e(o,te*"%Reg!"#$ te%t"%g ,o+%$,"#$ '"%g ee,t$ ("!"+ &e+/e*$"% e(,"#$ ("% $%o*+"#$
7/24/2019 Check List Dokumen Instrumen Akreditasi RS 2012
13/129
7/24/2019 Check List Dokumen Instrumen Akreditasi RS 2012
14/129
7/24/2019 Check List Dokumen Instrumen Akreditasi RS 2012
15/129
7/24/2019 Check List Dokumen Instrumen Akreditasi RS 2012
16/129
7/24/2019 Check List Dokumen Instrumen Akreditasi RS 2012
17/129
7/24/2019 Check List Dokumen Instrumen Akreditasi RS 2012
18/129
7/24/2019 Check List Dokumen Instrumen Akreditasi RS 2012
19/129
SCORE KETERAN#AN
32
2
7
2.3
10
10
3
6
5
0
10
10
8
10
8
10
7
10
7
2
0
116
5.8
8
8
8
9
8
8
49
8.2
8
2
7/24/2019 Check List Dokumen Instrumen Akreditasi RS 2012
20/129
8
18
7/24/2019 Check List Dokumen Instrumen Akreditasi RS 2012
21/129
0.8
5
7
5
7
7
77
45
6.4
0.0
1
1
1
5
2
1
5
2
55
2
4
5
2
5
5
7/24/2019 Check List Dokumen Instrumen Akreditasi RS 2012
22/129
2
2
5
5
5
70
3.25
2
7
5
0
0
0
6
0
23
3
0
0
3
3
0
0
0
39
2.1
2
12
2
2
2
2
5
4
4
7/24/2019 Check List Dokumen Instrumen Akreditasi RS 2012
23/129
0
0
2
2
5
2
22
2
0
3
2
3
0
0
0
3
30
0
0
5
5
5
0
5
0
6
5
5
56
1.4
0
00
0
0
0
2
2
2
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24/129
0
0
2
0
2
0
0
0
0
0
0
0
10
0.58
5
0
8
0
5
2
0
8
3
7
6
0
8
0
0
5
5
8
0
078
3.7
5
3
3
0
0
7/24/2019 Check List Dokumen Instrumen Akreditasi RS 2012
25/129
8
4
5
5
5
5
5
10
0
5
3
5
4
3
0
783.9
7
0
0
5
8
6
0
0
0
0
2
0
0
0
5
7
0
2
0
0
0
0
42
7/24/2019 Check List Dokumen Instrumen Akreditasi RS 2012
26/129
1.9
8
8
8
8
8
66
8
5
7
7
7
8
3
5
8
08
8
5
8
2
8
8
157
6.5
3
0
6
5
33
2
5
5
3
3
3
7/24/2019 Check List Dokumen Instrumen Akreditasi RS 2012
27/129
2
2
0
5
0
50
2.9
7/24/2019 Check List Dokumen Instrumen Akreditasi RS 2012
28/129
DA$TAR CHECKLIST DOKUMEN AKREDITAS
TAHUN 2012
NO
APK 1 Ke/$","% S,*$%$%g P"#$e%
P"%("% S,*$%$%g P"#$e%
P*o#e(* S,*$%$%g P"#$e%
PN
Do,+e% Re,"+ +e($#
APK 1.1 Ke/$","% &e%("t"*"% &"#$e% *":"t "!"% ("% &e%e*$+""% &"#$e% *":"t $%"&P"%("% &e%("t"*"% &"#$e% *":"t "!"% ("% &e%e*$+""% &"#$e% *":"t $%"&
P*o#e(* &e%("t"*"% &"#$e% *":"t "!"% ("% &e%e*$+""% &"#$e% *":"t $%"&
PN
Ke/$","% Pe%""%"% P"#$e% %t, O/#e*;"#$
P*o#e(* &e%""%"% &"#$e% %t, o/#e*;"#$
Ke/$","% &e%"%g"%"% &"#$e% /$!" t$(", te*#e($" te+&"t t$(* &"(" %$t '"%g ($t
P*o#e(* &e%"%g"%"% &"#$e% /$!" t$(", te*#e($" te+&"t t$(* &"(" %$t '"%g ($t
PN
APK 1.1.1 Ke/$","% TRIAG *e,"+ +e($#
> :e/#$te- /*o#*- !e"?et
APK 1.3 Ke/$","% RS ("!"+ +e%g$(e%t$=,"#$ "+/"t"% ("!"+ &o&!"#$ &"#$e%%'"
P*o#e(* +e%g"t"#$ +e+/"t"#$ +e%g*"%g$ "+/"t"%
Do,+e% $+&!e+e%t"#$ D"t" ",&"% RS
APK 1.4 Ke/$","% t*"%#e* &"#$e%P"%("% t*"%#e* &"#$e%
P*o#e(* t*"%#e* &"#$e%
Ke/$","% K*$te*$" +"#, @ ,e!"* &e!"'"%"% $%te%#$
P"%("% K*$te*$" +"#, @ ,e!"* &e!"'"%"% $%te%#$
PN
Do,+e% $+&!e+e%t"#$
> P*o#e# &e%'#%"% ,*$te*$"
> Re,"+ +e($#> Se*t$=,"#$ &e!"t$"% t*"%#e*
APK 2 > Ke/$","%- &"%("%- &*o#e(* t*"%#e* &"#$e%
> K*$te*$" t*"%#e*
Do,+e% $+&!e+e%t"#$
> Re,"+ +e($#
APK 2.1 Ke/$","% t*"%#e* &"#$e%
P"%("% Koo*($%"#$ &e!"'"%"%
Me($"! #t" /'!":#
Ke/$","% te%t"%g &e!"'"%"% DPP TP"%("% &e!"'"%"% DPP T
SPO &e!"'"%"% DPP T
Do,+e% $+&!e+e%t"#$ Re,"+ Me($#
APK 3 > Ke/$","% &e+!"%g"% &"#$e% te*+"#, t$
> P"%("% &e+!"%g"% &"#$e% te*+"#, t$
> P*o#e(* &e+!"%g"% &"#$e% te*+"#, t$
PN
> D$#"*ge P!"%%$%g $#t
Do,+e% $+&!e+e%t"#$ Re,"+ Me($#
APK 3.1 Ke/$","% R,"%P"%("% R,"%
P*o#e(* R,"%
PN
> K*$te*$" *,"% ,e RS !"$%
Do,+e% $+&!e+e%t"#$
> Re,"+ +e($#
> Mo
APK 3.2
SPO Re#+e "#"% &"#$e% ($/"t o!e DPP #e/e!+ &"#$e% &!"%g ("*$ *+" #",$t
Ke/$","% '"%g +e%et"&,"% /":" *e#+e "#"% &"#$e% ($/"t o!e DPP #e/e!+&"#$e% &!"%g ("*$ *+" #",$t
P"%("% *e#+e "#"% &"#$e% ($/"t o!e DPP #e/e!+ &"#$e% &!"%g ("*$ *+"
#",$t
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30/129
NOELEMEN
PENILAIANDOKUMEN ACUAN KEBI!AKAN PEDOMAN"PANDUAN SPO DAN PRO#RAM
KER!A
> Re,"+ +e($#
APK 3.2.1 Ke/$","% '"%g +e%et"&,"% *e#+e &"#$e% /e*$#$
". A!"#"% +"#, *+" #",$t.
/. Pe%e+"% ,e!"$%"% =#$, ("% !"$%%'" '"%g &e%t$%g.
. P*o#e(* ($"g%o#$# ("% &e%go/"t"% '"%g te!" ($!",,"%.
(. Pe+/e*$"% +e($,"+e%to#" ("% &e+/e*$"% o/"t :",t &!"%g.
e. St"t#-,o%($#$ &"#$e% :",t &!"%g.. I%#t*,#$ o!!o:>& - t$%(", !"%t.
Do,+e% $+&!e+e%t"#$
> Re,"+ +e($#
APK 3.3 Ke/$","% P*o#e(* &e+/"t"% *e#+e &( &e!"'"%"% R
P"%("% P*o#e(* &e+/"t"% *e#+e &( &e!"'"%"% R
P*o#e(* P*o#e(* &e+/"t"% *e#+e &( &e!"'"%"% R
Fo*+"t ("% I#$ Re#+e &e!"'"%"% R Do,+e% $+&e+e%t"#$ *e,"+ +e($#
APK 3.4 Ke/$","% R,"% P"#$e%
P"%("% R,"% P"#$%e
P*o#e(* R,"% P"#$e%PN
APK 3.5 Ke/$","% Pe%o!","% Pe!"'"%"% "t" Pe%go/"t"%
P"%("% Pe%o!","% Pe!"'"%"% "t" Pe%go/"t"%
Do,+e% $+&e+e%t"#$ *e,"+ +e($#
APK 4
P"%("% R,"% P"#$%e
P*o#e(* R,"% P"#$e%
Do,+e% $+&!e+e%t"#$
> Mo *,"%> Re,"+ +e($#
APK 4.1 > Ke/$","%- &"%("%- &*o#e(* *,"% &"#$e%
Do,+e% $+&!e+e%t"#$
> D"t"* RS (e%g"% &e!"'"%"%%'"
> Mo *,"%
APK 4.2 Ke/$","% R t*"%#e* $%te* o#&$t"!
P"%("% t*"%#e* $%te* o#&$t"!
P*o#e(* t*"%#e* $%te* o#&$t"!
Do,+e% $+&!e+e%t"#$
> Re,"+ +e($#
APK 4.3 Ke/$","%- &"%("%- &*o#e(*
Ke/$","% *,"% &"#$e% te*+"#, &e%("+&$%g T>%'"
P"%("% *,"% &"#$e% te*+"#, &e%("+&$%g T>%'"
P*o#e(* *,"% &"#$e% te*+"#, &e%("+&$%g T>%'"
Do,+e%t"#$ $+&!e+e%t"#$
> Re,"+ +e($#
APK 4.4 Do,+e% $+&!e+e%t"#$
> Re,"+ +e($#
APK 5 > Ke/$","% te%t"%g t*"%#&o*t"#$ *,"% &e+!"%g"%
> P"%("% te%t"%g t*"%#&o*t"#$ *,"% &e+!"%g"%
P*o#e(* te%t"%g t*"%#&o*t"#$ *,"% &e+!"%g"%
Ke/$","% R,"% P"#$e% te*+"#, Pe%"%gg%g ":"/ &e!"'"%"% *,"%t*"%&o*t"#$ *,"%
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31/129
NOELEMEN
PENILAIANDOKUMEN ACUAN KEBI!AKAN PEDOMAN"PANDUAN SPO DAN PRO#RAM
KER!A
> B,t$ &e+e!$"*""% t*"%#&o*t"#$
> Mo
SCORE
HPK 1 A"% 44-2009 te%t"%g RS
PN Pe+/e%t,"% TIM
SK Pe+/e%t,"% TIM
Ke/$","% )Pe*"t*"% ("% SK te%t"%g ", &"#$e% ("% ,e!"*g"Pe(o+"%
P*o#e(*
I+&!e+e%t"#$
Reg!"#$
HPK 1.1 Ke/$","% Pe!"'"%"% Ke*o"%$"% )D$#e/t,"% No+o* SK Ke/$","%
PN
P"%("% Pe!"'"%"% Ke*o"%$"%
SPO &e!"'"%"% ,e*o"%$"%
A(" /e/e*"&" +""+ SPO ($ Pe!"'"%"% Ke*o"%$"%
Fo*+!$* &e*+$%t""% &e!"'"%"% ,e*o"%$"%
I+&!e+e%t"#$ )Fo*+!$* Pe*+$%t""% Pe!"'"%"% Ke*o"%$"%
HPK 1.1.1 Reg!"#$ RS
Ke/$","%
P"%("% Pe!"'"%"% Ke*o"%$"%
SPO &e!"'"%"% ,e*o"%$"%
Fo*+!$* &e*+$%t""% &e!"'"%"% ,e*o"%$"%
Reg!"#$
I+&!e+e%t"#$ +e+e*!,"% Reg!"#$
HPK 1.2 Ke/$","% &e!"'"%"% #e#"$ ,e/t"% &*$;"#$ &"#$e%
P"%("% &e!"'"%"% #e#"$ ,e/t"% &*$;"#$ &"#$e%
SPO &e!"'"%"% #e#"$ ,e/t"% &*$;"#$ &"#$e%
HPK 1.3 Kete%t"% RS te%t"%g &"'" &e*!$%(%g"% "*t" +$!$, &"#$e%
Ke/$","% &"'" &e*!$%(%g"% "*t" +$!$, &"#$e%
Pe(o+"% &"'" &e*!$%(%g"% "*t" +$!$, &"#$e%
P*o#e(* &"'" &e*!$%(%g"% "*t" +$!$, &"#$e%
PN
HPK 1.4 Ke/$","% &e*!$%(%g"% te*"("& ,e,e*"#"% =#$,
P"%("% &e*!$%(%g"% te*"("& ,e,e*"#"% =#$,
SPO &e*!$%(%g"% te*"("& ,e,e*"#"% =#$,
Do,+e% $+&!e+e%t"#$ D"t"* &e%g%%g RS
HPK 1.5 Ke/$","%
P"%("% &e!$%(%g"% te*"("& ,e,e*"#"% =#$,
SPO &e*!$%(%g"% te*"("& ,e,e*"#"% =#$,
Do,+e% $+&!e+e%t"#$ D"t"* ,e!o+&o, '"%g /e*$#$,o
HPK 1.6
Ke/$","% te%t"%g &e*!$%(%g"% te*"("& ,e*""#$"% $%o*+"#$ &"#$e%
Pe(o+"% te%t"%g &e*!$%(%g"% te*"("& ,e*""#$"% $%o*+"#$ &"#$e%
P*o#e(* te%t"%g &e*!$%(%g"% te*"("& ,e*""#$"% $%o*+"#$ &"#$e%
A"% 29-2004 te%t"%g P*",t$, Ke(o,te*"% 36-2009 te%t"%g Ke#e"t"% 44-2009 te%t"%g R+" #",$t PP 10-1966 te%t"%g "$/ S$+&"% R""#$" Ke(o,te*"%
K /$ , , $, $ ,t$ t , ( , t !$/ t $ ( , !
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NOELEMEN
PENILAIANDOKUMEN ACUAN KEBI!AKAN PEDOMAN"PANDUAN SPO DAN PRO#RAM
KER!A
> Ke/$","% "*" +e+&e*o!e #eo%( o&$%$o% ($ ("!"+ "t" ($ !"* RS
> P"%("% "*" +e+&e*o!e #eo%( o&$%$o% ($ ("!"+ "t" ($ !"* RS
> SPO "*" +e+&e*o!e #eo%( o&$%$o% ($ ("!"+ "t" ($ !"* RS
Do,+e% $+&!e+e%t"#$
> B,t$ &e!",#"%""% &e!"t$"%
HPK 2.1 > Ke/$","% te%t"%g &e%e!"#"% ", &"#$e% ("!"+ &e!"'"%"%
> P"%("% te%t"%g &"%("% &e*#et"% t$%(","% ,e(o,te*"%
> Ke/$","% SPO te%t"%g &"%("% &e*#et"% t$%(","% ,e(o,te*"%
Do,+e%
> Fo*+!$* &e+/e*$"% e(,"#$
> Fo*+!$* &e*#et"% - &e%o!","% t$%(","% ,e(o,te*"%
HPK 2.1.1 Ke/$","% te%t"%g &e%e!"#"% ", &"#$e% ("!"+ &e!"'"%"%
Pe(o+"% &e%e!"#"% ", &"#$e% ("!"+ &e!"'"%"%
P*o#e(* &e%e!"#"% ", &"#$e% ("!"+ &e!"'"%"%
Do,+e%
> M"te*$ &e%e!"#"%
> Fo*+!$* &e+/e*$"% &e%e!"#"%-e(,"#$
HPK 2.2 Ke/$","% te%t"%g &e%e!"#"% ", &"#$e% ("!"+ &e!"'"%"%
P"%("% te%t"%g &e%e!"#"% ", &"#$e% ("!"+ &e!"'"%"%
SPO te%t"%g &e%e!"#"% ", &"#$e% ("!"+ &e!"'"%"%
PN
Do,+e%
> Fo*+!$* &e%o!","% &e%go/"t"%
HPK 2.3 > Ke/$","% &e%o!","% *e##$t"#$ )DNR
> P"%("% &e%o!","% *e##$t"#$ )DNR
> SPO &e%o!","% *e##$t"#$
> Fo*+!$* &e%o!","% *e##$t"#$
HPK 2.4 > Ke/$","% +"%"e+e% %'e*$
> P"%("% +"%"e+e% %'e*$> SPO "#e#+e% %'e*$
> SPO &e!"'"%"% ,e(o,te*"% te%t"%g +"%"e+e% %'e*$
HPK 2.5 > Ke/$","% &e!"'"%"% &"#$e% t""& te*+$%"!
> P"%("% &e!"'"%"% &"#$e% t""& te*+$%"!
> SPO &e!"'"%"% &"#$e% t""& te*+$%"!
Do,+e%t"#$ &e!"'"%"% ("!"+ *e,"+ +e($#
HPK 3 Reg!"#$ RS Ke/$","%%'" /e*&" Pe*"t*"% F!o:"*t ($&$#" (g P*o#e(*
P"%("% ,o+%$,"#$ ee,t$ %t, +e%(o*o%g ,ete*!$/"t"% &"#$e% ("% ,e!"*g"%'"("!"+ &*o#e# &e!"'"%"%
SPO ,o+%$,"#$ ee,t$ %t, +e%(o*o%g ,ete*!$/"t"% &"#$e% ("% ,e!"*g"%'" ("!"+&*o#e# &e!"'"%"%
> Se*t$=,"#$ &e!"t$"% #t" te%t"%g ,o+%$,"#$ &e+/e*$"% $%o*+"#$ ("% e(,"#$'"%g ee,t$
Ke/$","% &e%'e!e#"$"% ,o+&!"$% ,e!"% ,o%?$, "t" &e*/e(""% &e%("&"t &"#$e%
("% ,e!"*g"
P"%("% &e%'e!e#"$"% ,o+&!"$% ,e!"% ,o%?$, "t" &e*/e(""% &e%("&"t &"#$e%("% ,e!"*g"
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NOELEMEN
PENILAIANDOKUMEN ACUAN KEBI!AKAN PEDOMAN"PANDUAN SPO DAN PRO#RAM
KER!A
> B,t$ &e+/e*$t""% &*o#e# ,o+&!"$% "t" ,e!"%
> B,t$ "%"!$#$# ("% te!""
> "&o*"% &e%'e!e#"$"% ,o+&!"$% ,e!"% ,o%?$, "t" &e*/e(""% &e%("&"t
HPK 4 Ke/$","% te%t"%g $(e%t$=,"#$ %$!"$>%$!"$ ("% ,e&e*"'""% &"#$e% ("!"+ &e!"'"%"%
P"%("% te%t"%g $(e%t$=,"#$ %$!"$>%$!"$ ("% ,e&e*"'""% &"#$e% ("!"+ &e!"'"%"%
SPO te%t"%g $(e%t$=,"#$ %$!"$>%$!"$ ("% ,e&e*"'""% &"#$e% ("!"+ &e!"'"%"%
HPK 5 A"% 29-2004 te%t"%g P*",t$, Ke(o,te*"%
44-2009 te%t"%g R+" S",$t
Ke/$","% te%t"%g &e+/e*$"% $%o*+"#$ ", ("% t"%gg%g ":"/ &"#$e%
P"%("% te%t"%g &e+/e*$"% $%o*+"#$ ", ("% t"%gg%g ":"/ &"#$e%
SPO te%t"%g &e+/e*$"% $%o*+"#$ ", ("% t"%gg%g ":"/ &"#$e%
Fo*+!$* ", ("% t"%gg%g ":"/ &"#$e%
HPK 6
Ke/$","% te%t"%g &e*#et"% t$%(","% ,e(o,te*"%
Pe(o+"% te%t"%g &e*#et"% t$%(","% ,e(o,te*"%
P*o#e(* te%t"%g &e*#et"% t$%(","% ,e(o,te*"%
> D"t"* t$%(","% '"%g +e+e*!,"% &e*#et"% te*t!$#
Do,+e% $%o*+e( o%#e%t Fo*+!$* &e*#et"%- &e%o!","%
HPK 6.1 > Ke/$","% te%t"%g &e+/e*$"% $%o*+"#$ te*+"#, *e%"%" &e%go/"t"%
> P"%("% te%t"%g &e+/e*$"% $%o*+"#$ te*+"#, *e%"%" &e%go/"t"%
> SPO te%t"%g &e+/e*$"% $%o*+"#$ te*+"#, *e%"%" &e%go/"t"%
Ke/$","% te%t"%g &e%et"&"% DPPP"%("% te%t"%g &e%et"&"% DPP
SPO te%t"%g &e%et"&"% DPP
Do,+e%
> Fo*+!$* &e+/e*$"% $%o*+"#$
> Fo*+!$* &e%et"&"% DPP
HPK 6.2
Reg!"#$ RS
Ke/$","% te%t"%g &e*#et"% t$%(","% ,e(o,te*"%P"%("% te%t"%g &e*#et"% t$%(","% ,e(o,te*"%
SPO te%t"%g &e*#et"% t$%(","% ,e(o,te*"%
Do,+e%
> Fo*+!$* &e*#et"%-&e%o!","% t$%(","% ,e(o,te*"%
HPK 6.3 Ke/$","% te%t"%g &e%e!"#"% ("% &e*#et"% ++
Pe(o+"% te%t"%g &e%e!"#"% ("% &e*#et"% ++
P*o#e(* te%t"%g &e%e!"#"% ("% &e*#et"% ++
Do,+e% Fo*+!$* &e*#et"% ++
HPK 6.4
A"% 29-2004 te%t"%g P*",t$, Ke(o,te*"% 44-2009 te%t"%g R+" S",$t
PMK 290-2008 te%t"%g Pe*#et"% T$%(","% Ke(o,te*"% M"%"! Pe*#et"%T$%(","% Ke(o,te*"% KKI 2006
A"% PMK 290-2008 te%t"%g &e*#et"% t$%(","% ,e(o,te*"% Ke&t#"% D$*e%C"%+e( HK.00.06.3.5.1866 te%t"%g Pe(o+"% Pe*#et"% T$%(","% Me($, )I%o*+e(o%e%t 1999
A"% PMK 290-2008 te%t"%g &e*#et"% t$%(","% ,e(o,te*"% Ke&t#"% D$*e%C"%+e( HK.00.06.3.5.1866 te%t"%g Pe(o+"% Pe*#et"% T$%(","% Me($, )I%o*+e(o%e%t 1999
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NOELEMEN
PENILAIANDOKUMEN ACUAN KEBI!AKAN PEDOMAN"PANDUAN SPO DAN PRO#RAM
KER!A
P"%("% te%t"%g &e*#et"% t$%(","% ,e(o,te*"%
SPO te%t"%g &e*#et"% t$%(","% ,e(o,te*"%
Do,+e% Fo*+!$* &e*#et"%-&e%o!","% t$%(","% ,e(o,te*"%
HPK 6.4.1
HPK 7
Do,+e%
> Fo*+!$* &e+/e*$"% $%o*+"#$
> Fo*+!$* &e*#et"% +e%g$,t$ &e%e!$t$"%
HPK 7.1 Reg!"#$ RS
Do,+e% Fo*+!$* &e*#et"%- &e%o!","%
HPK 8 Reg!"#$ RS
Do,+e%
> Do,+e% $%o*+"#$
> Fo*+!$* &e*#et"%- &e%o!","% ,e$,t #e*t""% ("!"+ &e%e!$t$"% ,!$%$#
HPK 9 Reg!"#$ RS
> Ke&t#"% &e%et"&"% ,o+$te -&"%$t$" et$, &e%e!$t$"%
> P*og*"+ ,e*" ,o+$te et$, &e%e!$t$"%
HPK 10 Reg!"#$ RS
HPK 11 A"% 36-2009 te%t"%g Ke#e"t"%
Reg!"#$ RS
Do,+e%
> Fo*+!$* &e*#et"%-&e%o!","% (o%o*- t*"%#&!"%t"#$
t*"%#&!"%t"#$
> Ke*"#"+" (e%g"% !e+/"g" ,e+"#'"*","t"%
SCORE
AP 1 A"% PMK 269-Me%,e#-Pe*-III-2008 Reg!"#$ RS
SK T$+
PN
Pe(o+"%-P"%("% Me($#
Pe(o+"%-P"%("% Ke&e*":"t"%
SPO A#e#+e% P"#$e%
PN
Ke&e*":"t"% ("% Me($#
Do,+e% H"#$! "#e#+e% &"(" *e,"+ +e($#
AP 1.1 A"% PMK 269-Me%,e#-Pe*-III-2008 KMK te%t"%g #t"%("* &*oe#$
D"t"* t$%(","% ("% &e%go/"t"% '"%g +e+e*!,"% &e*#et"% &"#$e% "t" ,e!"*g"Do,+e%t"#$ *"&"t &e+/""#"% ("t"* te*#e/t
Ke/$","% te%t"%g &e+/e*$"% $%o*+"#$ te*+"#, +e%("&"t,"% "#$! &e%e!$t$"% '"%g+e%'"%g,t &e%go/"t"% &"#$e%
Pe(o+"% &e+/e*$"% $%o*+"#$ te*+"#, +e%("&"t,"% "#$! &e%e!$t$"% '"%g+e%'"%g,t &e%go/"t"% &"#$e%
P*o#e(* &e+/e*$"% $%o*+"#$ te*+"#, +e%("&"t,"% "#$! &e%e!$t$"% '"%g+e%'"%g,t &e%go/"t"% &"#$e%
> Ke/$,"% Pe(o+"% &e%go*g"%$#"#$"% ("% &e(o+"% &e!"'"%"% ,o+$te et$,&e%e!$t$"%
Do,+e% $%o*+"#$ te%t"%g t"t" "*" %t, +e%'+/"%g o*g"% t/ ("% "*$%g"%t/ !"$%%'"
Ke/$","% te%t"%g A#e#+e% P"#$e% te*+"#, I%o*+"#$ P"#$e% R":"t "!"% ("%R":"t I%"& '"%g "*# ($&e*o!e
Ke/$","% te%t"%g Pe!" "%"% Re,"+ Me($# te%t"%g "#e#+e% &"#$e% ,*e(e%#$"!$%g
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35/129
NOELEMEN
PENILAIANDOKUMEN ACUAN KEBI!AKAN PEDOMAN"PANDUAN SPO DAN PRO#RAM
KER!A
Ke/$","% Pe!"'"%"% A#e##+e%t P"#$e%
Ke/$","% K*e(e%#$"!
Ke/$","% Pe+/e*$"% Ke:e%"%g"%
Pe(o+"%-P"%("% "#e#+e% &"#$e% ,*e(e%#$"!$%g &e+/e*$"% ,e:e%"%g"%
SPO "#e#+e% &"#$e% ,*e(e%#$"!$%g &e+/e*$"% ,e:e%"%g"%
PN
Do,+e% A#e#+e% &"#$e% *":"t $%"& A#e#+e% &"#$e% *":"t "!"%
AP 1.2 A"% PMK 269-Me%,e#-Pe*-III-2008 Reg!"#$ RS
Ke/$","% te%t"%g "#e#+e% &"#$e%
Pe(o+"%-P"%("% "#e#+e% &"#$e%
SPO "#e#+e% &"#$e%
PN
Ke/$","% te%t"%g Pe!"'"%"% Re,"+ Me($#
Pe(o+"%-P"%("% Pe!"'"%"% Re,"+ Me($#
SPO Pe!"'"%"% Re,"+ Me($#
PN
Do,+e% Re,"+ +e($# *":"t "!"% Re,"+ +e($# *":"t $%"&
AP 1.3 29 2004 te%t"%g P*",t$, Ke(o,te*"% PMK 269-Me%,e#-Pe*-III-2008Ke/$","% te%t"%g Pe!"'"%"% Re,"+ Me($#
Pe(o+"% P"%("% te%t"%g Pe!"'"%"% Re,"+ Me($#
SPO te%t"%g Pe!"'"%"% Re,"+ Me($#
Ke/$","% te%t"%g A#e#+e% P"#$e% Me($# Ke&e*":"t"%
P"%("%-Pe(o+"% A#e#+e% P"#$e% Me($# Ke&e*":"t"%
SPO A#e#+e% P"#$e% Me($# Ke&e*":"t"%
PN
Do,+e% Re,"+ +e($# *":"t "!"% Re,"+ +e($# *":"t $%"&
AP 1.3.1 A"% PMK 269-Me%,e#-Pe*-III-2008
Ke/$","% te%t"%g Pe!"'"%"% Re,"+ Me($#
Pe(o+"%-P"%("% te%t"%g Pe!"'"%"% Re,"+ Me($#SPO te%t"%g Pe!"'"%"% Re,"+ Me($#
PN
Ke/$","% te%t"%g A#e#+e% P"#$e% G":"t D"**"t O&e*"#$
Pe(o+"%-P"%("% te%t"%g A#e#+e% P"#$e% G":"t D"**"t O&e*"#$
SPO te%t"%g A#e#+e% P"#$e% G":"t D"**"t O&e*"#$
Do,+e% Re,"+ +e($# g":"t ("**"t
AP 1.4 Ke/$","% te%t"%g A#e#+e% P"#$e%
P"%("%-Pe(o+"% A#e#+e% P"#$e%
SPO A#e#+e% P"#$e%
PN
Do,+e% Re,"+ +e($#
AP 1.4.1 Ke/$","% te%t"%g A#e#+e% P"#$e%
P"%("%-Pe(o+"% A#e#+e% P"#$e%
SPO A#e#+e% P"#$e%
PN
Do,+e% Re,"+ +e($#
AP 1.5 Ke/$","% te%t"%g Pe!"'"%"% Re,"+ Me($#
P"%("%-Pe(o+"% Pe!"'"%"% Re,"+ Me($#
SPO Pe!"'"%"% Re,"+ Me($#
P"%("%-Pe(o+"% te%t"%g A#e#+e% P"#$e%
Ke/$","% te%t"%g A#e#+e% P"#$e% te%t"%g &e%"t"t"% &"(" !o,"#$ te*te%t )"t"t"%Te*$%teg*"#$
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NOELEMEN
PENILAIANDOKUMEN ACUAN KEBI!AKAN PEDOMAN"PANDUAN SPO DAN PRO#RAM
KER!A
P"%("%-Pe(o+"% te%t"%g &e%"t"t"% &"(" !o,"#$ te*te%t )"t"t"% Te*$%teg*"#$
SPO te%t"%g te%t"%g &e%"t"t"% &"(" !o,"#$ te*te%t )"t"t"% Te*$%teg*"#$
PN
Do,+e% Re,"+ +e($#
AP 1.5.1 Ke/$","% te%t"%g A#e#+e% P"#$e% te*+"#, &"#$e% ","% ($o&e*"#$
P"%("%-Pe(o+"% A#e#+e% P"#$e% te*+"#, &"#$e% ","% ($o&e*"#$SPO A#e#+e% P"#$e% te*+"#, &"#$e% ","% ($o&e*"#$
PN
Do,+e% Re,"+ +e($#
AP 1.6 Ke/$","% te%t"%g "#e#+e% &"#$e%
P"%("%-Pe(o+"% "#e#+e% &"#$e%
SPO "#e#+e% &"#$e%
Ke/$","% te%t"%g "#e#+e% !"%t %t*$#$
P"%("%-Pe(o+"% "#e#+e% !"%t %t*$#$
SPO "#e#+e% !"%t %t*$#$
PN
Ke/$","% te%t"%g "#e#+e% !"%t %g#$o%#"!
P"%("%-Pe(o+"% "#e#+e% !"%t %g#$o%#"!
SPO "#e#+e% !"%t %g#$o%#"!
PN
Do,+e% H"#$! "#e#+e% ($ *e,"+ +e($# B,t$ ,o%#!t"#$
AP 1.7 Ke/$","% te%t"%g "#e#+e% %'e*$
P"%("%-Pe(o+"% "#e#+e% %'e*$
SPO "#e#+e% %'e*$
PN
Do,+e% H"#$! "#e#+e% ("% t$%(", !"%t%'" ($ *e,"+ +e($# B,t$ ,o%#!t"#$
AP 1.8 Ke/$","% te%t"%g "#e#+e% t"+/""%-,##
P"%("%-Pe(o+"% "#e#+e% t"+/""%-,##
SPO "#e#+e% t"+/""%-,##
PN
Do,+e% H"#$! "#e#+e% ("% t$%(", !"%t%'" ($ *e,"+ +e($#
AP 1.9 Reg!"#$ RS Ke/$","% te%t"%g "#e#+e% &"#$e% te*+$%"!
P"%("% "#e#+e% &"#$e% te*+$%"!
SPO "#e#+e% &"#$e% te*+$%"!
PNDo,+e% H"#$! "#e#+e% ("% t$%(", !"%t%'" ($ *e,"+ +e($#
AP 1.10 Reg!"#$ RS Ke/$","% te%t"%g "#e#+e% &"#$e%
P"%("% "#e#+e% &"#$e%
SPO "#e#+e% &"#$e%
PN
Do,+e% H"#$! "#e#+e% ,## ("% t$%(", !"%t%'" ($ *e,"+ +e($#
AP 1.11 Reg!"#$ RS Ke/$","% te%t"%g *e%"%" &e+!"%g"% &"#$e%
P"%("% *e%"%" &e+!"%g"% &"#$e%
SPO *e%"%" &e+!"%g"% &"#$e%
PN
Do,+e% H"#$! $(e%t$=,"#$ ("% *e%"%" &e+!"%g"% ($ *e,"+ +e($#
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NOELEMEN
PENILAIANDOKUMEN ACUAN KEBI!AKAN PEDOMAN"PANDUAN SPO DAN PRO#RAM
KER!A
AP 3 Ke/$","% te%t"%g "#e#+e% &"#$e% ,*e(e%#$"!$%g &e+/e*$"% ,e:e%"%g"%
P"%("% "#e#+e% &"#$e% ,*e(e%#$"!$%g &e+/e*$"% ,e:e%"%g"%
SPO "#e#+e% &"#$e% ,*e(e%#$"!$%g &e+/e*$"% ,e:e%"%g"%
PN
Do,+e% *"$"% tg"# :e:e%"%g Re,"+ +e($#
AP 4
AP 4.1
AP 5 Pe(o+"% P*",t$, "/o*"to*$+ Ke#e"t"% C"%g Be%"* De&,e# 2008
Ke/$","% &e!"'"%"% !"/o*"to*$+ &e!"'"%"% !"/o*"to*$+ !"*
Pe(o+"% &e!"'"%"% !"/o*"to*$+ &e!"'"%"% !"/o*"to*$+ !"*
SPO &e!"'"%"% !"/o*"to*$+ &e!"'"%"% !"/o*"to*$+ !"*PN
Ke/$","%
P"%("% Pe%'#%"% P*og*"+ Ke*" "/o*"to*$+
P*og*"+ !"/o*"to*$+
PN
Do,+e% Se*t$=,"t +t Mo (e%g"% !"/o*"to*$+ ($!"* *+" #",$t
AP 5.1
Reg!"#$ RS Ke/$","%-Pe(o+"%-SPO &e!"'"%"% !"/o*"to*$+
Pe(o+"%
SPO
Ke/$","% Ke#e!"+"t"%-Ke"+"%"% !"/o*"to*$+
P*og*"+ Ke#e!"+"t"%-Ke"+"%"% !"/o*"to*$+
Ke/$","%-P"%("%-SPO te%t"%g B3 ("% APD
P"%("%
SPO
Ke/$","-P"%("%-SPO te%t"%g K3RS
P"%("%SPO
Do,+e% Pe!",#"%""% &e!"t$"%
AP 5.2
Ke/$","% Pe%go*g"%$#"#$"% "/o*"to*$+
Pe(o+"% &e%go*g"%$#"#$"% !"/o*"to*$+ )&o!" ,ete%"g""%
Do,+e% Se*t$=,"t ,o+&ete%#$
Ke/$","%-Pe(o+"%-P"%("%-SPO te%t"%g Pe!"'"%"% Re,"+ Me($# te%t"%g A#e#+e%P"#$e% te%t"%g A#e#+e% te*$%teg*"#$ te%t"%g &e%"t"t"% &"(" !o,"#$ te*te%t)"t"t"% Te*$%teg*"#$ Do,+e% Re,"+ +e($#
Ke/$","%-Pe(o+"%-P"%("%-SPO te%t"%g Pe!"'"%"% Re,"+ Me($# te%t"%g A#e#+e%P"#$e% te%t"%g A#e#+e% te*$%teg*"#$ Pe%et"&"% &*$o*$t"# "#"% te%t"%g&e%"t"t"% &"(" !o,"#$ te*te%t )"t"t"% Te*$%teg*"#$ te%t"%g &e+/e*$"% $%o*+"#$"#$!>*e%"%" "#"%. Do,+e% Re,"+ +e($#
A"% KMK 432-Me%,e#-SK-IE-2007 te%t"%g Pe(o+"% M"%"e+e% Ke#e"t"% ("%Ke#e!"+"t"% Ke*" )K3 ($ R+" S",$t KMK 1087-Me%,e#-SK-EIII-2010 te%t"%gSt"%("* Ke#e"t"% ("% Ke#e!"+"t"% Ke*" ($ R+" S",$t Pe(o+"% P*",t$,"/o*"to*$+ Ke#e"t"% C"%g Be%"* De&,e# 2008
A"% KMK 370 t"% 2007 te%t"%g #t"%("* &*oe#$ "!$ te%o!og$ !"/o*"to*$+,e#e"t"% Reg!"#$ RS
Ke/$","%-Pe(o+"%-P"%("%-SPO te%t"%g ,o+&ete%#$,*e(e%#$"!$%g &e+/e*$"%,e:e%"%g"%
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NOELEMEN
PENILAIANDOKUMEN ACUAN KEBI!AKAN PEDOMAN"PANDUAN SPO DAN PRO#RAM
KER!A
Do,+e% "&o*"% "#$!
AP 5.3.1 Reg!"#$ RS P*og*"+ +t &e!"'"%"% !"/o*"to*$+
Ke/$","%
P*o#e(* te%t"%g H"#$! ,*$t$#
Do,+e% "&o*"% H"#$!
AP 5.4 A"% Pe(o+"% O&e*"#$o%"! ("% Pe+e!$"*""% Pe*"!"t"% Ke#e"t"% De&,e# 2001
AP 5.5 Reg!"#$ RS Ke/$","% Pe(o+"% &e!"'"%"% "*+"#$ )te%t"%g &e%ge!o!""% *e"ge%#$"
Pe(o+"% &e!"'"%"% "*+"#$ )te%t"%g &e%ge!o!""% *e"ge%#$"
Do,+e% D"t"* *e"ge%#$" "&o*"% #to, ("% &*o#e# &e%g"(""% *e"ge%#$"
AP 5.6 Reg!"#$ RS Ke/$","%-Pe(o+"%-SPO &e!"'"%"% !"/o*"to*$+
AP 5.7
AP 5.8
AP 5.9 Reg!"#$ RS P*og*"+ +t !"/o*"to*$+ Do,+e% B,t$ &e!",#"%""% &*og*"+
AP 5.9.1 Do,+e% B,t$ PMI ("% PM< !"/o*"to*$+
AP 5.10
AP 5.11 Do,+e% Pe%et"&"% (o,te* #&e#$"!$# ($ *+" #",$t S*"t &e%g"#"% ,!$%$#
AP 6
Ke/$","%-Pe(o+"%-SPO &e!"'"%"% *"($o!og$ ("% ($"g%o#t$, $+"$%g
Pe(o+"%
SPO
PN
AP 6.1 Ke/$","% SPO &e!"'"%"% *"($o!og$
Pe(o+"% &e!"'"%"% *"($o!og$
SPO &e!"'"%"% *"($o!og$PN
Do,+e% Mo (e%g"% &e!"'"%"% *"($o!og$ ($ !"* *+" #",$t
AP 6.2
Ke/$","% &e!"'"%"% R"($o!og$ ("% ($"g%o#t$, $+"$%g
P"%("%
SPO
Ke/$","% P*og*"+ Ke#e!"+"t"% R"($o!og$
P*og*"+ Ke#e!"+"t"%-Ke"+"%"% R"($o!og$ ("% ($"g%o#t$, $+"$%g
Ke/$","% te%t"%g B3 ("% APD
Reg!"#$ P*og*"+ Pe+e!$"*""% A!"t Do,+e% B,t$ &*o#e# &e%ge!o!""% &e*"!"t"%B,t$ &e+e!$"*""% /e*,"!" B,t$ ,"!$/*"#$
Reg!"#$ RS Ke/$","%-Pe(o+"%-SPO &e!"'"%"% !"/o*"to*$+ Do,+e% H"#$!&e+e*$,#""% !"/o*"to*$+
Reg!"#$ RS Ke/$","%-Pe(o+"%-SPO &e!"'"%"% !"/o*"to*$+ te*+"#,&e%go*g"%$#"#$"%%'" Do,+e% SK Ke&"!" Pe!"'"%"% "/o*"to*$+ Pe%%,"%B,t$&e!",#"%""%
Do,+e% SK &e%%,"% "/o*to*$+ !"* Mo (e%g"% !"/o*"to*$+ !"*-!"$%
P*o#e(* &e!",#"%""% ,o%t*o! +t "&o*"% te%t"%g &e!",#"%""% ,o%t*o! +t
A"% KMK 1012-Me%,e#-SK-II-2008 te%t"%g St"%("* Pe!"'"%"% R"($o!og$D$"g%o#t$, ($ S"*"%" Pe!"'"%"% Ke#e"t"%
A"% KMK 432-Me%,e#-SK-IE-2007 te%t"%g Pe(o+"% M"%"e+e% Ke#e"t"% ("%Ke#e!"+"t"% Ke*" )K3 ($ R+" S",$t
KMK 1087-Me%,e#-SK-EIII-2010 te%t"%g St"%("* Ke#e"t"% ("% Ke#e!"+"t"% Ke*" ($R+" S",$t Reg!"#$
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NOELEMEN
PENILAIANDOKUMEN ACUAN KEBI!AKAN PEDOMAN"PANDUAN SPO DAN PRO#RAM
KER!A
Ke/$"," te%t"%g K3RS
P"%("%
SPO
Do,+e% Pe!",#"%""% &e!"t$"%
AP 6.3
Pe(o+"%
Pe(o+"%
SPO
Do,+e% Se*t$=,"t ,o+&ete%#$
AP 6.4 P*og*"+ +t &e!"'"%"% *"($o!og$ ("% ($"g%o#t$, $+"$%g
Ke/$","% &e!"'"%"% R"($o!og$ ("% ($"g%o#t$, $+"$%g
Pe(o+"%
SPOPN
AP 6.5
AP 6.6
AP 6.7
AP 6.8
AP 6.9
AP 6.10 Do,+e% Pe%et"&"% (o,te* #&e#$"!$# ($ *+" #",$t S*"t &e%g"#"% ,!$%$#
SCORE
PP 1 Ke/$","% te%t"%g "#"% &"#$e% '"%g #e*"g"+ ($ #e!* *+" #",$tPN
Ke&t#"% Pe+/e%t,"% TIM P"%("% A#e##+e%t Me($#
Ke/$","% Pe+/e*!","% P"%("%
P"%("% A#e##+e%t Me($# )"#"% &"#$e% '"%g #e*"g"+ ($ #e!* *+" #",$t
P*o#e(* "#"% &"#$e% '"%g #e*"g"+ ($ #e!* *+" #",$t
PN
PP 2 Ke/$","% +e%ge%"$ &e%g$%teg*"#$"% ("% ,oo*($%"#$ ",t$;$t"# "#"% &"#$e%
PN
Pe+/e%t,"% T$+ Pe(o+"%
Reg!"#$ RS Pe(o+"% &e%go*g"%$#"#$"% *"($o!og$ ("% ($"g%o#t$, $+"$%g )&o!",ete%"g""%
Ke/$","% te%t"%g ,o+&ete%#$ ,*e(e%#$"!$%g &e+/e*$"% ,e:e%"%g"% SK &e%%,"%
Do,+e% H"#$! &e+e*$,#""% *"($o!og$ ("% ($"g%o#t$, $+"$%g
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NOELEMEN
PENILAIANDOKUMEN ACUAN KEBI!AKAN PEDOMAN"PANDUAN SPO DAN PRO#RAM
KER!A
PN
Ke/$","% te%t"%g Re,"+ Me($#
Pe(o+"%-P"%("%
SPO
PN
PP 2.1 Reg!"#$ Pe+/e*$"% "#"% &"#$e%Ke/$","% te%t"%g Re,"+ Me($#
Pe(o+"%-P"%("%
SPO
PN
PP 2.2 Ke/$","% '"%g +e%et"&,"% te%t"%g
o Pe+/e*$"% "#"% &"#$e%
o T$"& &e%ge"!$"% ($ &e!"'"%"% ,## #e&e*t$ IGD ("% %$t Pe!"'"%"% I%te#$
o Ko+&ete%#$-,e:e%"%g"% PPK 'g +e%!$#,"% &e*$%t"
Do,+e% $+&!e+e%t"#$
> Re,"+ +e($#
> Fo*+!$* &e*+$%t""% &e+e*$,#""%
PP 2.3 Ke/$","% te%t"%g t$%(","% $%;"#$ ("% %o% $%;"#$
Pe(o+"%-P"%("%
SPOPN
Do,+e% $+&!e+e%t"#$
> Re,"+ +e($#
PP 2.4 Ke/$","% Ko+%$,"#$ &e+/e*$"% $%o*+"#$ ("% e(,"#$ '"%g ee,t$
P"%("%
SPO &e+/e*$"% $%o*+"#$
PN
Ke/$","% te%t"%g I%#$(e% Ke#e!"+"t"% P"#$e%
P"%("% te%t"%g I%#$(e% Ke#e!"+"t"% P"#$e%
SPO te%t"%g I%#$(e% Ke#e!"+"t"% P"#$e%PN
Fo*+!$* &e+/e*$"% $%o*+"#$
PP 3 Ke/$","% &e!"'"%"% P"#$e% *$#$,o t$%gg$
P"%("% &e+/e*$"% &e!"'"%"% *$#$,o t$%gg$
P*o#e(* &e+/e*$"% &e!"'"%"% *$#$,o t$%gg$
PN
Do,+e% $+&!e+e%t"#$
> D"t"* &"#$e% ("% &e!"'"%"% 'g /e*$#$,o t$%gg$
> Se*t$=,"#$-/,t$ &e!"t$"% PPK
PP 3.1 Ke/$","% ("% &*o#e(* +e%g"*","% &e!"'"%"% ,"## e+e*ge%#$
SK T$+
Do,+e% $+&!e+et"#$ Pe%"/"*"% (g% &o!" SOAP )S/e,t$ O/e,t$ A#e#+e% P!"%($ *e,"+ +e($#
o Pe*+$%t""% &e+e*$,#""% ($"g%o#t$, $+"$%g ("% &e+e*$,#""% !"/o*"to*$+ ,!$%$,
te*+"#, $%($,"#$ ,!$%$#- *"#$o%"!
o ($!o,"#$ +"%" &e*$%t" te*#e/t ($"t"t ("!"+ *e,"+ +e($# &"#$e% ".!. "t"t"%Te*$%teg*"#$
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NOELEMEN
PENILAIANDOKUMEN ACUAN KEBI!AKAN PEDOMAN"PANDUAN SPO DAN PRO#RAM
KER!A
PN
Ke/$","% &e!"'"%"% &"#$e% g":"t ("**"t
P"%("%
P*o#e(*
PN
Do,+e% $+&!e+e%t"#$
> Re,"+ +e($#> Se*t$=,"#$-/,t$ &e!"t$"% PPK
PP 3.2
Reg!"#$ RS
Ke/$","% &e!"'"%"% *e##$t"#$
P"%("%
P*o#e(*
PN
Do,+e% $+&!e+e%t"#$
> Re,"+ +e($#
PP 3.3
Reg!"#$ RS
P"%("%
P*o#e(*
PN
Do,+e% $+&!e+e%t"#$
> Re,"+ +e($#
> Se*t$=,"#$-/,t$ &e!"t$"% PPK
PP 3.4
Reg!"#$ RS
Ke/$","% &e!"'"%"% &"#$e% t""& te*+$%"!
P"%("%
P*o#e(*
PN
PP 3.5
Reg!"#$ RS
Ke/$","% &e!"'"%"% &"#$e% (e%g"% &e%'",$t +e%!"*P"%("%
P*o#e(*
PN
Do,+e% $+&!e+e%t"#$
> Re,"+ +e($#
> Se*t$=,"#$-/,t$ &e!"t$"% PPK
PP 3.6 Ke/$","% ("% &*o#e(* +e%g"*","% &e!"'"%"% &"#$e% ($"!$#$# )$ ("*"
Reg!"#$ RS
Ke/$","% ("% &*o#e(* +e%g"*","% &e!"'"%"% &"#$e% ($"!$#$# )$ ("*"
Do,+e% $+&!e+e%t"#$
> Re,"+ +e($#
> Se*t$=,"#$-/,t$ &e!"t$"% PPK
Ke/$","% ("% &*o#e(* +e%g"*","% &e%"%g"%"% &e!"'"%"% *e##$t"#$ ($ #e!*%$t *+" #",$t
Ke/$","% ("% &*o#e(* +e%g"*","% &e%"%g"%"% &e%gg%""% ("% &e+/e*$"%("*" ("% ,o+&o%e% ("*".
Ke/$","%- &"%("%- &*o#e(* &e%"%g"%"% &e%gg%""% ("% &e+/e*$"% ("*" ("%,o+&o%e% ("*".
Ke/$","% ("% &*o#e(* +e%g"*","% &e!"'"%"% &"#$e% '"%g +e%gg%","%&e*"!"t"% /"%t $(& ("#"* "t" '"%g ,o+".
Ke/$","% ("% &*o#e(* +e%g"*","% &e!"'"%"% &"#$e% (e%g"% &e%'",$t +e%!"*("% +e*e," '"%g ("'" t""%%'" ($*e%(","%.
Ke/$","% ("% &*o#e(* +e%g"*","% &e%gg%""% "!"t &e%g"!"%g )*e#t*"$%t ("%
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NOELEMEN
PENILAIANDOKUMEN ACUAN KEBI!AKAN PEDOMAN"PANDUAN SPO DAN PRO#RAM
KER!A
Ke/$","% &e!"'"%"% &"#$e% (e%g"% "!"t &e%g"!"%g- &e%g$,"t )*e#t*"$%t
P"%("%
P*o#e(*
PN
Do,+e% $+&!e+e%t"#$
> Re,"+ +e($#
PP 3.8
Reg!"#$ RS
P"%("%
P*o#e(*
PN
Do,+e% $+&!e+e%t"#$
> Re,"+ +e($#
> Se*t$=,"#$-/,t$ &e!"t$"% PPK
PP 3.9
Ke/$","% &e!"'"%"% &"#$e% ,e+ote*"&$
P"%("%
P*o#e(*
PN
> Se*t$=,"#$-/,t$ &e!"t$"% PPK
PP 4 Ke/$","% &e!"'"%"% g$$
P"%("% &e!"'"%"% g$$
P*o#e(* &e!"'"%"% g$$
PNKe/$","% &e+/e*$"% e(,"#$
SPO &e+/e*$"% e(,"#$
Fo*+!$* &e+/e*$"% e(,"#$
Do,+e% $+&!e+e%t"#$
D"t"* +e% +","%"% &"#$e% *":"t $%"&
Pe%g,"$"% #t"t# g$$ ("!"+ *e,"+ +e($#
PP 4.1 Ke/$","% Pe!"'"%"% g$$
P"%("% Pe!"'"%"% G$$
P*o#e(* &e%'$"&"% +","%"%
P*o#e(* &e%'$+&"%"% +","%"%
P*o#e(* &e%'"!*"% +","%"%Do,+e% $+&!e+e%t"#$
> "&o*"% &*o#e#-,eg$"t"%
> "(:"! &e+/e*$"% +","%"%
> Ke/$","%- P"%("%- &*o#e(* &e!"'"%"% &"#$e% ,e+ote*"&$
> Se*t$=,"#$-/,t$ &e!"t$"% PPK
PP 5 Ke/$","% Pe!"'"%"% g$$
P"%("% &e!"'"%"% g$$
P*o#e(* &e*e%"%""% te*"&$ %t*$#$
P*o#e(* &e+/e*$"% te*"&$ %t*$#$
P*o#e(* +e+o%$to* te*"&$ %t*$#$
PN
Do,+e% $+&!e+e%t"#$
Pe%g,"$"% #t"t# g$$ ("!"+ *e,"+ +e($#
Ke/$","% ("% &*o#e(* +e%g"*","% "#"% &"#$e% #$" !"%t +e*e," '"%g ""t"%",>"%", ("% &o&!"#$ '"%g /e*$#$,o ($#$,#".
Ke/$","% &e!"'"%"% &"#$e% *e%t"% !"%t #$" "%",>"%", (e%g"% ,ete*g"%t%g"%/"%t"% ("% *$#$,o ,e,e*"#"%.
Ke/$","% ("% &*o#e(* +e%g"*","% &e!"'"%"% &"(" &"#$e% '"%g +e%("&"t,e+ote*"&$ "t" te*"&$ *$#$,o t$%gg$.
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NOELEMEN
PENILAIANDOKUMEN ACUAN KEBI!AKAN PEDOMAN"PANDUAN SPO DAN PRO#RAM
KER!A
P"%("% M"%"e+e% N'e*$
SPO M"%"e+e% N'e*$
PN
Do,+e% $+&!e+e%t"#$
> Pe%g,"$"% %'e*$ ("!"+ *e,"+ +e($#
> Do,+e% &e!"t$"%
PP 7 Reg!"#$ RS
P"%("%
SPO
PN
P"%("%
SPO
PN
PP 7.1 Reg!"#$ RS
SCORE
Ke/$","% &e!"'"%"% &"#$e% t""& te*+$%"! '"%g +e+"t Se#"$ SPO
A#e#+e% &"#$e%
+e+"#t$,"% /":" ge"!">ge"!"%'" ","% ($!",,"% "#e#+e% ("% ($,e!o!" #e"*"
te&"t.
+e+"#t$,"% /":" &"#$e% (e%g"% &e%'",$t te*+$%"! ($!"'"%$ (e%g"% o*+"t ("%
*e#&e,.
+e!",,"% "#e#+e% ,e"(""% &"#$e% #e#e*$%g +%g,$% #e#"$ ,e/t"% %t,
+e%g$(e%t$=,"#$ ge"!">ge"!". +e*e%"%","% &e%(e,"t"% &*e;e%t$ ("% te*"&et$, ("!"+ +e%ge!o!" ge"!">
ge"!".
+e%'"+&"$,"% $# '"%g #e%#$t$ #e&e*t$ "to$ ("% (o%"#$ o*g"%
+e%go*+"t$ %$!"$ '"%g ($"%t &"#$e% "g"+" ("% &*ee*e%#$ /("'"
+e%g$,t#e*t","% &"#$e% ("% ,e!"*g"%'" ("!"+ #e+" "#&e, &e!"'"%"%
+e+/e*$ *e#&o% &"(" +"#"!">+"#"!" $,o!og$# e+o#$o%"! #&$*$t"! ("% /("'"
("*$ &"#$e% ("% ,e!"*g"%'".
+e%($($, #t" te%t"%g &e%ge!o!""% ge"!">ge"!".
Do,+e% $+&!e+e%t"#$
Re,"+ +e($#
Ke/$","%- P"%("%- &*o#e(* &e!"'"%"% &"#$e% t""& te*+$%"! '"%g +e+"t
A#e#+e% &"#$e%
+e+"#t$,"% /":" ge"!">ge"!"%'" ","% ($!",,"% "#e#+e% ("% ($,e!o!" #e"*"
te&"t.
+e+"#t$,"% /":" &"#$e% (e%g"% &e%'",$t te*+$%"! ($!"'"%$ (e%g"% o*+"t ("%
*e#&e,. +e!",,"% "#e#+e% ,e"(""% &"#$e% #e#e*$%g +%g,$% #e#"$ ,e/t"% %t,
+e%g$(e%t$=,"#$ ge"!">ge"!".
+e*e%"%","% &e%(e,"t"% &*e;e%t$ ("% te*"&et$, ("!"+ +e%ge!o!" ge"!">
ge"!".
+e%'"+&"$,"% $# '"%g #e%#$t$ #e&e*t$ "to$ ("% (o%"#$ o*g"%
+e%go*+"t$ %$!"$ '"%g ($"%t &"#$e% "g"+" ("% &*ee*e%#$ /("'"
+e%g$,t#e*t","% &"#$e% ("% ,e!"*g"%'" ("!"+ #e+" "#&e, &e!"'"%"%
+e+/e*$ *e#&o% &"(" +"#"!">+"#"!" $,o!og$# e+o#$o%"! #&$*$t"! ("% /("'"
("*$ &"#$e% ("% ,e!"*g"%'".
+e%($($, #t" te%t"%g &e%ge!o!""% ge"!">ge"!".
Do,+e% $+&!e+e%t"#$
Re,"+ +e($#
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NOELEMEN
PENILAIANDOKUMEN ACUAN KEBI!AKAN PEDOMAN"PANDUAN SPO DAN PRO#RAM
KER!A
PAB 1
Reg!"#$ RS
Reg!"#$ te%t"%g &e!"'"%"% "%e#te#$ ($ RS
Ke/$","%
Pe(o+"%-P"%("%
SPO
PNDo,+e%
> D"t"* &e!"'"%"% "%e#te#$ #e("#$ +o(e*"t-("!"+
PAB 2 Reg!"#$ &e!"'"%"% "%e#te#$
P"%("%
P*o#e(*
PN
Do,+e% Re,"+ +e($#
PAB 3 Ke/$","% Pe!"'"%"% "%e#te#$ )te*+"#, #e("#$ +o(e*"t-("!"+
P"%("% Pe!"'"%"% A%"#te#$
SPO Pe!"'"%"% A%"#te#$
Do,+e%
> Kete*!$/"t"% PPK (!+ &e%'#%"% ,e/$","% &*o#e(*
> D"t"* PPK #e("#$
> S*"t ,o+&ete%#$-,e:e%"%g"% &"*" PPK te*,"$t
> A#e#+e% &*"#e("#$ ("!"+ *e,"+ +e($# &"#$e%
> H"#$! &e+"%t""% &"#$e% #e!"+" #e("#$
> K*$te*$" %t, &e+!$"% ("*$ #e("#$
PAB 4 Reg!"#$ &e!"'"%"% "%e#te#$
Do,+e%
> D"t"* PPK "%e#te#$ ,o+&ete%#$-,e:e%"%g"%
> B,t$ &e%"t"t"% "#e#+e% &*""%e#te#$ ("% &*"$%(,#$ ("!"+ *e,"+ +e($#
PAB 5 Reg!"#$ &e!"'"%"% "%e#te#$
Do,+e%
> B,t$ &e%"t"t"% &e*e%"%""% &e!"'"%"% "%e"te#$ ("!"+ *e,"+ +e($#
PAB 5.1 Ke/$","% &e+/e*$"% $%o*+"#$ ("% &e*#et"% t$%(","% ,e(o,te*"%
P"%("%
SPO
PN
Do,+e% Ko+&ete%#$-,e:e%"%g"% PPK "%e#te#$
M"te*$ e(,"#$
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PAB 5.2 Reg!"#$ &e!"'"%"% "%e#te#$ Do,+e%
Reg!"#$ &e!"'"%"% "%e#te#$ Do,+e%
PAB 5.3 Reg!"#$ &e+/e*$"% "%e#te#$ Do,+e%
Ke/$","% Mo%$to*$%g #e!"+" &e+/e*$"% "%"#te#$
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PAB 6 Reg!"#$ &e!"'"%"% "%e#te#$ +o%$to*$%g &"#" "%e#te#$
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> D"t"* #+/e* "%e#te#$ ("*$ !"* RS /e*("#"*,"% *e,o+e%("#$ ($*e,t*-,e&"!"-PPe!"'"%"% A%e#te#$
Ke/$","% te%t"%g "#"% &"#$e% '"%g #e*"g"+ ($ #e!* *+" #",$t TKe&"!"-P Pe!"'"%"% A%e#te#$
B,t$ "#$! &e+"%t""% #t"t# =#$o!og$# &"#$e% #e!"+" &e+/e*$"% "%e#te#$ ("!"+
*e,"+ +e($#
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NOELEMEN
PENILAIANDOKUMEN ACUAN KEBI!AKAN PEDOMAN"PANDUAN SPO DAN PRO#RAM
KER!A
D"t"* PPK &e!"'"%"% *"%g &!$
H"#$! &e+"%t""% #e!"+" ($ *"%g &e+!$"% ("!"+ *e,"+ +e($#
K*$te*$" &e+$%(""% &"#$e% ("*$ %$t &"#" "%e#te#$-*"%g &!$
PAB 7 Reg!"#$ &e!"'"%"% /e("
Pe(o+"%
SPO
PN
Do,+e% Ke:e%"%g"% ,!$%$#
A#e#+e% &*" o&e*"#$ ("!"+ *e,"+ +e($#
PAB 7.1 A"%
M"%"! Ko%#$! Ke(o,te*"% I%(o%e#$" te%t"%g &e*#et"% t$%(","% ,e(o,te*"%
> Fo*+!$* $%o*+e( o%#e%t
> Fo*+!$* &e*#et"%- &e%o!","% t$%(","% ,e(o,te*"%
PAB 7.2 P*o#e(* /e(" ("% te%t"%g !"&o*"%%'" Do,+e% > "&o*"% o&e*"#$ ("!"+ *e,"+ +e($# &"#$e%
PAB 7.3 P*o#e(* +o%$to*$%g &"#" /e(" Do,+e%
PAB 7.4 Reg!"#$ &e!"'"%"% /e(" Do,+e%
SCORE
MPO 1
Reg!"#$ RS
Ke/$","% &e!"'"%"% "*+"#$ !e%g,"&
Ke/$","% &e%go*g"%$#"#$"% "*+"#$
PN Pe(o+"%
Pe(o+"% &e%go*g"%$#"#$"% "*+"#$
St*,t* o*g"%$#""#$
*"$"% tg"# +"#$g>+"#$%g #t"
MPO 1.1 Reg!"#$ RS
Pe(o+"% &e%go*g"%$#"#$"% "*+"#$ )*"$"% "/"t"% #&e;$#o*
SK &e%g"%g,"t"% #&e*;$#o* )STRA ("% SIPA !e%g,"&
Do,+e% I+&!e+e%t"#$
> "t"t"% #&e*;$#$
MPO 2 SK Pe+/e*!","%
PN
> Me+$!$,$ Fo*+!"*$+ RS
> Ke/$","% te%t"%g &e%"%g"%"% /$!" te*"($ ,et$(",te*#e($""% #to, o/"t ($ RS
> P*o#e(* te%t"%g &e%"%g"%"% /$!" te*"($ ,et$(",te*#e($""% #to, o/"t ($ RS
Do,+e% $+&!e+e%t"#$
Reg!"#$ te%t"%g ,o+%$,"#$ '"%g ee,t$ ("!"+ &e+/e*$"% e(,"#$ ("% $%o*+"#$Do,+e%
> B,t$ &e+"%t""% #t"t# =#$o!og$# &"#$e% #e!"+" &e+/e(""% ("!"+ *e,"+ +e($#
> B,t$ *e%"%" "#"% &"#" /e(" ("!"+ Reg!"#$ &e!"'"%"% /e(" Do,+e% > B,t$ *e%"%" "#"% &"#" /e(" ("!"+
A"% 44-2009 te%t"%g R+" S",$t KMK 1197-2004 te%t"%g St"%("* Pe!"'"%"%F"*+"#$ R+" S",$t
Do,+e% I+&!e+e%t"#$ Fo*+!"*$+ *+" #",$t @$%o o/"t ($ $t &e!"'"%"% B,t$*e;$e: #'#te+ +"%"e+e% o/"t
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NOELEMEN
PENILAIANDOKUMEN ACUAN KEBI!AKAN PEDOMAN"PANDUAN SPO DAN PRO#RAM
KER!A
> Mo (e%g"% &e+"#o, o/"t
MPO 2.1 Ke/$","% &e%g":"#"% &e%gg%""% o/"t ("% &e%g"+"%"% o/"t
SK Pe+/e%t,"% PFT
Pe(o+"% Pe%g":"#"% Pe%gg%""% O/"t ("% Pe%g"+"%"% O/"t
> Pe(o+"% &e!"'"%"% "*+"#$ te%t"%g &e%g":"#"% ("% ($#t*$/#$ o/"t ($ RS
PNDo,+e% $+&!e+e%t"#$
> K*$te*$" +e%"+/" ("% +e%g*"%g$ o/"t ("!"+ o*+!"*$+
> Fo*+ #!"% o/"t /"*
> Fo*+ +o%$to*$%g &e%gg%""% o/"t /"* ("% KTD
> P*o#e# *e;$#$ o*+!"*$+ )+$%$+"! #et"% #e,"!$ ("% Not!e% *"&"t
MPO 2.2
> SPO /$!" &e*#e($""% o/"t-#to,,o#o%g
> SPO /$!" "*+"#$ tt&-&e*#e($""% o/"t te*,%$
PN
Do,+e% $+&!e+e%t"#$
MPO 3 Ke/$","% &e%'$+&"%"% o/"t !e%g,"& %t, +"#$%g +"#$%g "*e" &e%'$+&"%"%
Pe(o+"% &e%'$+&"%"% o/"t !e%g,"& %t, +"#$%g +"#$%g "*e" &e%'$+&"%"%
Ke/$","% &e!"/e!"% o/"t o/"t ("% /""% ,$+$" '"%g ($g%","% +e%'$"&,"% o/"t
Pe(o+"% &e!"/e!"% o/"t o/"t ("% /""% ,$+$"
SPO &e!"/e!"% o/"t o/"t ("% /""% ,$+$"
Ke/$","% &e!"&o*"% o/"t ("*$ %$t
SPO Pe!"&o*"% O/"tPN
Do,+e% $+&!e+e%t"#$
> "&o*"% %"*,ot$, @ $,ot*o&$,
> B,t$ &e!"/e!"% o/"t ("% /""% ,$+$" '"%g ($g%","% +e%'$"&,"% o/"t
> Do,+e%-"t"t"% $%#&e,#$ /e*,"!"
> Fo*+!$* *e,o%#$!$"#$ o/"t
MPO 3.1 Reg!"#$
Pe(o+"% &e!"'"%"% te%t"%g &e%'$+&"%"% &*o(, %t*$#$ *"($o",t$ ("% o/"t #"+&!e> SPO &e%'$+&"%"% &*o(, %t*$#$
> SPO &e%'$+&"%"% *"($o",t$
> SPO &e%'$+&"%"% o/"t #"+&e!
PN
MPO 3.2
> SPO &e%'$+&"%"% o/"t e+e*ge%#$ ($ +"#$%g>+"#$%g %$t
> SPO &e%gg"%t$"% o/"t e+e*ge%#$ '"%g *#", "t" ,"("!"*#"
PN
Do,+e% I+&!e+e%t"#$ "t"t"% #&e*;$#e-&e%gg"%t$"% o/"t e+e*ge%#$
MPO 3 3 Ke/$","% &e%"*$,"% o/"t
Reg!"#$ /$!" &e*#e($""% o/"t-#to,,o#o%g ("% /$!" "*+"#$ tt&-&e*#e($""% o/"tte*,%$
> B, "t"t"% ("% Fo*+!$* &e*+$%t""% o/"t-"!,e# /$!" #to, ,o#o%g-t$(", te*#e($" ($RS
Ke/$","% &e!"'"%"% te%t"%g &e%'$+&"%"% &*o(, %t*$#$ *"($o",t$ ("% o/"t#"+&!e
Ke/$","% &e%'$+&"%"% o/"t e+e*ge%#$ #t"%("* o/"t e+e*ge%#$ ($ +"#$%g>+"#$%g%$t.
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NOELEMEN
PENILAIANDOKUMEN ACUAN KEBI!AKAN PEDOMAN"PANDUAN SPO DAN PRO#RAM
KER!A
Ke/$","% &e%ge!o!""% o/"t ,"("!"*#"
Pe(o+"%
SPO
Ke/$","% &e+#%""% o/"t
Pe(o+"%
SPO
PN
Do,+e% I+&!e+e%t"#$ Be*$t" ""*" &e+#%""% o/"t
MPO 4
SPO te!"" *e,o%#$!$"#$ o/"t
Do,+e% $+&!e+e%t"#$
> R"&"t P"%$t$" F"*+"#$ ("!"+ +e%'#%-+e%g+/"%g,"% Ke/$","% ("% SPO
> Pe!"t$"% #t" ("!"+ &e%!$#"% *e#e& &e+e#"%"% o/"t &e%"t"t"% o/"t
> Fo*+!$* *e,o%#$!$"#$ o/"t
MPO 4.1 > Ke/$","% &e%!$#"% *e#e& +e+"t 9 e!e+e%
> P"%("% &e%!$#"% *e#e& +e+"t 9 e!e+e%
Do,+e% $+&!e+e%t"#$
> Re#e& #e#"$ ,e/$","%
MPO 4.2 Ke/$","% &e%!$#"% *e#e& ++ #e#"$ ,ete%t"% &e*%("%g>%("%g"%
MPO 4.3
PN
Do,+e% $+&!e+e%t"#$
MPO 5 Ke/$","% &e!"'"%"% te%t"%g &e%'$"&"% ("% &e%'"!*"% o/"t ("% &*o(, #te*$!
Do,+e% I+&!e+e%t"#$
Se*t$=,"t &e!"t$"% te,%$, "#e&t$ %t, &etg"# te*,"$t
MPO 5.1
SPO Pe%e!"""% ,ete&"t"% *e#e& #e/e!+ &e+/e*$"% )+$%$+"! 7 e!e+e%
SPO +e%g/%g$ &etg"# /$!" t!$#"% *e#e&-&e#"%"% t", e!"#-t$+/! &e*t"%'""%
P"%("% te!"" $%te*",#$ o/"t )/$!" /e!+ +e+$!$,$ #ot>:"*e (*g $%te*"t$o%
Ke/$","% Pe*e#e&"% Pe+e#"%"% o/"t Pe%"t"t"% o/"t SPO /$!" *e#e& t", te*/""-t",e!"# SPO te!"" *e,o%#$!$"#$ o/"t
Ke/$","% /"t"#"% &e%!$#"% *e#e& ,## )+$#"! o/"t ,e+ote*"&$ *"($o",t$%"*,ot$,"-$,ot*o&$," (!!
SK ($*e,t* te%t"%g '"%g /e*", +e%!$#,"% *e#e& #e*t" ("t"* o*"%g%'" ("% #$"&"'"%g /e*", +e%!$# *e#e& ,## #e*t" ("t"* o*"%g g" ("t"* o*"%g '"%g /e*",
+e+e#"% o/"t ("% "!,e#
Ke/$","% Pe%'e*t""% o*+!$* &e%"t"t"% o/"t ("!"+ #t"t# &"#$e% #""t &"#$e%($&$%(","%- ($&!"%g,"%
SPO Pe%'e*t""% o*+!$* &e%"t"t"% o/"t ("!"+ #t"t# &"#$e% #""t &"#$e%($&$%(","%- ($&!"%g,"%
> Fo*+!$* &e%"t"t"% &e+/e*$"% o/"t +e+"t %"+" o/"t ("% (o#$# #e*t" +e%",&I%o*+"#$ o/"t )+$#"! /$!" &e*!J
Pe(o+"%- &*o#e(* &e!"'"%"% te%t"%g &e%'$"&"% ("% &e%'"!*"% o/"t ("% &*o(,#te*$!
Ke/$","% '"%g +e%et"&,"% ,*$te*$" $%o*+"#$ #&e#$=, &"#$e% "&" '"%g ($/t,"%%t, &e%e!"""% *e#e& '"%g ee,t$ ("% ,*$te*$" te!"" *e#e&-&e+e#"%"%
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NOELEMEN
PENILAIANDOKUMEN ACUAN KEBI!AKAN PEDOMAN"PANDUAN SPO DAN PRO#RAM
KER!A
> $ ,o+&ete%#$ &etg"# &e%e!"" *e#e&
> Fo*+ te!"" *e#e&-&e#"%"% o/"t
> B,t$ /,t$ te!"" *e#e&-&e#"%"% o/"t
MPO 5.2 Ke/$","% &e%'"!*"% ("% &e%($#t*$/#$"% o/"t #e*"g"+
Ke/$","% &e+/e*$"% !"/e! %t, o/"t '"%g ($,e!"*,"% ("*$ :"(" "#!$SPO &e+/e*$"% !"/e! %t, o/"t '"%g ($,e!"*,"% ("*$ :"(" "#!$
Do,+e% $+&!e+e%t"#$
> B,t$ &e%gee,"% ,e",*"#$"% &e%'"!*"% o/"t ("% te&"t :",t
> "&o*"% $%($,"to* +t ("% ,ete&"t"% :",t &e!"'"%"%
MPO 6 Ke/$","% '"%g +e%et"&,"% #t" '"%g /e*:e%"%g +e+/e*$,"% o/"t
Pe(o+"% &e%go*g"%$#"#$"% '"%g +e+"t *"$"% "/"t"%
Do,+e% $+&!e+e%t"#$
> STR ("% SIP ("*$ o*"%g '"%g ($/e*$ ,e:e%"%g"% +e+/e*$,"% o/"t
MPO 6.1 Ke/$","% :",t t%gg &e!"'"%"% o/"t
Ke/$","% ;e*$=,"#$ &e#"%"% o/"t /e*("#"*,"% +!" (o#$# ("% *te &e+/e*$"%
Pe(o+"% ;e*$=,"#$ &e#"%"% o/"t /e*("#"*,"% +!" (o#$# ("% *te &e+/e*$"%
SPO ;e*$=,"#$ &e#"%"% o/"t /e*("#"*,"% +!" (o#$# ("% *te &e+/e*$"%
PN
Do,+e% $+&!e+e%t"#$
> Re,"+ +e($#
MPO 6.2
Do,+e% I+&!e+e%t"#$
Fo*+ Re,o%#$!$"#$ o/"t '"%g ($/":" &"#$e%
MPO 7 Ke/$","% P"%("% &"t$e% #"et' ("!"+ MPO
IKP ($"t"t ("!"+ *e,"+ +e($#
Pe!"&o*"% IKP-KTD #e#"$ ,ete%t"% '"%g /e*!",
Do,+e% $+&!e+e%t"#$
Re,"+ +e($#
"&o*"% IKP-KTD
MPO 7.1 Ke/$","%
Pe(o+"% &e%go*g"%$#"#$"% &"%$t$" ,e#e!"+"t"% &"#$e% RS
Do,+e% $+&!e+e%t"#$
"&o*"% IKP
SCORE
PPK 1 A"% 36-2009 Te%t"%g Ke#e"t"% KMK 1426-Me%,e#-SK-II-2006 Reg!"#$ RS
> Pe%et"&"% #ot:"*e ,o+&te* %t, $%te*",#$ o/"t ("% "!e*g$ #e*t" ,ete%t"% %t,&>("t$%g
Ke/$","% &e!"'"%"% '"%g +e+"t &e%ge!o!""% o/"t '"%g ($/":" &"#$e% ,e RS%t, &e%gg%""% #e%($*$ ,ete*#e($""% ("% &e%gg%""% o/"t #"+&e!
P"%("% &"t$e% #"et' ("!"+ MPO '"%g +e%et"&,"% Mo%$to*$%g ee, &e%go/"t"%te*+"#,
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NOELEMEN
PENILAIANDOKUMEN ACUAN KEBI!AKAN PEDOMAN"PANDUAN SPO DAN PRO#RAM
KER!A
Pe(o+"%
Ke/$","% RKA
RKA
Ke/$","% P*og*"+ %$t Ke*"-PKRS
P*og*"+ ,e*" %$t ,e*"-PKRS
PN
PPK 2
Ke/$","% Pe+/e*$"% I%o*+"#$ @
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NOELEMEN
PENILAIANDOKUMEN ACUAN KEBI!AKAN PEDOMAN"PANDUAN SPO DAN PRO#RAM
KER!A
Do,+e%
> Not!e% *"&"t Ko+$te-P"%$t$" Mt
> "&o*"% &*og*"+ &e%$%g,"t"% +t ("% ,e#e!"+"t"% &"#$e%
PMKP 1.1 A"% PMK 1691-2011 te%t"%g Ke#e!"+"t"% P"#$e% RS
Pe(o+"% &"'" Pe%$%g,"t"% MtPe!"'"%"% RS De&,e# 1994
P"%("% N"#$o%"! Ke#e!"+"t"% P"#$e% R+" S",$t )P"t$e%t S"et' De&,e# 2008
Reg!"#$ RS P*og*"+ Pe%$%g,"t"% Mt ("% Ke#e!"+"t"% &"#$e%.
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NOELEMEN
PENILAIANDOKUMEN ACUAN KEBI!AKAN PEDOMAN"PANDUAN SPO DAN PRO#RAM
KER!A
S$#te+ Pe%"t"t"% ("% Pe!"&o*"% I%($,"to* Mt
SK S$#te+ Pe%"t"t"% ("% Pe!"&o*"% I%($,"to* Mt
P"%("% S$#te+ Pe%"t"t"% ("% Pe!"&o*"% I%($,"to* Mt
Do,+e% D"t" $%($,"to* +t "&o*"%
PMKP 3.1 Reg!"#$
P*og*"+ Pe%$%g,"t"% Mt ("% Ke#e!"+"t"% P"#$e% R+" S",$tP"%("% Pe%$%g,"t"% Mt ("% Ke#e!"+"t"% P"#$e%
S$#te+ Pe%"t"t"% ("% Pe!"&o*"% I%($,"to* Mt
P*o=!-K"+# I%($,"to*
Do,+e% D"t" $%($,"to* +t H"#$! e;"!"#$ ("% t$%(", !"%t
PMKP 3.2
Do,+e% D"t" $%($,"to* +t H"#$! e;"!"#$ ("% t$%(", !"%t
PMKP 3.3
Do,+e% D"t" $%($,"to* +t H"#$! e;"!"#$ ("% t$%(", !"%t
PMKP 4
PMKP 4.1 Do,+e% D"t" $%($,"to* +t H"#$! e;"!"#$ /e*,"!"
PMKP 4.2 Do,+e% H"#$! "%"!$#$# e;"!"#$
PMKP 5 Ke/$","% E"!$("#$ D"t"
SPO ;"!$("#$ ("t"
Do,+e% H"#$! ;"!$("#$ ("t"
PMKP 5.1
PMKP 6
Ke/$","% &e!",#"%""% Root "#e A%"!'#$#
P"%("% &e!",#"%""% Root "#e A%"!'#$#
PN
Do,+e%
> H"#$! Root "#e A%"!'#$# +e%ge%"$ "("%'" I%#$(e% Ke#e!"+"t"% P"#$e%
> T$%(", !"%t "t"# "#$! RA
PMKP 7
Ke/$","% ("!"+ SK
PN
Do,+e%
> H"#$! "%"!$#$# KTD ("% !"&o*"%%'"
PMKP 8
S$#te+ &e%"t"t"% ("% &e!"&o*"% $%#$(e% ,e#e!"+"t"% &"#$e%
De=%$#$ KN
Ke/$","%
P"%("% S$#te+ &e%"t"t"% ("% &e!"&o*"% $%#$(e% ,e#e!"+"t"% &"#$e% De=%$#$ KN
PN
Do,+e% "&o*"% KN H"#$! "%"!$#$# ("% t$%(", !"%t%'"
Reg!"#$ P*og*"+ Pe%$%g,"t"% Mt ("% Ke#e!"+"t"% P"#$e% R+" S",$t P"%("%Pe%$%g,"t"% Mt ("% Ke#e!"+"t"% P"#$e% S$#te+ Pe%"t"t"% ("% Pe!"&o*"%I%($,"to* Mt P*o=!-K"+# I%($,"to*
Reg!"#$ P*og*"+ Pe%$%g,"t"% Mt ("% Ke#e!"+"t"% P"#$e% R+" S",$t P"%("%Pe%$%g,"t"% Mt ("% Ke#e!"+"t"% P"#$e% S$#te+ Pe%"t"t"% ("% Pe!"&o*"%
I%($,"to* Mt P*o=!-K"+# I%($,"to*
Reg!"#$ S$#te+ &e%"t"t"% ("% &e!"&o*"% $%($,"to* )te*+"#, "%"!$#" ("% ;"!$("#$("t" S$#te+ Pe%"t"t"% ("% Pe!"&o*"% $%#$(e% ,e#e!"+"t"% P"#$e%
Do,+e% D"t" $%($,"to* +t "%"!$#$# ("% t$%(", !"%t%'" "&o*"% ,eg$"t"% ("*$Ko+$te PMKP ,e D$*e,t* RS
Reg!"#$ SPO ;"!$("#$ ("t" )("t" '"%g ","% ($#"+&"$,"% ,e &/!$, Do,+e% H"#$!;"!$("#$ ("t" D"t" '"%g ($#"+&"$,"% ,e&"(" &/!$,
Reg!"#$ De=%$#$ #e%t$%e! S$#te+ &e%"t"t"% ("% &e!"&o*"% $%#$(e% ,e#e!"+"t"%&"#$e%.
Pe%et"&"% KTD '"%g "*# ($ "%"!$#" S$#te+ &e%"t"t"% ("% &e!"&o*"% $%#$(e%,e#e!"+"t"% &"#$e%
P"%("% Pe%et"&"% KTD '"%g "*# ($ "%"!$#" S$#te+ &e%"t"t"% ("% &e!"&o*"%$%#$(e% ,e#e!"+"t"% &"#$e%
A"% PMK 1691-2011 te%t"%g Ke#e!"+"t"% P"#$e% RS P"%("% N"#$o%"!Ke#e!"+"t"% P"#$e% R+" S",$t )P"t$e%t S"et' De&,e# 2008
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NOELEMEN
PENILAIANDOKUMEN ACUAN KEBI!AKAN PEDOMAN"PANDUAN SPO DAN PRO#RAM
KER!A
PMKP 10 P*og*"+ &e%$%g,"t"% +t &e!"'"%"% *+" #",$t SK P"%$t$" Mt RS
Do,+e%
"&o*"% &e!",#"%""% ,eg$"t"% &"'" &e%$%g,"t"% +t &e!"'"%"% *+" #",$t
B,t$>/,t$ &e*/"$,"%-&e*/""%
H"#$! "%"!$#$#PMKP 11 P*og*"+ +"%"e+e% *$#$,o
Ke/$","% P*og*"+ +"%"e+e% *$#$,o
P*og*"+
PN
Do,+e% A%"!$#$# FM Se*t$=,"#$ ,o+&ete%#$
> "&o*"% ,e*"
MFK 3.1 Ke/$","%
> P*og*"+ +o%$to*$%g +"%"e+e% *$#$,o
> D"t" "#$! &e+"%t""% &*og*"+ +"%"e+e% *$#$,o "#$!$t"#-!$%g,%g"%
> RT ("*$ "#$! +o%$to*$%g
PN
MFK 4 A"%
> Ke&+e% P 10-2000
> Pe*+e% P 24-2008
Reg!"#$ RS
Ke/$","% ,e#e!"+"t"% ("% ,e"+"%"% "#$!$t"# =#$,
Pe(o+"%
SPO
PN
Ke/$","% P*og*"+ ,e#e!"+"t"% ("% ,e"+"%"% "#$!$t"# =#$,
P*og*"+ ,e#e!"+"t"% ("% ,e"+"%"% "#$!$t"# =#$,
SPO
Do,+e% "&o*"% /!"%"% ("% "%"!$#$# &e%$%g,"t"% +t ("% ,e#e!"+"t"% &"#$e%B,t$>/,t$ &e*/"$,"% T$%(", !"%t ("% "#$!%'"
A"% Pe*"t*"% ("% &e*%("%g"% '"%g te*,"$t (e%g"% ,e#e!"+"t"% ("% ,e"+"%"%"#$!$t"#
Do,+e% $+&!e+e%t"#$ B,t$ &e!",#"%""% ,eg$"t"% B,t$ e;"!"#$-&("te&*og*"+-*e%"%" $%(,
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NOELEMEN
PENILAIANDOKUMEN ACUAN KEBI!AKAN PEDOMAN"PANDUAN SPO DAN PRO#RAM
KER!A
> "&o*"% ,e"($"% e(e*"
> Pe!",#"%""% &e%g"+"%"% &"(" +"#" &e+/"%g%"% ("% *e%o;"#$
> Mo (e%g"% &e%'e:" !""% RS
MFK 4.1 Do,+e%
> H"#$! &e+e*$,#""% "#$!$t"#
> T$%(", !"%t "t"# "#$! &e+e*$,#""%
> H"#$! e;"!"#$ &e!",#"%""% t$%(", !"%t.
MFK 4.2 Reg!"#$ te%t"%g "#$!$t"# RS
RKA
Do,+e% A%gg"*"% %t, &e*/"$,"%
MFK 5
Mo%$to*$%g %$t $%(e&e%(e% %t, +e%$!"$ ,e&"t"% te*"("& &*og*"+ MFK
Pe(o+"%
SPO
SK T$+Do,+e% $+&!e+e%t"#$
> D"t"* ("% !o,"#$ /""% !$+/" /e*/""'" te*/"* ($ RS
> MSDS
> H"#$! $%;e#t$g"#$ ("*$ t+&""% &"&"*"% ("% $%#$(e% !"$%%'"
> Mo (e%g"% &e%'e:" !""% RS
MFK 6 Reg!"#$
Ke/$","% TIM
SK
Pe(o+"% &e%"%gg!"%g"% ,e/","*"% ,e:"#&"(""% /e%"%" ("% e;","#$
Mo%$to*$%g %$t $%(e&e%(e% %t, +e%$!"$ ,e&"t"% te*"("& &*og*"+ MFKPe(o+"+
SPO
MFK 6.1 Do,+e%
> P*og*"+ &e%"%gg!"%g"% ,e/","*"% ,e:"#&"(""% /e%"%" ("% e;","#$
> Po#tte#t
> Se*t$=,"#$
> Mo (e%g"% &e%'e:" !""% RS
MFK 7
Do,+e%
> P*og*"+ K3
> "&o*"% ,eg$"t"%
> Se*t$=,"#$
> Mo (e%g"% &e%'e:" !""% RS
MFK 7.1 Ke/$","%
Do,+e% P*og*"+ Pe%g"+"%"% ,e/","*"% ("% e;","#$
MFK 7.2 Ke/$","%
Reg!"#$ RS Reg!"#$ RS te%t"%g /""% ("% !$+/" /e*/""'" #e*t" &e%gg%""%APD )&e*e%"%""% &e%g"(""% &e%'$+&"%"% ($#t*$/#$ &"&"*"% B>3
Do,+e% Pe!"t$"% &e%"%gg!"%g"% ,e/","*"% ,e:"#&"(""% /e%"%" ("%e;","#$
Reg!"#$ te%t"%g &e%"%gg!"%g"% ,e/","*"% Mo%$to*$%g %$t $%(e&e%(e% %t,+e%$!"$ ,e&"t"% te*"("& &*og*"+ MFK
Reg!"#$ te%t"%g &e+e!$"*""% #$#te+ (ete,#$ ,e/","*"% ("% &e+"("+"%Do,+e%
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NOELEMEN
PENILAIANDOKUMEN ACUAN KEBI!AKAN PEDOMAN"PANDUAN SPO DAN PRO#RAM
KER!A
> Se*t$=,"#$ &e!"t$"% &e+"("+"% ("% e;","#$
MFK 7.3
Reg!"#$ te%t"%g !"*"%g"% +e*o,o,
Pe(o+"+
SPO
MFK 8 Re%"%" Ke*" ("% A%gg"*"% "!"t +e($# Do,+e%
> D"t"* $%;e%t"*$# &e*"!"t"% +e($#
> B,t$ &e+e!$"*""% ("% ,"!$/*"#$ "!"t +e($#
> B,t$ $o/" "!"t
> S*"t tg"#- #e*t$=,"#$ &etg"# &e+e!$"*""% "!"t
MFK 8.1 Reg!"#$ te%t"%g &e+e!$"*""% "!"t Do,+e% $+&!e+e%t"#$
P"%("%
SPO
> B,t$ &e+e!$"*""% ("% ,"!$/*"#$ "!"t
> H"#$! &e+e!$"*""% ("% ,"!$/*"#$
MFK 8.2 Ke/$","% te%t"%g &e%"*$,"% ,e+/"!$ &*o(,-&e*"!"t"% RS
P"%("%
SPO
Do,+e%
> B,t$ &e%"*$,"% &*o(,-"!"t
MFK 9
MFK 9.1
P"%("%
SPODo,+e%
> D"t"* "*e" /e*$#$,o t$%gg$ /$!" te*"($ g"%gg"% !$#t*$, "t" "$* +$%+
> D"t"* #+/e* "!te*%"t$ !$#t*$, "t" "$* +$%+
MFK 9.2 Do,+e%
> D"t"* #+/e* "!te*%"t$ "$* +$%+ ("% !$#t*$,
> B,t$ $o/" #+/e* "!te*%"t$ "$* +$%+ ("% !$#t*$,
> D"t" "#$! $o/"
MFK 10
P"%("%SPO
Do,+e%
> D"t"* #$#te+ &e%(,%g g"# +e($# ;e%t$!"#$ ("% #$#te+ ,%$ '"%g "(" ($ RS
> H"#$! &e+e*$,#""%
> B,t$ &e+e!$"*""%
> B,t$ $o/"
MFK 10.1 Ke/$","% te%t"%g
> Pe%g"(""% "$* /e*#$
> Pe+"%t""% "$* /e*#$
Pe(o+"+
SPO
A"% I%#t*,#$ Me%,e# RI No. 84-Me%,e#-I%#t-II-2002 te%t"%g K":"#"% T"%&" Ro,o,($ Te+&"t Ke*" ("% S"*"%" Ke#e"t"%
Ke/$","% te%t"%g &e%g"(""% #+/e* !$#t*$, ("% "$* +$%+ #e*t" #+/e*"!te*%"t$%'".
Ke/$","% te%t"%g &e+e!$"*""% #$#te+ &e%(,%g g"# +e($# ;e%t$!"#$ ("% #$#te+,%$
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PENILAIANDOKUMEN ACUAN KEBI!AKAN PEDOMAN"PANDUAN SPO DAN PRO#RAM
KER!A
MFK 11 Re%"%" Ke*" ("% A%gg"*"% Do,+e%
> P*og*"+ +"%"e+e% "#$!$t"# ("% ,e#e!"+"t"%
> D"t"* "($*
> P*e- &o#t te#t
> Se*t$=,"#$
MFK 11.1
Pe(o+"+
SPO
MFK 11.2
MFK 11.3
> P*og*"+ K3 te%t"%g &e!"t$"% &e+e!$"*""% "#$!$t"# RS
> P*e-&o#t te#t> Se*t$=,"#$
SCORE
PPI 1
PN
SK Ko+$te-&"%$t$" PPI
SK IPN @IPN
P*og*"+ ,e*" IPN
PPI 2
Ke/$","% SK Pe*"t*"% Pe(o+"% &e!"'"%"%"%-o&e*"#$o%"! Ko+$te-&"%$t$" PPI
Pe(o+"% &e!"'"%"%"%-o&e*"#$o%"! Ko+$te-&"%$t$" PPI
PN
Do,+e%Not!e% *"&"t
B,t$ (o,+e%t"#$ !"$%%'" +$#"!%'" #*"t +e%'*"t
PPI 3
Reg!"#$ RS te%t"%g &e%g"+"%"% ,e/","*"% ,e"+"%"% /""% /e*/""'" ("%,e("**"t"%
Ke/$","% te%t"%g &e%go&e*"#$"% &e*"!"t"% +e($# ("% #$#te+ t$!$t$ Do,+e%$+&!e+e%t"#$ > P*og*"+ &e!"t$"%> Se*t$=,"#$
Ke/$","% '"%g +e+"t *"$"% tg"# ,et" ("% "%ggot" P"%$t$" K3 #e*t" %$t&e+e!$"*""% "#$!$t"# RS Do,+e% $+&!e+e%t"#$
A"% Pe(o+"% M"%"e*$"! Pe%eg""% ("% Pe%ge%("!$"% I%e,#$ ($ RS ("% F"#$!$t"#Ke#e"t"% "$%%'" De&,e# 2007 Pe(o+"% Pe%eg""% ("% Pe%ge%("!$"% I%e,#$ ($RS ("% F"#$!$t"# Ke#e"t"% "$%%'" De&,e# Pe*("!$% HPI
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NOELEMEN
PENILAIANDOKUMEN ACUAN KEBI!AKAN PEDOMAN"PANDUAN SPO DAN PRO#RAM
KER!A
Ke/$","% Pe+/e*!","% P*og*"+
PPI 4 Reg!"#$ RS Pe(o+"% &e%go*g"%$#"#$"% Ko+$te-&"%$t$" PPI )&o!" ,ete%"g""%
Ke/$","%
PPI )&o!" ,ete%"g""%
RKA RS
A("%'" SIRS %t, &*og*"+ PPI ) /$#" #e"*" +"%"! "t" e!e,t*o%$, M$%$+"!
PPI 5
Reg!"#$ RS P*og*"+ PPI
Ke/$","%
P"%("% Pe%'#%"% P*og*"+
PN
PPI 5.1 P*og*"+ PPI
B,t$ &e!",#"%""%
PPI 6 Reg!"#$ RS Kete%t"% #*;e$!"%e
Ke/$","%
Pe(o+"%
Do,+e% &e!",#"%""%
"&o*"% Ko+$te-&"%$t$" PPI
D"t" #*;e$!"%e "#$! "%"!$#$# ("% *e,o+e%("#$
T$%(", !"%t "#$! "%"!$#$# ("% *e,o+e%("#$
H"#$! "#e#+e% *$#$,o $%e,#$ &"(" #et$"& %$t ,e*" &e!"'"%"%
PPI 7
PPI 7.1
Pe(o+"%
SPO
Do,+e% H"#$! +o%$to*$%g ("% e;"!"#$ &e+/e*#$"% ("% #te*$!$#"#$
PPI 7.1.1Pe(o+"%
SPO
PN
Do,+e% +o%$to*$%g ("% e;"!"#$ Do,+e% "#$! &e+e*$,#""% ,+"%
PPI 7.2
Pe(o+"%
SPO
A"% Pe(o+"% M"%"e*$"! Pe%eg""% ("% Pe%ge%("!$"% I%e,#$ ($ RS ("% F"#$!$t"#Ke#e"t"% "$%%'" De&,e# 2007
B,t$ te!" ($!",,"% "##e##e+e% *$#$,o )IRA Not!e% *"&"t "&o*"% Ko+$te-&"%$t$"PPI S*"t #!"%
A"% Pe(o+"% I%#t"!"#$ P#"t Ste*$!$#"#$ ($ R+" S",$t De&,e# 2009 Pe(o+"%M"%"e+e% $%e% ($ R+" S",$t De&,e# 2004
Ke/$","% &e!"'"%"%"%-o&e*"#$o%"! %$t Ste*$!!$#"#$ @ &e!"'"%"%"%-o&e*"#$o%"! %$t$%e% ("% "%(*'
Ke/$","% te%t"%g &e%g":"#"% &e*"!"t"% ,"("!:"*#" @ &e+","$"% !"%g )*e>#e
&e*"!"t"% ("% +"te*$"!
A"% Pe(o+"% S"%$t"#$ R+" S",$t ($ I%(o%e#$" De&,e# 2000 Pe(o+"%&e%"t"!",#"%""% &e%ge!o!""% !$+/" &"("t ("% !$+/" "$* ($ *+" #",$t De&,e#2006 St"%("* K"+"* e%"" De&,e# 2004
Reg!"#$ RS Kete%t"% &e%ge!o!""% #"+&" $%e,#$# ("% "$*"% t/ Kete%t"%&e%ge!o!""% ("*" ("% ,o+&o%e% Kete%t"% &e!"'"%"% ,"+"* e%""
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NOELEMEN
PENILAIANDOKUMEN ACUAN KEBI!AKAN PEDOMAN"PANDUAN SPO DAN PRO#RAM
KER!A
PPI 7.3
Ke/$","%
Pe(o+"%
PPI 7.4
Reg!"#$ RS Kete%t"% &e*#$"&"% +","%"% Kete%t"% &e%go%t*o!"% "#$!$t"#
Pe(o+"%
SPO
PPI 7.5
Pe(o+"%
SPO
Do,+e% H"#$! &e!",#"%""% &e+"%t""% ,"!$t"# ("*".",$/"t ("+&", *e%o;"#$.
PPI 8 Reg!"#$ RS Kete%t"% te%t"%g &e*":"t"% &"#$e% &e%'",$t +e%!"*
Pe(o+"%
SPO
Do,+e% B,t$ e(,"#$ #t"
PPI 9
Reg!"#$ RS
Pe(o+"%
SPO
Do,+e% H"#$! &e+"%t""% $ t"%g"% )o+&!$"%e%'"
PPI 10
Ke/$","% P*og*"+ Pe%$%g,"t"% Mt ("% Ke#e!"+"t"% &"#$e%
Pe(o+"% Pe%'#%"% P*og*"+ Pe%$%g,"t"% Mt ("% Ke#e!"+"t"% &"#$e%
P*og*"+ PPI '"%g "(" PMKP
PPI 10.1 D"t" &e+"%t""% "%g," $%e,#$ te*+"#, $%($,"to* "%g," $%e,#$
Not!e% *"&"t &e+/""#"%
"&o*"% Ko+$te-&"%$t$" PPI
PPI 10 2 H"#$! +o%$to*$%g ("% e;"!"#$ &e!",#"%""% ,eg$"t"% PPI
A"% Pe(o+"% S"%$t"#$ R+" S",$t ($ I%(o%e#$" De&,e# 2000 Pe(o+"%&e%"t"!",#"%""% &e%ge!o!""% !$+/" &"("t ("% !$+/" "$* ($ *+" #",$t De&,e#2006
Reg!"#$ RS Kete%t"% &e%ge!o!""% !$+/" RS ,##%'" %t, /e%(" t""+ ("%"*+
A"% Pe(o+"% S"%$t"#$ R+" S",$t ($ I%(o%e#$" De&,e# 2000 Pe(o+"%M"%"e*$"! Pe%eg""% ("% Pe%ge%("!$"% I%e,#$ ($ RS ("% F"#$!$t"# Ke#e"t"%"$%%'" De&,e# 2007 Pe(o+"% Pe%eg""% ("% Pe%ge%("!$"% I%e,#$ ($ RS ("%F"#$!$t"# Ke#e"t"% "$%%'" De&,e# Pe*("!$% HPI
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NOELEMEN
PENILAIANDOKUMEN ACUAN KEBI!AKAN PEDOMAN"PANDUAN SPO DAN PRO#RAM
KER!A
PPI 10.4 B,t$ ("t" RS !"$%
B,t$ ("t" ""%
H"#$! "%"!$#$#
PPI 10.5 B,t$ ,o+%$,"#$ +$#"!%'" ("!"+ o*+ *"&"t
Do,+e% !"&o*"% Ko+$te-&"%$t$" PPI ,e&"(" +"%"e+e% RS
PPI 10.6 Do,+e% !"&o*"% ,e&"(" Ke+,e# "t" D$%"# Ke#e"t"%
B,t$ t$%(", !"%t "t"# !"&o*"%
PPI 11 P*og*"+ ,e*" PPI-P*og*"+ ($,!"t te%t"%g PPIP*og*"+ &e%($($,"% &"#$e% ("% ,e!"*g"
B,t$ $+&!e+e%t"#$ &e!"t$"% ("% e(,"#$
SCORE
TKP 1 Reg!"#$ RS
Ho#&$t"! B'!":#
Ke/$","% HB
SK &e%g"%g,"t"%
SK M$#$ *+" #",$t
TKP 1.2 Reg!"#$ RS Kete%t"% ($ Ho#&$t"! /'!":#
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NOELEMEN
PENILAIANDOKUMEN ACUAN KEBI!AKAN PEDOMAN"PANDUAN SPO DAN PRO#RAM
KER!A
TKP 1.4 Reg!"#$ RS Kete%t"% ($ o#&$t"! /' !":#
"&o*"% /!"%"% ,&( (e:"% &e%g":"#
> H"#$! $%#&e,#$ ("% *e,o+e%("#$
TKP 3 Do,+e%t"#$
> SK &e%g"%g,"t"%
> Do,+e% /,t$ &*o#e# &e%et"&"% +$#$ RS
> B,t$ &e!",#"%""% *"&"t ,oo*($%"#$
TKP 3.1 Do,+e%t"#$
> Pe*te+"% (e%g"% to,o +"#'"*","t %t, +e+/""# (e&,e#
> Pe*te+"% &e*,+&!"%>&e*,+&!"% ($ *+" #",$t. M$#"! &e*,+&!"% ($"/et
> R"&"t ("% %ot!e% *"&"t ,oo*($%"#$ (g% &e+"%g, ,e&e%t$%g"%
> Do,+e% &e!",#"%""% #*"t tg"#
TKP 3.2
Do,+e%t"#$
> Re%#t*"
> P*o=! RS ("% /*o#* RS #e*t" (o,+e% /,t$> R"&"t ,oo*($%"#$ ("% !"&o*"% /!"%"%
Ke/$","% ,"$"% %t, "!"t "t" /""% o/"t /"*
TKP 3.2.1
Do,+e%t"#$
> B,t$ (o,+e% &e%g"(""% "#$!$t"# RS
> D"t"* "!"t ("% o/"t #t"%("*
> D"t"* +t"#$ "!"t ("% o/"t.
TKP 3.3
Ke/$","%
C"%g +e%et"&,"% D$*e,t* *+" #",$t
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NOELEMEN
PENILAIANDOKUMEN ACUAN KEBI!AKAN PEDOMAN"PANDUAN SPO DAN PRO#RAM
KER!A
Do,+e%t"#$
> B,t$ ,o%t*",
> Do,+e% ,o%t*", 'g /e*,"$t"% (g% &e!"'"%"% &"#$e%
> Do,+e% ,o%t*", te*,"$t &e!"'"%"% ,!$%$#
> B,t$ ,o%t*", /"* #g +e%"+$% ,o%t$%$t"# &e!"'"%"%
TKP 3.3.1 Reg!"#$ Ke/$","% +o%$to*$%g ,!$%$,
Ke/$","%Pe(o+"%
SPO
Do,+e%t"#$
> S*;e$ ,e&"#"%
> Do,+e% ,o%t*", ("% e;"!"#$ ,$%e*"
TKP 3.3.2 Reg!"#$ SK D$* '"%g +e%et"&,"% e%$# &e!"'"%"% "&" #"" '"%g ($*,
K*e(e%#$"!$%g &e!",#"%" P*",t$, +"%($*$ '"%g +e%e*$+" ,o%#! ("*$ RS
Do,+e%t"#$
> D"t"* (o,te* ,e*" #"+"
> Ko%t*", ,e*"
> Do,+e% ,*e(e%#$"!> A($t ,$%e*"
TKP 3.4
Ke/$","%
P*og*"+ D$,!"t M"%"e+e% Mt
Do,+e%t"#$
> B,t$ &e!"t$"% +"%"e+e% +t
> "&o*"% /!"%"%
> B,t$ (o,+e% &e%$!"$"% ,$%e*" &*oe#$o%"!
TKP 3.5 Reg!"#$ RS te%t"%g Pe%e*$+""% St"Ke/$","% Pe%e*$+""% St"
P"%("% Pe%e*$+""% St"
SPO Pe%e*$+""% St"
PN Pe%e*$+""% St"
Do,+e%t"#$
> SK &e%%,"%
> #e*t$=,t &e!"t$"%
> P*og*"+ &e!"t$"% #e!* %$t
TKP 4 Do,+e%t"#$
> St*,t* O*g"%$#"#$ RS ("% %$t ,e*"
TKP 5 Reg!"#$ RS te%t"%g &e*#'"*"t"% "/"t"% Reg!"#$ RS te%t"%g *"$"% "/"t"%
Do,+e%t"#$
> Se*t$=,"#$ ("% (o,+e% &e%(,%g
TKP 5.1
Ke/$","% Fo*+!$* #!"% o/"t /""% "/$# &","$ &e*"!"t"% "g"* #e*"g"+
SPO Fo*+!$* #!"% o/"t /""% "/$# &","$ &e*"!"t"% "g"* #e*"g"+
Do,+e%t"#$
> P*og*"+ ,e*" t$"& %$t
> RKA
> Pe!"t$"% &e%e*"&"% ("!"+ SPO Pe!"'"%"%
TKP 5 1 1 Do,+e%t"#$
P*og*"+ D$,!"t ) P$+&$%"% +e($# ,e&e*":"t"% ("% &$+&$%"% !"$%%'" +e%("&"t,"%&e%($($,"% ("!"+ ,o%#e& &e%$%g,"t"% +t
Reg!"#$ Ke/$","% ("% P*o#e(* Fo*+!$* #!"% o/"t /""% "/$# &","$ &e*"!"t"%"g"* #e*"g"+
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NOELEMEN
PENILAIANDOKUMEN ACUAN KEBI!AKAN PEDOMAN"PANDUAN SPO DAN PRO#RAM
KER!A
TKP 5.2 Reg!"#$ RS te%t"%g St"%("* F"#$!$t"#
> Ke/$","% St"%("* F"#$!$t"#
> Pe(o+"% St"%("* F"#$!$t"#
> SPO St"%("* F"#$!$t"#
Reg!"#$ RS te%t"%g St"%("* Kete%"g""%
> Ke/$","% St"%("* Kete%"g""%
> Pe(o+"% St"%("* Kete%"g""%> SPO St"%("* Kete%"g""%
PN
TKP 5.3 Do,+e%t"#$
> Do,+e% &e*#'"*"t"% "/"t"% ($ t$"& %$t ,e*"
TKP 5.4 Do,+e%t"#$
> Pe!",#"%""% o*$e%t"#$
> P*og*"+ O*$e%t"#$
TKP 5.5 Do,+e%t"#$
> P*og*"+ ,e*"
> "&o*"% /!"%"% ttg $%($,"to* +t> A%"!$#$# te*"("& "&"$"% $%($,"to* +t
> T$%(", !"%t "t"# "#$! "%"!$#$#
> "&o*"% /!"%"%
TKP 6 Do,+e%t"#$
> SK P"%$t$" et$," RS
Ke/$","%
> P*og*"+ ,e*" P"%$t$" SK $$% RS
> Do,+e% $%o*+"#$ &e!"'"%"% RS - P*o=! RS> SK t"*$ RS
> R$%$"% t"g$"% ,e&"(" &"#$e%
TKP 6.2 Reg!"#$ RS
P*og*"+ ,e*" P"%$t$" P*og*"+ ,e*" S/ Ko+$te
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NOELEMEN
PENILAIANDOKUMEN ACUAN KEBI!AKAN PEDOMAN"PANDUAN SPO DAN PRO#RAM
KER!A
KPS 2 Ke/$","% &e%e*$+""% #t"
P"%("% &e%e*$+""% #t"
SPO &e%e*$+""% #t"
PN
Do,+e% SK &e%g"%g,"t"% #t"
KPS 3 Pe*"t*"% I%te*%"! St" Me($# )MSBKe/$","% ++
Ke/$","% Pe+/e*!","%
Pe(o+"% )MSB
PN
Do,+e% B,t$ e;"!"#$
KPS 4 Do,+e% B,t$ &*o#e# &e%e*$+""% #t" ("% e;"!"#$ /e*,e!"%t"% B,t$ e;"!"#$
KPS 5 Ke/$","% te%t"%g &e+e!$"*""% $%o*+"#$ ,e&eg":"$"% )SPO
Reg!"#$ te%t"%g &e+e!$"*""% $%o*+"#$ ,e&eg":"$"% )SPO
PN
KPS 6
Ke/$","%
P"%("%
SPO
PN
KPS 6.1 Do,+e% B,t$ e;"!"#$ Re;$#$ &o!" ,ete%"g""%
KPS 7
P"%("%
SPO
PN
KPS 8 A"% St"%("* &*oe#$
Ke/$","% RKA
SK T$+ Pe%'#% Pe(o+"%
P"%("% Pe%'#%"% RKA
RKA
Ke/$","% P*og*"+ ($,!"tP*og*"+ ($,!"t
Do,+e% B,t$ &e!",#"%""% &e!"t$"% Se*t$=,"t &e!"t$"%
PN
KPS 8.1 Reg!"#$ RS RKA P*og*"+ ($,!"t
Do,+e% B,t$ &e!",#"%""% &e!"t$"% Se*t$=,"t &e!"t$"%
KPS 8.2 Reg!"#$ RS RKA P*og*"+ ($,!"t P*og*"+ %$t ,e*"
Do,+e% B,t$ &e!",#"%""% &e!"t$"% Se*t$=,"t &e!"t$"%
KPS 8.3 Reg!"#$ RS RKA P*og*"+ ($,!"t P*og*"+ %$t ,e*"
Do,+e% SK !$%$"! $%#t*t* B,t$ &e!",#"%""% &e!"t$"% Se*t$=,"t &e!"t$"%
F$!e ,e&eg":"$"% )K"!$=,"#$ *"$"% Tg"# R$:"'"t Ke*" +"#$%g %$t,e*"
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NOELEMEN
PENILAIANDOKUMEN ACUAN KEBI!AKAN PEDOMAN"PANDUAN SPO DAN PRO#RAM
KER!A
P*og*"+ &e!"'"%"% ,e#e"t"% #t"
P*og*"+ ;",#$%"#$ ("% $+%$#"#$
SPO &e%"%g"% #t" 'g te*&"&"* &e%'",$t $%e,#$# te*,"$t &*og*"+ PPI
KPS 9
KPS 9.1
KPS 10
KPS 11 A"% PMK 1438-2010 te%t"%g St"%("* Pe!"'"%"% Ke(o,te*"%
P*og*"+ ,e*" Ko+$te Me($,
SPO Pe!"'"%"% Ke(o,te*"%
Do,+e% B,t$ &e!",#"%""% e;"!"#$
KPS 12 A"% PMK 1796-2011 te%t"%g Reg$#t*"#$ Te%"g" Ke#e"t"%
Ke/$","% ,*e(e%#$"! #t" ,e&e*":"t"%
P"%("% ,*e(e%#$"! #t" ,e&e*":"t"%PN
Do,+e% Be*,"# ,e&eg":"$"% #t" ,e&e*":"t"%
KPS 13
KPS 14
KPS 15 A"% PMK 1796-2011 te%t"%g Reg$#t*"#$ Te%"g" Ke#e"t"% St"%("* P*oe#$
Ke/$","% &*o#e# ,*e(e%#$"! #t" te%"g" ,e#e"t"%
P"%("% &*o#e# ,*e(e%#$"! #t" te%"g" ,e#e"t"%SPO &*o#e# ,*e(e%#$"! #t" te%"g" ,e#e"t"%
Do,+e% B,t$ &*o#e# ,*e(e%#$ Be*,"# ,e&eg":"$"%
KPS 16 A"% St"%("* &*oe#$
Do,+e% Do,+e% &e%g"#"%
KPS 17
SCORE
MKI 1 A"% 36-2009 Te%t"%g Ke#e"t"% KMK 1426-Me%,e#-SK-II-2006Ke/$","% Pe%et"&"% %$t ,e*" '"%g +e%ge!o!" e(,"#$ ("% $%o*+"#$-PKRS
PN D$*e,t*
SK Pe+/e%t,"% TIM
PN T$+ Ke*" PKRS
S*"t Ke/$","% Te%t"%g MKI
Ke/$","% &e%go*g"%$#"#$"%
Pe(o+"%
PN
Ke/$","% &e(o+"% &e!"'"%"% %$t ,e*" te*#e/t-PKRS
Pe(o+"%
SPO
PN
Do,+e% Pe%et"&"% ("% &e%g++"% #t" +e($# '"%g ("&"t +e!",,"% "#"%&"#$e% #e"*" +"%($*$ )SPK (g% RKK P*o#e# ("% ("t" ,*e(e%#$"!$%g Ee*$=,"#$ $"#"("% STR ("*$ #+/e* "#!$%'"
Do,+e% RS B,t$ &*o#e# *e,*e(e%#$"! Pe%et"&"% SPK (g RKK o!e ($*e,t* B,t$&e*&"%"%g"% SPK (g RKK
Ke/$","% ("% &*o#e# &e+/e*$"% #*"t &e%g"#"% ,!$%$# (e%g"% *$%$"% ,e:e%"%g"%,!$%$# &"(" &e%g"#"% &e*t"+" ("% &e%g"#"% !"%g Pe(o+"% ,e&t#"% %t,&e%g"#"% !"%g ),*$te*$" " #( #e/"g"$ *e;$e: ,$%e*"
A"% PMK 1796-2011 te%t"%g Reg$#t*"#$ Te%"g" Ke#e"t"% KMK 369-2007 te%t"%gSt"%("* P*oe#$ B$("% KMK 378-2007 te%t"%g St"%("* P*oe#$ Pe*":"t G$g$
Do,+e% B,t$ ,ete*!$/"t"% #t" ,e&e*":"t"% ("!"+ ,eg$"t"% &e%$%g,"t"% +t*+" #",$t Re;$e: ,$%e*" #t" ,e&e*":"t"%
Do,+e% B,t$ &"*t$#$&"#$ ("!"+ ,eg$"t"% &e%$%g,"t"% +t RS Re;$e: #t" /$!" "("$%($,"#$ te*,"$t te+"% &"(" &"'" &e%$%g,"t"% +t RS
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NOELEMEN
PENILAIANDOKUMEN ACUAN KEBI!AKAN PEDOMAN"PANDUAN SPO DAN PRO#RAM
KER!A
P*og*"+ ,e*" %$t ,e*"-PKRS
Ke/$","%
P*og*"+
PN
Do,+e% D"t" &o&!"#$ &"#$e% RS B*o#*. e"?et te%t"%g &e!"'"%"% RS
MKI 2
Ke/$","% &e(o+"% &e!"'"%"% %$t ,e*" te*#e/t-PKRS
Pe(o+"%
PN
Do,+e%-/,t$ $%o*+"#$ B*o#* !e"?et (#/. e/#$te D"% !"$%>!"$%
MKI 3 Pe(o+"% &e!"'"%"% %$t ,e*" &e+/e*$ $%o*+"#$-PKRS
MKI 4 Pe(o+"% &e!"'"%"% %$t ,e*" &e+/e*$ $%o*+"#$-PKRS
Kete%t"% te%t"%g *"&"t
Ke/$","% Kete%t"% te%t"%g *"&"tPe(o+"% Kete%t"% te%t"%g *"&"t
Do,+e%t"#$ *"&"t-&e*te+"% S*"t
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NOELEMEN
PENILAIANDOKUMEN ACUAN KEBI!AKAN PEDOMAN"PANDUAN SPO DAN PRO#RAM
KER!A
MKI 12 A"% PMK 269-Me%,e#-Pe*-III-2008
Reg!"#$ RS Ke/$","% te%t"%g *ete%#$ *e,"+ +e($# te*+"#, &e+#%""%
Pe(o+"% te%t"%g *ete%#$ *e,"+ +e($#
SPO te%t"%g *ete%#$ *e,"+ +e($#
PN
MKI 13 Ke/$","% RS Pe(o+"% Pe%'e!e%gg"*""% Re,"+ Me($# '"%g +e+"t
Ko(e ($"g%o#$#Ko(e &*o#e(*- t$%(","%
De=%$#$ '"%g ($g%","%
S$+/o! te*+"#, '"%g t$(", /o!e ($g%","%
S$%g,"t"% te*+"#, &e+#%""% *e,"+ +e($#
MKI 14
MKI 15 Do,+e%t"#$ *"&"t
MKI 16 Ke/$","% te%t"%g &e*!$%(%g"% ("*$ Ke$!"%g"% ("% ,e*#","% *e,"+ +e($#
Ke/$","% te%t"%g &e*!$%(%g"% ("*$ G"%gg"% ("% &e%'"!">g%""% *e,"+ +e($#
Pe(o+"% Te%t"%g &e*!$%(%g"% ("*$ Ke$!"%g"% ("% ,e*#","% *e,"+ +e($#
Pe(o+"% Te%t"%g &e*!$%(%g"% ("*$ G"%gg"% ("% &e%'"!">g%""% *e,"+ +e($#
SPO Ke$!"%g"% ("% ,e*#","% *e,"+ +e($#
SPO G"%gg"% ("% &e%'"!">g%""% *e,"+ +e($#
MKI 17 Do,+e% /,t$ &e!"t$"%
MKI 18 44-2009 Te%t"%g R+" S",$t )P"#"! 13
P"%("%SPO
PN
MKI 19 PMK 269-Me%,e#-Pe*-III-2008
Ke/$","% Pe!"'"%"%- Pe%'e!e%gg"*""% Re,"+ Me($# )S$#te+ &e%o+o*"% RM
Pe(o+"% Pe!"'"%"%- Pe%'e!e%gg"*""% Re,"+ Me($# )S$#te+ &e%o+o*"% RM
SPO S$#te+ &e%o+o*"% RM
MKI 19.1 Do,+e% *e,"+ +e($#
MKI 19.1.1 Do,+e% *e,"+ +e($#
MKI 19.2
Ke/$","% Pe!"'"%"% Re,"+ Me($#
"+&$*"% /e*,"# *e,"+ +e($# '"%g /e*!", ($ RS
Do,+e% *e,"+ +e($#
MKI 19.3 Do,+e% *e,"+ +e($#
MKI 19.4
Do,+e% &e!"&o*"% #e#"$ ,ete%t"% '"%g /e*!", Do,+e% e;"!"#$ &e%'"+&"$"%("t" ("% $%o*+"#$ o!e &e%gg%" ("t"
Ke/$","% te%t"%g &e*/""% *eg!"#$ RS +e!$&t$ Pe%ge+/"%g"% ("% &e*/""%*eg!"#$ A("&t"#$ *eg!"#$ %"#$o%"! #e/"g"$ *eg!"#$ RS Rete%#$ *eg!"#$ '"%g #("($%'"t","% t$(", /e*!", Pe+"%t""% &e!",#"%""% *eg!"#$ )+$#"!%'" o!e SPI
29-2004 Te%t"%g P*",t$, Ke(o,te*"% 44-2009 Te%t"%g R+" S",$t PMK269-Me%,e#-Pe*-III-2008
Pe(o+"% Pe!"'"%"%-Pe%'e!e%gg"*""% Re,"+ Me($# /e#e*t" !"+&$*"% /e*,"# *e,"++e($# '"%g /e*!", ($ RS
29-2004 Te%t"%g P*",t$, Ke(o,te*"% 44-2009 Te%t"%g R+" S",$t PMK269-Me%,e#-Pe*-III-2008
Ke/$","% &"'" &e%$%g,"t"% +t RS I%($,"to* +t te*,"$t *e;$e: &e%g$#$"% *e,"++e($#
P"%("% &"'" &e%$%g,"t"% +t RS I%($,"to* +t te*,"$t *e;$e: &e%g$#$"% *e,"++e($#
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NOELEMEN
PENILAIANDOKUMEN ACUAN KEBI!AKAN PEDOMAN"PANDUAN SPO DAN PRO#RAM
KER!A
SPO Pe!"'"%"% Ke(o,te*"% H"#$! "%"!$#$# ("t" ("!"+ &"'" &e%$%g,"t"% +t RS
MKI 20.1 Do,+e% ("t" Do,+e% &e!"&o*"% ("t"
MKI 20.2
MKI 21 St*,t* o*g"%$#"#$ RSSCORE
SKP 1 A"%
PMK 1691-2011 te%t"%g Ke#e!"+"t"% P"#$e% RS
Reg!"#$ RS
Ke/$","% I(e%t$=,"#$ &"#$e%
P"%("% I(e%t$=,"#$ &"#$e%
SPO &e+"#"%g"% ge!"%g $(e%t$=,"#$
SPO $(e%t$=,"#$ #e/e!+ +e+/e*$,"% o/"t ("*"-&*o(, ("*"
SPO Me%g"+/$! ("*"-#&e$+e% !"$%%'"
SPO Pe+/e*$"% &e%go/"t"% ("% t$%(","%-&*o#e(*.
PN
SKP 2 Ke/$","% Ko+%$,"#$ &e+/e*$"% $%o*+"#$ ("% e(,"#$ '"%g ee,t$
SK Pe%g"%g,"t"% T$+ Ko+%$,"#$ &e+/e*$"% $%o*+"#$ ("% e(,"#$ '"%g ee,t$
P"%("% Ko+%$,"#$ &e+/e*$"% $%o*+"#$ ("% e(,"#$ '"%g ee,t$
SPO ,o+%$,"#$ ;$" te!&
PN
SKP 3
P"%("%
SPOPN
> D"t"* o/"t>o/"t"% $g "!e*t
SKP 4
P"%("%
SPO
SPO &e%"%(""% !o,"#$ o&e*"#$
PN
SKP 5 Ke/$","% H"%( 'g$e%e
P"%("% H"%( 'g$e%e
SPO $ t"%g"%
SPO !$+" +o+e% $ t"%g"%
PN
Do,+e% I+&!e+e%t"#$
> I%($,"to* $%e,#$ '"%g te*,"$t &e!"'"%"% ,e#e"t"%
> So#$"!$#"#$ ,e/$","% ("% &*o#e(* $ t"%g"%
SKP 6 Ke/$","% "#e#+e% ("% "#e#+e% !"%g *$#$,o &"#$e% "t
P"%("%
SPO
Ke/$","% Pe!"'"%"% Ke(o,te*"% H"#$! "%"!$#$# ("t" ("!"+ &"'" &e%$%g,"t"% +tRS
29-2004 Te%t"%g P*",t$, Ke(o,te*"% 36-2009 Te%t"%g Ke#e"t"% 44-2009Te%t"%g R+" S",$t PMK 269-Me%,e#-Pe*-III-2008
Ke/$","% +e%ge%"$ o/"t>o/"t '"%g $g "!e*t +$%$+"! +e%",& $(e%t$=,"#$ !o,"#$&e!"/e!"% ("% &e%'$+&"%"% o/"t $g "!e*t
Ke/$","% &e!"'"%"% /e(" %t, %t, +e+"#t$,"% te&"t !o,"#$ te&"t &*o#e(*("% te&"t &"#$e% te*+"#, &*o#e(* +e($# ("% t$%(","% &e%go/"t"% g$g$ - (e%t"!
Do,+e% S*ge*' #"et' e, !$#t ($ !",#"%","% ("% ($"t"t ($ *e,"+ +e($# &"#$e%o&e*"#$
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NOELEMEN
PENILAIANDOKUMEN ACUAN KEBI!AKAN PEDOMAN"PANDUAN SPO DAN PRO#RAM
KER!A
SPO &e+"#"%g"% ge!"%g *$#$,o "t
Do,+e% I+&!e+e%t"#$
> Fo*+ +o%$to*$%g ("% e;"!"#$ "#$! &e%g*"%g"% e(e*" ",$/"t "t
PN
SCORE
MDGS 1 Ke/$","% D$*e,t* Te%t"%g PON Re%"%" Ke*" @ A%gg"*"%
> P*og*"+ %$t Ke*" te*,"$t
> Pe!"t$"% T$+ PON
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NOELEMEN
PENILAIANDOKUMEN ACUAN KEBI!AKAN PEDOMAN"PANDUAN SPO DAN PRO#RAM
KER!A
P"%("%
SPO
/. Pe!",#"%""% R,"%
Ke/$","%
P"%("%
SPO
P*og*"+
> Re%"%" St*"teg$> Re%"%" Ke*" @ A%gg"*"%
> Pe!"t$"% T$+ DOTS
Do,+e% $+&!e+e%t"#$
". "&o*"% ,eg$"t"%
/. Se*t$=,"#$ &e!"t$"% DOTS
. Mo R,"% (e%g"% RS R,"%
SCORE
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STATUS SCORE KETERAN#AN PIC
7/24/2019 Check List Dokumen Instrumen Akreditasi RS 2012
70/129
STATUS SCORE KETERAN#AN PIC
7/24/2019 Check List Dokumen Instrumen Akreditasi RS 2012
71/129
STATUS SCORE KETERAN#AN PIC
7/24/2019 Check List Dokumen Instrumen Akreditasi RS 2012
72/129
STATUS SCORE KETERAN#AN PIC
7/24/2019 Check List Dokumen Instrumen Akreditasi RS 2012
73/129
STATUS SCORE KETERAN#AN PIC
7/24/2019 Check List Dokumen Instrumen Akreditasi RS 2012
74/129
STATUS SCORE KETERAN#AN PIC
7/24/2019 Check List Dokumen Instrumen Akreditasi RS 2012
75/129
STATUS SCORE KETERAN#AN PIC
7/24/2019 Check List Dokumen Instrumen Akreditasi RS 2012
76/129
STATUS SCORE KETERAN#AN PIC
7/24/2019 Check List Dokumen Instrumen Akreditasi RS 2012
77/129
STATUS SCORE KETERAN#AN PIC
7/24/2019 Check List Dokumen Instrumen Akreditasi RS 2012
78/129
STATUS SCORE KETERAN#AN PIC
7/24/2019 Check List Dokumen Instrumen Akreditasi RS 2012
79/129
STATUS SCORE KETERAN#AN PIC
7/24/2019 Check List Dokumen Instrumen Akreditasi RS 2012
80/129
STATUS SCORE KETERAN#AN PIC
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81/12