Instrumen Supervisi

Berikan tanda ceklis tempat yang disediakan

1. Kas Umum
o Sudah dibuat sejak dana ditarik dari rekening sekolah ;
o Seluruh transaksi pada bulan bersangkutan sudah tercatat.
2. Pemeriksaan Kas
o Pemeriksaan Kas dilakukan setiap bulan;
o Pemeriksa oleh Kepala SMK dan Bendahara sekolah;
o Saldo harian tidak lebih dari Rp. 50.000.000,00.
3. Bukti transaksi belanja barang/jasa
o Kwitansi ditandatangani Kepala Sekolah, Bendahara Sekolah, dan pihak
vendor/suplayer/penjual; Kwitansi yang nilainya ≥ Rp 1.000.000,00 dibubuhi materai senilai
Rp. 6.000,00
o Kwitansi yang nilainya < Rp. 1.000.000,00 dibubuhi materai senilai Rp. 3.000,00,
o Kwitansi yang nilainya < Rp 250.000,00 tanpa materai
o Nilai > 50 s.d 200 jt, menggunakan bukti transaksi SPK;
o Nilai >200 jt, menggunakan bukti transaksi Surat Perjanjian (lelang).
4. Faktur/Nota belanja barang
o Pembelian barang dilengkapi dengan faktur atau nota belanja barang
o Seluruh faktur/nota belanja tertanggal setelah MOU ditandatangani
5. Pembayaran Pajak
o Membuat buku pembantu pengeluaran pajak;
o PPN pembelian barang, sudah ditarik dari vendor/toko oleh Bendahara SMKN *);
o PPN dan atau PPh disetor ke kantor pajak tiap bulan
o Melengkapi Bukti pembayaran pajak berupa Surat Setoran Pajak (SSP);
6. Laporan pertanggungjawaban Bantuan
o Laporan awal masih tersimpan/diarsipkan
o Laporan kemajuan penyelesaian pekerjaan 50% sudah dibuat dan dikirimkan
o Laporan kemajuan penyelesaian pekerjaan 100% sudah disiapkan dokumen pendukungnya.

Catatan : *) khusus SMK swasta tidak diwajibkan

II. KOMPONEN PELAKSANAAN TEKNIS PROGRAM PETUNJUK

Komponen Pelaksanaan Teknis Program terdiri dari 19 aspek dengan 56 deskriptor, berikan ceklis pada
tanda

1. Sosialisasi

o Melibatkan semua unsur sekolah yang berkepentingan;

o Daftar hadir peserta sesuai jumlah yang direncanakan (RAB)
o Notula yang disusun merefleksikan kegiatan sosialisasi

2. Koordinasi
 o Melibatkan unsur ekternal terkait
o Daftar hadir peserta sesuai jumlah yang direncanakan (RAB)
o Notula yang disusun merefleksikan butir-butir materi koordinasi

3. Penyusunan program kerja

o Melibatkan unsur lain yang berkepentingan diluar Tim Pelaksana

o Daftar hadir peserta sesuai jumlah yang direncanakan (RAB)
o Program kerja sekurang-kurangnya memenuhi kecukupan aspek; kegiatan, penggungjawab,
pihak yang terlibat, dan waktu

4. Penyelarasan kurikulum

o Dilaksanakan dengan kegiatan workshop

o Unsur industri yang dilibatkan sesuai dengan kompetensi keahlian yang dikembangkan;
o Daftar hadir peserta sesuai jumlah yang direncanakan (RAB)
o Penyelarasan kurikulum mengacu pada KKNI dan SKKNI dan atau skema yang relevan dengan
kompetensi keahlian.
o Legalitas kurikulum hasil penyelarasan sudah di ttd Kepala Sekolah dan akan dimintakan ttd
Dinas Pendidikan Provinsi

5. Analisis kebutuhan pembelajaran

o Dilaksanakan dengan kegiatan workshop

o Daftar hadir peserta sesuai jumlah yang direncanakan (RAB)
o Analisis didasarkan pada kurikulum yang diselaraskan dan fokus pada kompetensi keahlian yang
dikembangkan
o Hasil análisis sekurang-kurangnya berupa kebutuhan bahan ajar, kebutuhan guru tambahan,
metode pembelajaran, kebutuhan alat/bahan.

6. Penyusunan bahan ajar

o Dilaksanakan dengan kegiatan workshop

o Daftar hadir peserta sesuai jumlah yang direncanakan (RAB)
o Bahan ajar berfokus pada kompetensi keahlian yang dikembangkan
7. Pengadaan ATK
o Jumlah dana yang digunakan ≤ Rp 5 jt
o Kekurangan belanja ATK diatasi dengan dana sharing sekolah
8. Penggandaan bahan ajar
o Jumlah dana yang digunakan ≤ Rp 5 jt
o Jumlah eksemplar bahan ajar sesuai kebutuhan untuk referensi perpustakaan
9. Pengadaan bahan praktik
o Jenis bahan praktik hanya untuk keperluan kompetensi keahlian yang dikembangkan
o Jumlah bahan praktik sesuai skala produksi (bukan praktik simulasi)
10. Pengadaan peralatan praktik
o Jenis peralatan praktik hanya untuk keperluan kompetensi keahlian yang dikembangkan
 o Jenis dan jumlah peralatan praktik memadai untuk praktik skala produksi (bukan praktik
simulasi)
11. In house training TPM
o Menghadirkan narasumber dari P4TK dan atau Industri
o Seluruh guru produktif (semua kompetensi keahlian) dilibatkan sebagai peserta
12. Magang industri
o Jumlah guru yang dimagangkan sesuai di RAB
o Industri tempat magang guru sesuai dengan kompetensi keahlian yang dikembangkan
o Lama pelaksanaan magang ≥ 3 bulan
13. Sertifikasi pendidik
o Jumlah guru yang disertifikasi sesuai di RAB
o Mensertifikasi assesor metodologi
o Mensertifikasi kompetensi kejuruan level 4
14. IHT perangkat soal
o Narasumber yang dihadirkan telah memiliki sertifikat sebagai pengembang soal dari Pusjian
o Instansi asal narasumber P4TK dan atau LPMP provinsi
o Minimal setiap mata pelajaran yang USBN diwakili oleh seorang guru sebagai peserta
o Lama penyelenggaraan IHT sesuai RAB
15. Pelatihan penulisan MUK
o Narasumber yang dihadirkan telah berpredikat master assesor
o Semua guru yang assesor diikutkan sebagai perserta
o Semua guru produktif pada kompetensi keahlian yang dikembangkan diikutsertakan sebagai
peserta
o Lama penyelenggaraan pelatihan sesuai RAB
16. Production Based Learning (PBL)
o Secara berkala menghadirkan guru sumber dari industri
o Pembelajaran menggunakan sistem blok,
17. Kelompok kewirausahaan
o Jumlah kelompok yang dibentuk sesuai di RAB
o Komposisi anggota kelompok tertidiri siswa kelas XII, kelas XI, dan siswa kelas X
o Setiap kelompok telah diterimakan modal kerja
18. Pendampingan industri/ institusi mitra
o Pendampingan pelaksanaan kegiatan kejuruan telah dilaksanakan oleh
Biotrop/UGM/P4TK/Industri Mitra
o Pendampingan manajemen sekolah (Revitalisasi) telah dilaksanakan oleh Pendamping
Revitalisasi
19. Penyusunan laporan
o Arsip laporan awal masih tersimpan secara baik
o Arsip laporan 50% kemajuan pekerjaan masih tersimpan secara baik
o Materi laporan pertanggungjawaban bantuan 100% telah terhimpun setiap tahap kegiatan
o Materi laporan teknis akhir 100% telah terhimpun setiap tahap kegiatan

III. KOMPONEN OUTPUT PROGRAM

1. Notula kegiatan
 o Notula yang dibuat pada kegiatan sosialisasi menginformasikan ruang lingkup dan tujuan
program Banper;
o Notula yang dibuat pada kegiatan koordinasi eksternal menginformasikan mekanisme
pencapaian program Banper

2. Program kerja

o Program kerja menjadi acuan pelaksanaan program;

o Setiap tahapan kegiatan mendiskripsikan suatu proses yang menjamin tercapainya program.

3. Kurikulum yang diselaraskan

o Penyelarasan kurikulum telah dilakukan sampai pada silabus mata pelajaran C3;
o Kurikulum yang diselaraskan telah menjadi acuan dalam menyusun RPP/LKS

4. Kebutuhan pembelajaran

o Kebutuhan pembelajaran dibuat secara komprehensif (kebutuhan guru, bahan ajar, peralatan,
metode pembelajaran, dll)

5. Bahan ajar

o Bahan ajar sudah dimanfaatkan sebagai sumber belajar

6. Pengadaan bahan praktik

o Bahan praktik sudah dimanfaatkan untuk praktik

7. Pengadaan peralatan praktik

o Peralatan praktik telah diberi label dan dicatat dalam buku inventaris
o Peralatan praktik sudah digunakan

8. In house training TPM

o Guru produktif (semua kompetensi keahlian) telah melakukan penataan bengkel/laboratorium

Sudah nampak adanya gerakan perawatan peralatan praktik

9. Magang industri

o % jumlah guru produktif pada Kompetensi Keahlian yang dikembangkan, yang telah mengikuti
magang industri > 75%; 50% - 75%; 25% - 50%; 0% - 25%

10. Sertifikasi pendidik

o % jumlah guru produktif pada Kompetensi Keahlian yang dikembangkan, yang telah memiliki
sertifikat assesor metodologi ; (> 75%; 50% - 75%; 25% - 50%; 0% - 25%)
 o % jumlah guru produktif pada Kompetensi Keahlian yang dikembangkan, yang telah memiliki
sertifikat kompetensi level 4 (> 75%; 50% - 75%; 25% - 50% ; 0% - 25%)

11. IHT perangkat soal

o Guru pada mata pelajaran yang di USBN telah menerapkan penulisan soal dalam ulangan
harian/mid semester/semesteran.

12. Pelatihan penulisan MUK

o Asessor dan atau guru produktif telah menyusun MUK dari skema yang terkait

13. Production Based Learning (PBL)

o Pelaksanaan PBL menyatu (blended) dalam reguler pembelajaran Hasil pembelajaran praktik
berupa produk/jasa yang layak jual

14. Kelompok kewirausahaan

o Kelompok kewirausahaan telah melaksanakan transaksi membeli dan menjual produk hasil PBL
o Tiap kelompok kewirausahaan telah melakukan pencatatan transaksi kewirausahaan (cash in dan
cash out)

15. Pendampingan industri/ institusi mitra

o Dampak pendampingan pelaksanaan kegiatan kejuruan oleh Biotrop/UGM/P4TK/Industri Mitra

o Dampak pendampingan manajemen sekolah (Revitalisasi) oleh Pendamping Revitalisasi

16. Penyusunan laporan

o Kesiapan laporan akhir pertanggungjawaban bantuan

o Kesiapan laporan akhir 100% penyelesaian pekerjaan

DETAIL SUPERVISI
Isilah pada tempat yang disediakan!

Sub Bagian : Penyusunan

Komponen/Aspek yang di Supervisi

1. Kurikulum Sinkronisasi (Jika lebih dari 2 dapat dicatat dalam lembar terpisah)

1.1.Kegiatan 1

a. Judul
Kegiatan : .......................................................................................................................................................
.................b.Unsur yang
terlibat : ..........................................................................................................................................................
........................................................................................................................................................................
...........

c.
Tanggal : .........................................................................................................................................................
...............

d.
Lokasi : ...........................................................................................................................................................
.............

e.
Pemasalahan : ................................................................................................................................................
........................ ...............................................................................................................................................
.........................

f. Tindakan
Supervisi : .......................................................................................................................................................
.................

1.2 Kegiatan 2

a. Judul
Kegiatan : .......................................................................................................................................................
.................

b. Unsur yang
terlibat : ..........................................................................................................................................................
........................................................................................................................................................................
..............

c.
Tanggal : .........................................................................................................................................................
...............
d.
Lokasi : ...........................................................................................................................................................
.............

e.
Pemasalahan : ................................................................................................................................................
........................................................................................................................................................................
........................

f. Tindakan
Supervisi : .......................................................................................................................................................
.................

2. Perangkat Mengajar (Modul Penyelarasan, Silabus, RPP) (Jika lebih dari 2 dapat dicatat dalam
lembar terpisah)

2.1.Kegiatan 1

a. Judul
Kegiatan : .......................................................................................................................................................
.................

b. Unsur yang
terlibat : ..........................................................................................................................................................
........................................................................................................................................................................
..............

c.
Tanggal : .........................................................................................................................................................
...............

d.
Lokasi : ...........................................................................................................................................................
.............

e.
Pemasalahan : ................................................................................................................................................
........................

f. Tindakan
Supervisi : .......................................................................................................................................................
.................

2.2 Kegiatan 2

a. Judul Kegiatan:
.......................................................................................................................................................................

b. Unsur yang
terlibat : ..........................................................................................................................................................
........................................................................................................................................................................
..............

c.
Tanggal : .........................................................................................................................................................
...............

d.
Lokasi : ...........................................................................................................................................................
.............

e.
Pemasalahan : ................................................................................................................................................
........................

f. Tindakan
Supervisi : .......................................................................................................................................................
.................

3. Panduan Kelas Industri (Jika lebih dari 2 dapat dicatat dalam lembar terpisah)

3.1.Kegiatan 1

a. Judul
Kegiatan : .......................................................................................................................................................
.................

b.Unsur yang
terlibat : ..........................................................................................................................................................
........................................................................................................................................................................
..............

4. SOP Industri (Jika lebih dari 2 dapat dicatat dalam lembar terpisah)

4.1.Kegiatan 1

a. Judul
Kegiatan : .......................................................................................................................................................
.................

b.Unsur yang
terlibat : ..........................................................................................................................................................
........................................................................................................................................................................
..............

c.
Tanggal : .........................................................................................................................................................
...............

d.
Lokasi : ...........................................................................................................................................................
.............

e.
Pemasalahan : ................................................................................................................................................
........................

f. Tindakan
Supervisi : .......................................................................................................................................................
.................

4.2 Kegiatan 2

a. Judul
Kegiatan : .......................................................................................................................................................
.................b. Unsur yang
terlibat : ..........................................................................................................................................................
........................................................................................................................................................................
..............

c.
Tanggal : .........................................................................................................................................................
...............

d.
Lokasi : ...........................................................................................................................................................
.............

e.
Pemasalahan : ................................................................................................................................................
........................................................................................................................................................................
........................

f. Tindakan
Supervisi : .......................................................................................................................................................
.................
5. Materi Uji Kompetensi/Perangkat Asesment (Jika lebih dari 2 dapat dicatat dalam lembar terpisah)
5.1.Kegiatan 1

a. Judul
Kegiatan : .......................................................................................................................................................
.................

b.Unsur yang
terlibat : ..........................................................................................................................................................
........................................................................................................................................................................
..............

c.
Tanggal : .........................................................................................................................................................
...............

d.
Lokasi : ...........................................................................................................................................................
.............

e.
Pemasalahan : ................................................................................................................................................
........................

f. Tindakan
Supervisi : .......................................................................................................................................................
.................

5.2 Kegiatan 2

a. Judul
Kegiatan : .......................................................................................................................................................
.................

b. Unsur yang
terlibat : ..........................................................................................................................................................
........................................................................................................................................................................
..............

c.
Tanggal : .........................................................................................................................................................
...............
d.
Lokasi : ...........................................................................................................................................................
.............

e.
Pemasalahan : ................................................................................................................................................
........................................................................................................................................................................
........................

f. Tindakan
Supervisi : .......................................................................................................................................................
.................

Sub Bagian : Pelatihan

Komponen/Aspek yang di Supervisi

1. Magang/OJT (Jika lebih dari 2 dapat dicatat dalam lembar terpisah)

1.1.Kegiatan 1

a. Judul
Materi : ...........................................................................................................................................................
.............

b. Jumlah
Peserta : .........................................................................................................................................................
........................................................................................................................................................................
...............

c. Tanggal
Pelatihan : ......................................................................................................................................................
..................

d.
Lokasi : ...........................................................................................................................................................
.............

e.
Pemasalahan : ................................................................................................................................................
........................................................................................................................................................................
........................

f. Tindakan
Supervisi : .......................................................................................................................................................
.................
1.2.Kegiatan 2

a. Judul
Materi : ...........................................................................................................................................................
.............

b. Jumlah
Peserta : .........................................................................................................................................................
........................................................................................................................................................................
...............

c. Tanggal
Pelatihan : ......................................................................................................................................................
..................

d.
Lokasi : ...........................................................................................................................................................
.............

e.
Pemasalahan : ................................................................................................................................................
........................................................................................................................................................................
........................

f. Tindakan
Supervisi : .......................................................................................................................................................
.................

2. Peningkatan Kompetensi (Jika lebih dari 2 dapat dicatat dalam lembar terpisah)

2.1.Kegiatan 1

a. Judul
Materi : ...........................................................................................................................................................
.............

b. Jumlah
Peserta : .........................................................................................................................................................
........................................................................................................................................................................
...............

c. Tanggal
Pelatihan : ......................................................................................................................................................
..................
d.
Lokasi : ...........................................................................................................................................................
.............

e.
Pemasalahan : ................................................................................................................................................
........................................................................................................................................................................
........................

f. Tindakan
Supervisi : .......................................................................................................................................................
.................

2.2.Kegiatan 2

a. Judul
Materi : ...........................................................................................................................................................
.............

b. Jumlah
Peserta : .........................................................................................................................................................
........................................................................................................................................................................
...............

c. Tanggal
Pelatihan : ......................................................................................................................................................
..................

d.
Lokasi : ...........................................................................................................................................................
.............

e.
Pemasalahan : ................................................................................................................................................
........................................................................................................................................................................
........................

f. Tindakan
Supervisi : .......................................................................................................................................................
.................

3. Pelatihan Asesor (Metodologi) (Jika lebih dari 2 dapat dicatat dalam lembar terpisah)

3.1.Kegiatan 1
a. Judul
Materi : ...........................................................................................................................................................
.............

b. Jumlah
Peserta : .........................................................................................................................................................
........................................................................................................................................................................
...............

c. Tanggal
Pelatihan : ......................................................................................................................................................
..................

d.
Lokasi : ...........................................................................................................................................................
.............

e.
Pemasalahan : ................................................................................................................................................
........................................................................................................................................................................
........................

f. Tindakan
Supervisi : .......................................................................................................................................................
.................

3.2.Kegiatan 2

a. Judul
Materi : ...........................................................................................................................................................
.............

b. Jumlah
Peserta : .........................................................................................................................................................
........................................................................................................................................................................
...............

c. Tanggal
Pelatihan : ......................................................................................................................................................
..................

d.
Lokasi : ...........................................................................................................................................................
.............
e.
Pemasalahan : ................................................................................................................................................
........................................................................................................................................................................
........................

f. Tindakan
Supervisi : .......................................................................................................................................................
.................

4. Pelatihan Penyusunan MUK (Jika lebih dari 2 dapat dicatat dalam lembar terpisah)

4.1.Kegiatan 1

a. Judul
Materi : ...........................................................................................................................................................
.............

b. Jumlah
Peserta : .........................................................................................................................................................
........................................................................................................................................................................
...............

c. Tanggal
Pelatihan : ......................................................................................................................................................
..................

d.
Lokasi : ...........................................................................................................................................................
.............

e.
Pemasalahan : ................................................................................................................................................
........................................................................................................................................................................
........................

f. Tindakan
Supervisi : .......................................................................................................................................................
.................4.2.Kegiatan 2

a. Judul
Materi : ...........................................................................................................................................................
.............

b. Jumlah
Peserta : .........................................................................................................................................................
........................................................................................................................................................................
...............

c. Tanggal
Pelatihan : ......................................................................................................................................................
..................

d.
Lokasi : ...........................................................................................................................................................
.............

e.
Pemasalahan : ................................................................................................................................................
........................................................................................................................................................................
........................

f. Tindakan
Supervisi : .......................................................................................................................................................
.................

5. Pelatihan Penyusunan Soal USBN (Jika lebih dari 2 dapat dicatat dalam lembar terpisah)

5.1.Kegiatan 1

a. Judul
Materi : ...........................................................................................................................................................
.............

b. Jumlah
Peserta : .........................................................................................................................................................
........................................................................................................................................................................
...............

c. Tanggal
Pelatihan : ......................................................................................................................................................
..................

d.
Lokasi : ...........................................................................................................................................................
.............

e.
Pemasalahan : ................................................................................................................................................
........................................................................................................................................................................
........................
 f. Tindakan
Supervisi : .......................................................................................................................................................
.................

5.2.Kegiatan 2

a. Judul
Materi : ...........................................................................................................................................................
.............

b. Jumlah
Peserta : .........................................................................................................................................................
........................................................................................................................................................................
...............

c. Tanggal
Pelatihan : ......................................................................................................................................................
..................

d.
Lokasi : ...........................................................................................................................................................
.............

e.
Pemasalahan : ................................................................................................................................................
........................................................................................................................................................................
........................

f. Tindakan
Supervisi : .......................................................................................................................................................
.................

6. Pelatihan Pembentukan Karakter (bagi siswa) (Jika lebih dari 2 dapat dicatat dalam lembar terpisah)
6.1.Kegiatan 1

a. Judul
Materi : ...........................................................................................................................................................
.............

b. Jumlah
Peserta : .........................................................................................................................................................
........................................................................................................................................................................
...............
 c. Tanggal
Pelatihan : ......................................................................................................................................................
..................

d.
Lokasi : ...........................................................................................................................................................
.............

e.
Pemasalahan : ................................................................................................................................................
........................................................................................................................................................................
........................

f. Tindakan
Supervisi : .......................................................................................................................................................
.................

6.2.Kegiatan 2

a. Judul
Materi : ...........................................................................................................................................................
.............

b. Jumlah
Peserta : .........................................................................................................................................................
........................................................................................................................................................................
...............

c. Tanggal
Pelatihan : ......................................................................................................................................................
..................

d.
Lokasi : ...........................................................................................................................................................
.............

e.
Pemasalahan : ................................................................................................................................................
........................................................................................................................................................................
........................

f. Tindakan
Supervisi : .......................................................................................................................................................
.................
Sub Bagian : Sertifikasi (Asesment Kompetensi Teknis) (Jika lebih dari 2 dapat dicatat dalam lembar
terpisah)

1. Kegiatan 1

a. Judul
Skema : ...........................................................................................................................................................
.............

b. Jumlah
Guru : .............................................................................................................................................................
........................................................................................................................................................................
...........

c. Tanggal
Mulai : ............................................................................................................................................................
............

d.
Lokasi : ...........................................................................................................................................................
.............

e.
Pemasalahan : ................................................................................................................................................
........................................................................................................................................................................
........................

f. Tindakan
Supervisi : .......................................................................................................................................................
.................

2. Kegiatan 2

a. Judul
Skema : ...........................................................................................................................................................
.............

b. Jumlah
Guru : .............................................................................................................................................................
........................................................................................................................................................................
...........

c. Tanggal
Mulai : ............................................................................................................................................................
............
d.
Lokasi : ...........................................................................................................................................................
.............

e.
Pemasalahan : ................................................................................................................................................
........................................................................................................................................................................
........................

f. Tindakan
Supervisi : .......................................................................................................................................................
.................

Sub Bagian : Alat Bahan

a. Daftar Alat : Ada / Tidak

b. Daftar Bahan : Ada/Tidak

c. Hasil
Produk : ..........................................................................................................................................................
..............

d. Keberlanjutan Program: (lingkari jawaban yang dipilih) a). Unit Produksi b). Kewirausahaan c).
Permasalahan : ...............................................................................................................................................
.........................

f. Tindakan
Supervisi : .......................................................................................................................................................
.................

Sub Bagian : Kewirausahaan (Jika lebih dari 2 dapat dicatat dalam lembar terpisah)

1. Kegiatan 1

a. Nama Program
Kewirausahaan : .............................................................................................................................................
...........................

b. Jumlah
Peserta : .........................................................................................................................................................
...............

c. Pemasalahan:

........................................................................................................................................................................
.......................................................................................................................................................................
d. Tindakan
Supervisi : .......................................................................................................................................................
.................

2. Kegiatan 2

a. Nama Program
Kewirausahaan : .............................................................................................................................................
...........................

b. Jumlah
Peserta : .........................................................................................................................................................
...............

c. Pemasalahan:

........................................................................................................................................................................
.......................................................................................................................................................................

d. Tindakan
Supervisi : .......................................................................................................................................................
.................

CATATAN PETUGAS SUPERVISI

a. Potensi sekolah untuk menindaklanjuti pelaksanaan program:

b. Hal-hal yang perlu dibenahi dan dikembangkan:

c. Komentar umum:

Petugas Supervisi ,

(..........................................)

NIP