NO NAMA GOL JABATAN GRADE

1 2 3 4 5

1 Dr. Hj. Fitria Ananda IV.A JF DOKTER MADYA 12

2 Drg. Elvi Marleni IV.b JF DOKTER GIGI MADYA 12
3 Maiyarnis III.D JF BIDAN PENYELIA 8
4 Lolita , Amd.Kep III.D JF PERAWAT PENYELIA 8
5 Dasmalinda , AMK III.D JF PERAWAT PENYELIA 8
6 Hafni Zahara, Amd.Keb III.D JFB BIDAN PENYELIA 8
7 Syahnidar, AMKG III.D JF PERAWAT GIGI PENYELIA 8
JF PRANATA LABORATORIUM
8 Sri Mitra Evita, AMAK III.D KESEHATAN PENYELIA 8
9 Sri Firma Dona III.D JF PERAWAT PENYELIA 8
10 Sri Rezki, SST III.C JF NUTRISIONIS MUDA 9
JF PERAWAT PELAKSANA
11 Wellya Rahmi , AMd.Kep III.B LANJUTAN 7
12 Sony Yartati, AMd.Keb III.A JF BIDAN PELAKSANA LANJUTAN 7
13 Dwi Eka Kurniati, AMd.Keb III.A JF BIDAN PELAKSANA LANJUTAN 7
14 Srimayeti, AMd.Keb III.A JF BIDAN PELAKSANA LANJUTAN 7
15 Rismalinda, AMd.Keb III.A JF BIDAN PELAKSANA LANJUTAN 7
16 Armainita, AMd.Keb III.A JF BIDAN PELAKSANA LANJUTAN 7
17 Zelmawitra, AMd.Keb III.A JF BIDAN PELAKSANA LANJUTAN 7
18 Desi Susilawati, AMd.Keb III.A JF BIDAN PELAKSANA LANJUTAN 7
JF PERAWAT PELAKSANA
19 Betty Emelia, AMK III.B LANJUTAN 7
20 M. Yulius III.A PENGADMINISTRASI UMUM 5
21 Mira Indiana II.D JF SISTEN APOTEKER PELAKSANA 6
JF ASISTEN APOTEKER PELAKSANA
22 Fitri Yani, Amd.Farm III.A LANJUTAN 7
23 Insanil Arsyah,Amd.RM II.D JF Teknisi Elektromedis Pelaksana 6
24 Siska Ratna Sari, Amd.Keb II.C JF BIDAN PELAKSANA 6
25 Vivi Prioriti, Amd.Keb II.C JF BIDAN PELAKSANA 6
26 Shiska Shinta Dewi, Amd.Keb II.C JF BIDAN PELAKSANA 6
27 Desi Musfariani, Amd.Keb II.C JF BIDAN PELAKSANA 6
28 Novrita, Amd.Keb II.C JF BIDAN PELAKSANA 6
29 Vivi Erva Noflita, AMd.Keb II.C JF BIDAN PELAKSANA 6

JUMLAH

Keterangan : n = Jumlah hari kerja dalam 1 bulan

KEPALA DINAS KESEHATAN

dr.Hj.YESRITA ZEDRIANIS,M.Kes
dr.Hj.YESRITA ZEDRIANIS,M.Kes
NIP. 196509061999032001
 POTONGAN TIDAK HADIR TANPA KETERANGAN

TPP TPP DASAR

JML JML CUTI LBH JML JML TK JML POT (Rp)
HARI 12 HARI HARI

6 7=(6)*50%) 8 9=(8)/n*(2,5%)*(7) 10 11=(10)/n*(2,5%)*(7) 12=9+11

2,169,375 1,084,688 - - -
2,169,375 1,084,688 - - -
1,199,250 599,625 - - -
1,228,500 614,250 - -
1,228,500 614,250 - - -
1,199,250 599,625 - - -
1,228,500 614,250 - - -
1,199,250 - - -
599,625
1,228,500 614,250 - - -
1,516,125 758,063 - - -
1,009,125 504,563 - - -
979,875 489,938 - - -
979,875 489,938 - - -
979,875 489,938 - - -
 979,875 489,938 - - -
979,875 489,938 - - -
979,875 489,938 - - -
979,875 489,938 - - -
1,009,125 504,563 - - -
1,708,875 854,438 - - -
736,125 368,063 - - -
994,500 497,250 - - -
750,750 375,375 - - -
721,500 360,750 - - -
721,500 360,750 - - -
721,500 360,750 - - -
 721,500 360,750 - - -
721,500 360,750 - - - - -
721,500 360,750 - - - - -

31,763,250 15,881,632 - - - - -
 BERDASARKAN CAPAIAN SKP KERJA (60%)
JUMLAH TPP TPP PRESTASI
DASAR SKP BULANAN PEMBEBASAN
KERJA
DITERIMA SEMENTARA L K H
DARI JABATAN
NILAI JMLH
13=7-12 14=(6)*50% 15 16=((14)*(15)/100))*60% 17 18

1,084,688 1,084,687 100 650,812 - -

1,084,688 1,084,687 100 650,812 -
599,625 599,625 100 359,775 -
614,250 614,250 100 368,550 -
614,250 614,250 100 368,550 -
599,625 599,625 100 359,775 -
614,250 614,250 100 368,550 -
599,625 599,625 100 -
359,775
614,250 614,250 100 368,550 -
758,063 758,062 100 454,837 -
504,563 504,562 100 302,737 -
489,938 489,937 100 293,962 -
489,938 489,937 100 293,962 -
489,938 489,937 100 293,962 -
489,938 489,937 100 293,962 -
489,938 489,937 100 293,962 -
489,938 489,937 100 293,962 -
489,938 489,937 100 293,962 -
504,563 504,562 100 302,737 -
854,438 100
368,063 368,062 100 220,837 -
497,250 497,250 100 298,350 -
375,375 375,375 100 225,225 -
360,750 360,750 100 216,450 -
360,750 360,750 100 216,450 -
360,750 360,750 100 216,450 -
 360,750 360,750 100 216,450 -
360,750 360,750 100 216,450 - -
360,750 360,750 100 216,450 - -

15,881,632 15,027,181 2,900 9,016,306 - -

PEJABAT PENATAUSAHAAN KEUANGAN

ELFA , SE
 ELFA , SE
NIP.198102052009012003
 DAFTAR PEMBAYARAN TAMBAHAN PENGHASILAN PEGAWAI NEGER
DILINGKUNGAN DINAS/BADAN/KANTOR
BULAN : FEBRUARI

ORIENTASI PELAYANAN
BERDASARKAN INTEGRITAS (15%)
PERILAKU KERJA
(40%) PIMPINAN / FUNGSIONAL/PELAKSANA
ADMINISTRATOR (15%) (20%)
NILAI JMLH NILAI JMLH NILAI
19=((14)*(15)/100))*40% 20 21=((19)*(20)/100))*15% 22 23=((19)*(22)/100))*20% 24

433,875 100 86,775 100

433,875 100 86,775 100
239,850 100 47,970 100
245,700 100 49,140 100
245,700 100 49,140 100
239,850 100 47,970 100
245,700 100 49,140 100
239,850
100 47,970 100
245,700 100 49,140 100
303,225 100 60,645 100
201,825 100 40,365 100
195,975 100 39,195 100
195,975 100 39,195 100
195,975 100 39,195 100
195,975 100 39,195 100
195,975 100 39,195 100
195,975 100 39,195 100
195,975 100 39,195 100
201,825 100 40,365 100
-
147,225 100 29,445 100
198,900 100 39,780 100
150,150 100 30,030 100
144,300 100 28,860 100
144,300 100 28,860 100
144,300 100 28,860 100
 144,300 100 28,860 100
144,300 100 28,860 100
144,300 100 28,860 100

6,010,875 - - 2,800 1,202,175 2,800

GAWAI NEGERI SIPIL
OR

KEPEMIMPIN
TEGRITAS (15%) KOMITMEN (20%) KERJASAMA (5%)
PIMPINAN / ADM

JMLH NILAI JMLH NILAI JMLH NILAI

25=((19)*(24)/100))*15% 26 27=((19)*(26)/100))*20% 28 29=((19)*(28)/100))*5% 30

65,081 100 86,775 100 21,694

65,081 100 86,775 100 21,694
35,978 100 47,970 100 11,993
36,855 100 49,140 100 12,285
36,855 100 49,140 100 12,285
35,978 100 47,970 100 11,993
36,855 100 49,140 100 12,285

35,978 100 47,970 100 11,993

36,855 100 49,140 100 12,285
45,484 100 60,645 100 15,161
30,274 100 40,365 100 10,091
29,396 100 39,195 100 9,799
29,396 100 39,195 100 9,799
29,396 100 39,195 100 9,799
29,396 100 39,195 100 9,799
29,396 100 39,195 100 9,799
29,396 100 39,195 100 9,799
29,396 100 39,195 100 9,799

30,274 100 40,365 100 10,091

22,084 100 29,445 100 7,361

29,835 100 39,780 100 9,945

22,523 100 30,030 100 7,508
21,645 100 28,860 100 7,215
21,645 100 28,860 100 7,215
21,645 100 28,860 100 7,215
21,645 100 28,860 100 7,215
21,645 100 28,860 100 7,215
21,645 100 28,860 100 7,215

901,632 2,800 1,202,175 2,800 300,547 -

MIMPINAN (5%) DISIPLIN (40%)

/ ADMINISTRATOR TK CEPAT PULANG/ TERLAMBA

NILAI JML
JMLH HARI JMLH MENIT
31=((19)*(30)/100))*5% 32 33=((19)*(32)/100))*40% 34 35=(34)/n*(5%)*(33) 36

100 173,550 -
100 173,550 - 480
100 95,939 - 240
100 98,280 - 180
100 98,280 - 240
100 95,939 - 420
100 98,280 - 390
95,939 - 180
100
100 98,280 - 300
100 121,290 - 520

100 80,730 - 150

100 78,390 - 240
100 78,390 - 180
100 78,390 - 240
100 78,390 - 450
100 78,390 - 180
100 78,390 - 480
100 78,390 -

100 80,730 - 390

100 - - 120
100 58,890 - 110

100 79,560 - 340

100 60,059 -
100 57,720 -
100 57,720 - 60
100 57,720 - 60
 100 57,720 - 240
100 57,720 - 240
100 57,720 - 300

- ### 2,404,346 - - 6,730

 JUMLAH TPP PRESTASI JUMLAH TPP DITERIMA PPH PASAL 21
KERJA DITERIMA
ANG/ TERLAMBAT JML DISIPLIN
DITERIMA
JMLH
37=(36)/450*(3%)*(33) 38=33-(35+37) 39=(16+21+23+25+27+29+31+38) 40=(13+39) 41=40*(5% atau 15%)

- 173,550 1,084,687 2,169,375 325,406

5,554 167,996 1,079,133 2,163,821 324,573
1,535 94,404 598,090 1,197,715 59,886
1,179 97,101 613,071 1,227,321 61,366
1,572 96,708 612,678 1,226,928 61,346
2,686 93,253 596,939 1,196,564 59,828
2,555 95,725 611,695 1,225,945 61,297
94,788 598,474 1,198,099
1,151 59,905
1,966 96,314 612,284 1,226,534 61,327
4,205 117,085 753,857 1,511,920 75,596
807 79,923 503,755 1,008,318 50,416
1,254 77,136 488,683 978,621 48,931
941 77,449 488,996 978,934 48,947
1,254 77,136 488,683 978,621 48,931
2,352 76,038 487,585 977,523 48,876
941 77,449 488,996 978,934 48,947
2,508 75,882 487,429 977,367 48,868
78,390 489,937 979,875 48,994

2,099 78,631 502,463 1,007,026 50,351

- - 854,438 42,722
432 58,458 367,630 735,693

1,803 77,757 495,447 992,697 49,635

60,059 375,375 750,750
57,720 360,750 721,500
231 57,489 360,519 721,269
231 57,489 360,519 721,269
924 56,796 359,826 720,576
924 56,796 359,826 720,576
1,154 56,566 359,596 720,346

40,258 2,364,088 14,986,923 30,868,555 1,686,148

BENDAHARA PENGELUARAN

Insanil Aryah
NIP. 198806182010012013
 KET. (NO.
JUMLAH BERSIH URUT DI
PERBUP)

42=40-41 43

1,843,969 29
1,839,248 30 480 -
1,137,829 325 240 -
1,165,955 329 180 -
1,165,582 329 240 -
1,136,736 325 420 -
1,164,648 331 390 -
1,138,194 333 180 -
1,165,207 329 300 -
1,436,324 185 520 -
957,902 567 150 -
929,690 565 240 -
929,987 565 180 -
929,690 565 240 -
928,647 565 450 -
929,987 565 180 -
928,499 565 480 -
930,881 565 -
956,675 567 390 -
811,716 1,066 120 -
735,693 862 110 -
943,062 564 340 -
750,750 870 -
721,500 863 -
721,269 863 60 -
721,269 863 60 -
 720,576 863 240 -
720,576 863 240 -
720,346 863 300 -

29,182,407
NO NAMA GOL JABATAN GRADE TPP

1 2 3 4 5 6

Dr.
1 Hj. Fitria Ananda
IV.A JF DOKTER MADYA 12 2,169,375
2 Drg. Elvi MarleniIV.bJF DOKTER GIGI MADYA 12 2,169,375
3 Maiyarnis III.D JF BIDAN PENYELIA 8 1,199,250
 4 Lolita , Amd.KepIII.DJF PERAWAT PENYELIA 8 1,228,500
5Dasmalinda , AMK
III.DJF PERAWAT PENYELIA 8 1,228,500
Hafni
6 Zahara, Amd.Keb
III.D JFB BIDAN PENYELIA 8 1,199,250
7Syahnidar, AMKG
III.D
JF PERAWAT GIGI PENYELIA 8 1,228,500
Sri
8 Mitra
JF Evita,
PRANATA
AMAK
III.D
LABORATORIUM KESEHATAN8PENYELIA
1,199,250
9 Sri Firma Dona III.DJF PERAWAT PENYELIA 8 1,228,500
10 Sri Rezki, SST III.CJF NUTRISIONIS MUDA 9 1,516,125
Wellya
11 Rahmi , AMd.Kep
JF PERAWAT
III.B PELAKSANA LANJUTAN
7 1,009,125
Sony
12 Yartati, AMd.Keb
JFIII.A
BIDAN PELAKSANA LANJUTAN
7 979,875
Dwi13
Eka Kurniati, AMd.Keb
JFIII.A
BIDAN PELAKSANA LANJUTAN
7 979,875
14
Srimayeti, AMd.Keb
JFIII.A
BIDAN PELAKSANA LANJUTAN
7 979,875
Rismalinda,
15 AMd.Keb
JFIII.A
BIDAN PELAKSANA LANJUTAN
7 979,875
 Armainita,
16 AMd.Keb
JFIII.A
BIDAN PELAKSANA LANJUTAN
7 979,875
Zelmawitra,
17 AMd.Keb
JFIII.A
BIDAN PELAKSANA LANJUTAN
7 979,875
Desi
18Susilawati, AMd.Keb
JFIII.A
BIDAN PELAKSANA LANJUTAN
7 979,875
19
Betty Emelia,JF
AMKPERAWAT
III.B PELAKSANA LANJUTAN
7 1,009,125
20 M. Yulius III.A
PENGADMINISTRASI UMUM 5 1,708,875
21 Mira Indiana
JF II.D
SISTEN APOTEKER PELAKSANA
6 736,125
22
Fitri Yani,JFAmd.Farm
ASISTEN
III.AAPOTEKER PELAKSANA LANJUTAN
7 994,500
Insanil
23 Arsyah,Amd.RM
JFII.D
Teknisi Elektromedis Pelaksana6 750,750
Siska
24 Ratna Sari, Amd.Keb
II.C JF BIDAN PELAKSANA 6 721,500
Vivi
25 Prioriti, Amd.Keb
II.C JF BIDAN PELAKSANA 6 721,500
hiska
26 Shinta Dewi, Amd.Keb
II.C JF BIDAN PELAKSANA 6 721,500
Desi
27Musfariani, Amd.Keb
II.C JF BIDAN PELAKSANA 6 721,500
 28Novrita, Amd.KebII.C JF BIDAN PELAKSANA 6 721,500
Vivi29Erva Noflita, AMd.Keb
II.C JF BIDAN PELAKSANA 6 721,500

JUMLAH 31,763,250

KEPALA DINAS/BADAN/KANTOR

TTD

TOM
 TOM
NIP. 19XXXXXXXXXXXXXXX
 DAFTAR P

POTONGAN TIDAK HADIR TANPA

KETERANGAN
JUMLAH TPP
TPP DASAR JML CUTI DASAR
LBH 12 JML TK JML POT (Rp) DITERIMA
HARI

7=(6)*50% 8 9 10=(8)+(9) 11=(7)-(10)

1,084,688 - - - 1,084,688
1,084,688 - - - 1,084,688
599,625 - - - 599,625
614,250 - - - 614,250
614,250 - - - 614,250
599,625 - - - 599,625
614,250 - - - 614,250
599,625 - - - 599,625
614,250 - - - 614,250
758,063 - - - 758,063
504,563 - - - 504,563
489,938 - - - 489,938
489,938 - - - 489,938
489,938 - - - 489,938
489,938 - - - 489,938
489,938 - - - 489,938
489,938 - - - 489,938
489,938 - - - 489,938
504,563 - - - 504,563
854,438 - - - 854,438
368,063 - - - 368,063
497,250 - - - 497,250
375,375 - - - 375,375
360,750 - - - 360,750
360,750 - - - 360,750
360,750 - - - 360,750
360,750 - - - 360,750
 360,750 - - - 360,750
360,750 - - - 360,750

15,881,632 - - - 15,881,632

PEJABAT PENATAUSAH

TTD

SNOWY
 SNOWY
NIP. 19XXXXXXXX
DAFTAR PEMBAYARAN TAMBAHAN PENGHASILAN PEGAWAI NEGERI
DILINGKUNGAN DINAS/BADAN/KANTOR
BULAN : ………………………………

BERDASARKAN CAPAIAN SKP (60%)

TPP PRESTASI
KERJA PEMBEBASAN BERDASARKAN
SKP BULANAN SEMENTARA L K H PERILAKU KERJA
DARI JABATAN (40%)

12=(6)*50% 13=(12)*60% 14 15 16=(12)*40%

1,084,687 650,812 - - 433,875

1,084,687 650,812 - - 433,875
599,625 359,775 - - 239,850
614,250 368,550 - - 245,700
614,250 368,550 - - 245,700
599,625 359,775 - - 239,850
614,250 368,550 - - 245,700
599,625 359,775 - - 239,850
614,250 368,550 - - 245,700
758,062 454,837 - - 303,225
504,562 302,737 - - 201,825
489,937 293,962 - - 195,975
489,937 293,962 - - 195,975
489,937 293,962 - - 195,975
489,937 293,962 - - 195,975
489,937 293,962 - - 195,975
489,937 293,962 - - 195,975
489,937 293,962 - - 195,975
504,562 302,737 - - 201,825
0 - - - -
368,062 220,837 - - 147,225
497,250 298,350 - - 198,900
375,375 225,225 - - 150,150
360,750 216,450 - - 144,300
360,750 216,450 - - 144,300
360,750 216,450 - - 144,300
360,750 216,450 - - 144,300
 360,750 216,450 - - 144,300
360,750 216,450 - - 144,300

15,027,181 9,016,306 - - 6,010,875

PENATAUSAHAAN KEUANGAN

TTD

SNOWY
 SNOWY
19XXXXXXXXXXXXXXX
WAI NEGERI SIPIL

BERDASARKAN PERILAKU KERJA (40%)

ORIENTASI INTEGRITAS KOMITMEN KERJA SAMA KEPEMIMPINAN

PELAYANAN (15%) (20%) (5%) (5%)
(20%/15%)

17=(16)*20% atau 15% 18=(16)*15% 19=(16)*20% 20=(16)*5% 21=(16)*5%

86,775 65,081 86,775 21,694 -

86,775 65,081 86,775 21,694 -
47,970 35,978 47,970 11,993 -
49,140 36,855 49,140 12,285 -
49,140 36,855 49,140 12,285 -
47,970 35,978 47,970 11,993 -
49,140 36,855 49,140 12,285 -
47,970 35,978 47,970 11,993 -
49,140 36,855 49,140 12,285 -
60,645 45,484 60,645 15,161 -
40,365 30,274 40,365 10,091 -
39,195 29,396 39,195 9,799 -
39,195 29,396 39,195 9,799 -
39,195 29,396 39,195 9,799 -
39,195 29,396 39,195 9,799 -
39,195 29,396 39,195 9,799 -
39,195 29,396 39,195 9,799 -
39,195 29,396 39,195 9,799 -
40,365 30,274 40,365 10,091 -
- - - - -
29,445 22,084 29,445 7,361 -
39,780 29,835 39,780 9,945 -
30,030 22,523 30,030 7,508 -
28,860 21,645 28,860 7,215 -
28,860 21,645 28,860 7,215 -
28,860 21,645 28,860 7,215 -
28,860 21,645 28,860 7,215 -
 28,860 21,645 28,860 7,215 -
28,860 21,645 28,860 7,215 -

1,202,175 901,632 1,202,175 300,547 -

 JUMLAH TPP JUMLAH TPP PPH PASAL 21 JUMLAH
KINERJA (5% atau
DISIPLIN DITERIMA BERSIH
DITERIMA 15%)
(40%)

23=(13+17+18+19 25=(24)*(5%
22=(16)*40% 24=(11)+(23) 26=(24)-(25)
+20+21+22) atau 15%)

173,550 1,084,687 2,169,375 325,406 1,843,969

167,996 1,079,133 2,163,821 324,573 1,839,248
94,404 598,090 1,197,715 59,886 1,137,829
 97,101 613,071 1,227,321 61,366 1,165,955
96,708 612,678 1,226,928 61,346 1,165,582
93,253 596,939 1,196,564 59,828 1,136,736
95,725 611,695 1,225,945 61,297 1,164,648
94,788 598,474 1,198,099 59,905 1,138,194
96,314 612,284 1,226,534 61,327 1,165,207
117,085 753,857 1,511,920 75,596 1,436,324
79,923 503,755 1,008,318 50,416 957,902
77,136 488,683 978,621 48,931 929,690
77,449 488,996 978,934 48,947 929,987
77,136 488,683 978,621 48,931 929,690
76,038 487,585 977,523 48,876 928,647
77,449 488,996 978,934 48,947 929,987
75,882 487,429 977,367 48,868 928,499
78,390 489,937 979,875 48,994 930,881
78,631 502,463 1,007,026 50,351 956,675
- 0 854,438 42,722 811,716
58,458 367,630 735,693 - 735,693
77,757 495,447 992,697 49,635 943,062
60,059 375,375 750,750 - 750,750
57,720 360,750 721,500 - 721,500
57,489 360,519 721,269 - 721,269
57,489 360,519 721,269 - 721,269
56,796 359,826 720,576 - 720,576
 56,796 359,826 720,576 - 720,576
56,566 359,596 720,346 - 720,346

2,364,088 14,986,923 30,868,555 1,686,148 29,182,407

30,868,555 1,686,148 29,182,407

BENDAHARA PENGELUARAN

TTD
 JERRY
NIP. 19XXXXXXXXXXXXXXX
KET. (NO.
URUT DI
PERBUP)

27

29
30
325
329
329
325
331
333
329
185
567
565
565
565
565
 565
565
565
567
1,066
862
564
870
863
863
863
863
863
863