PEDOMAN RELAWAN PALANG MERAH INDONESIA (1)
MANAJEMEN
RELAWAN
( KSR )
KORPS
SUKARELA
i
Pedoman KSR PMI
DAFTAR ISI
!
" "
$
#
'
!
(
"
)
"
)*#
"
"
/
+
+
+
+
-
)*#
*
%1 1
)
&
*
/
)*#
"
*.
$
!
&
,
) (
)
!
%
1 "
*
*
&
+
)
)
)*#
)*#
%1 1
"
&
+
-
1
$
6
!
%
1
"
)*#
)*#
$
0
0
0
0
2
2
3
3
4
5
5
5
5
7
7
8 1
&
"
8
*
$
.
!
"
9
:
&
+
-
1
,
.
"
1
& )
9
) $
1
) $
&
&
&
+
+
+
+
0
3
4
4
4
i
Pedoman KSR PMI
DAFTAR ISI
"
"
' ;
$
6
&
+
0
2
3
4
/
"
*
"
;
$
1
1 "
"
" ;
$
"
1
*
)
1,
1 $
1
1
)
1
)
!
/
*
"
)
)
)
"
!
$
;
4
5
5
&7
&7
&
&&
&&
&&
&+
&-
*
*
&
/
"
;
$"
)
!
"
"
"
$"
;
;
;
"
&&&&&3
&3
&3
&3
&5
1$
ii
Pedoman KSR PMI
!
"
#
$
%
&
'
"!(
)
"!(
*
&
+),
,
#
-
*
&
.
!
/
"!(
"!(
"!(
"!(
0& 1 0(
(
!
23
44) - 44+
&
%
44+4*"
"
)
7
+,
,
4) 6) "
/
(
)
++, 5
4
67 7+,
737+,
4 6,*"
7
"
7 7 27+,
"
27 +,
/!
44)
/!
$
&
7 27+,
-
(
/ !
5
+,
/6
7
%
),+
+7
!8
4 6% "
!
7
+,
5
)%79 "7 ++,
"
7
+,
"!(
0
"!(
Bab 1 - Pendahuluan
1
Pedoman KSR PMI
"!(
0
'
"
'
%
"!(
0
! #
'
"!(
"!(
9
%
)
,
/
:
6
+
"
$
"
"
"
"
!
"!(
;
Bab 1 - Pendahuluan
2
Pedoman KSR PMI
!
' .
1$
$
<
$
1
.
(
"
)*#
#
# $ %
=
1$
(
1$
$
"
7
%
)
,
/
&
0
"
:
6
+
5
"!(
0
#
"
4
!
" !
# &
%
!
#
!
'
!
!
"!(
"!(
"
"
"
"
<
=& ";0 >
.
$
)
-
"!(
!
0
"!(
=
>
Bab 2 - Pengertian, Hak dan Kewajiban
3
#
)*
!!(
#
!
"!(
?5
<
@
A
B
6
%,
"!(
!;
%
)
,
*
*
&
.
!
0
"!(
#
/
:
=
> "!(
6
%
+
"!(
#
%
#)
'
'
"!(
+
&
*
5
)
=%,
+
>
#)
"!(
"!(
'
'
"!(
"!(
"!(
'
Bab 3 - Keanggotaan
4
,
( !
#
.
) )
)
#
- -(
(
$
>
>
%>
)>
"!(
*
;
;
;
;
<
'
7;
7
8
"!(
/
%4
- (
"
'
!
(
(
#
"!(
<
>
'
>
%>
)>
"!(
(
(
"!(
,>
'
"
"!(
<
> "
"!(
>
%>
)>
=
,>
>
"!(
/>
'
"!(
Bab 4 - Organisasi dan Struktur
5
)
. )
#
( !
) ) #)
!#
!
STRUKTUR ORGANISASI KSR
DI TINGKAT CABANG
PENGURUS PMI
PUSAT
PIMPINAN
INSTANSI PUSAT
PENGURUS PMI
DAERAH
PIMPINAN INSTANSI
PROPINSI
PENGURUS PMI
CABANG
PIMPINAN INSTANSI
KABUPATEN/KOTA
UNIT
Markas Cabang
UNIT
Perguruan Tinggi
UNIT
Masyarakat umum
UNIT
Instansi
$
$
Bab 4 - Organisasi dan Struktur
6
/
)
#
( !
) ) #)
Pembina KSR
Pembina Teknis KSR
KOMANDAN KSR
WK.KOMANDAN KSR
SEKERTARIS
Seksi
BENDAHARA
Seksi
Seksi
A N G G O T A
Seksi
KSR
$
$
'
<
•
0
+
>
C
>
"!(
&
C
'
%>
"!(
C
"!(
)>
,>
/>
(
&
'
#
D
"!(
Bab 4 - Organisasi dan Struktur
7
7
>
>
%>
)>
,>
/>
:>
6>
>
>
%>
)>
,>
7
"!(
&
0
&
5
"
7
7
7D
"
&
!
D
75
#
"
"!(
>
>
%>
)>
,>
0
<
7
"!(
!
#
*
&
.
!
"!(
>
>
%>
0
"!(
'
Bab 4 - Organisasi dan Struktur
8
,
%
#
#)
1
%
- .
+
-'
#)
!
=
#
>
#
<
>
>
#
=
#
>
#
!
<
>
>
%>
)>
0
?
"
D
!
&
&
;
"!(7 $
( "!( !(
=
(
9
!
9
!
'
> &
"!(
(
"!( '
#
<
"!(
"!(
*
/ $
%
'
*
"!(
Bab 5 – Ketentuan Umum Manajemen Pembinaan KSR
9
0
"!(
! #
'
"!(
7
7
"!(
2
&'!
+
( (
&'
!)&*
&
(*,&-)& &*
('(
&,
&
(*$! ! &*
.& ' ('(
Bab 5 – Ketentuan Umum Manajemen Pembinaan KSR
10
+
1
%
"!(
.
3 -
+
>
;
'
>
),
4
*
=
=
%>
4 E ),F 8 ;>
C
4
#
#
48
'
>
"!(
)>
'
#
"
0
"!(
,>
'
-
/>
"!(
!
"!(
>
&
44:
"!(
"!(
>
"!(
7
%>
=" 0>
&
&
!
#
"!(
"!(
Bab 5 – Ketentuan Umum Manajemen Pembinaan KSR
44:
11
/
+
.
$
"
9
= >
= ">
(! >
"
#
"
=
0
'
&
=& >
;
!7 (
D
;
=?
?
!
=(D;>
>
!
)
"
!7(
#
= >
= ">
= (! >
"
(
!
D
?
0
;
"
;
=?
!
= ! >
=(D;>
>
!0(
&
0
+
;
!
=&
#
> "!( &
<
'
!
(
&
#
$
!
2
+
5
=
><
C
=
0
=
C
> < $9
#
-
><
=
" &
(!
-
>
Bab 5 – Ketentuan Umum Manajemen Pembinaan KSR
12
4
)
5
'
&
0
!
&
6
"!(
"!(
#
'
"!(
#
7
'
=
"!(
7
>
)
!
!
!
5
"!(
7
*
( #
7
( #
7
% * /
"!(
( #
'
&
7
7
7
8
+
#)
,
'&) ,& &
('&*)
( ) -
(
!!(
&*%
&
! )
!! !
% $
!
)
#) 9
: )
):
!
!
& () '&) .&*
,
(*!$&
&* &
'&)
( &'
,
'&)
(
( ) -
&'
&
&
! )
% $
!!
"
)
:
(*!$& &*
)
Bab 5 – Ketentuan Umum Manajemen Pembinaan KSR
!
!"
):
!
13
'
:
1
%
&
.
-
'
"!(
%
"
7
7
"
/
'
#
#
=
>
7
&
'
>
&
7
'
7
"!(
7
7
(
<
*
=
#
>
>
&
7
'
"!(
=;
&
>
%>
7
7
'
)>
&
!
7
7
"!(
Bab 5 – Ketentuan Umum Manajemen Pembinaan KSR
14
'
+
>
&
"!(
7
&
7
'
'
"!(
7
7
7
<
=
>
&
#
7
>
&
'
'
"!(
)>
7
&
,>
!
"!(
'
&
3
>
&
"!(
'
7
7
&
7
'
"!(
>
&
7
7
&
'
'
"!(
%>
7
)>
!
"!(
'
#
>
-
&
+
(
7
=
>
>
0
;
-
$
0
7
7
*
) ' >
!
#
=
>
>
! #
"!(
&
7
=
Bab 5 – Ketentuan Umum Manajemen Pembinaan KSR
#
#
<
>
15
C
#
-
=
>
'
;
&
44:
%>
)>
'
7
)
>
0
"!(
-
>
=
%>
)>
#
>
C
7
#
&
44:>
3
3
>
!
#
>
=
&
#
<
= ! >
&
(
'
7
=
>
>
)
=
>
9)
0
>
>
%>
)>
>
!
&'
" 0
0
&
= 0 & >
%>
&
'
&
&
<
>
>
> 0
> "
)>
&
Bab 5 – Ketentuan Umum Manajemen Pembinaan KSR
16
+
>
0
=
#
>
%>
"!(
>
#
&
&
7
9
(
)>
9
-9
9
5
(
#
#
!
(
;
!
"
(
#
(
!
C
"!(
-
7
-
5
>
>
'
"!(
'
7
:
&
(
) ):
#)
'
! )
! &)
,&( &.
&/&*$
*&* )% * )&*
'( /&$&
(*$! !
!* ) & &
&/&*$
(*$! ! !* )
)%
* )&* % '( /&$&
-
-
Bab 5 – Ketentuan Umum Manajemen Pembinaan KSR
%
&)$&*&
($ &)&* ('&0&*&*
+ &' ,&* ('&0&*&*
( (.&)&*
($ &)&* ( / *&&*
,&* (*$( /&*$&*
17
-'
#
1
%
7
7
7
'
;
7&
7
7
.
"!(
7
7
7;
7
#
7
"!(
/
#
*
"
>
>
%>
'
"
-'
#
<
"
( #
0 #
7
G
;
'
0
8
"
=
$
- '
)>
' D0
> B( 0 0 =
"
(
,>
0
=
A
90!
>
7
(
!
#
'
!
(
>
*
!
/>
?
'
=
>
:>
6>
"!(
-
&
.
!
9
+>
Bab 5 – Ketentuan Umum Manajemen Pembinaan KSR
18
4>
>
>
%>
"
"!(
(
-
&
"
!
"
;
-"
&
=
"
#
# *
>
&
*
" 1
1
%
C
#
#
*
"!(
<
>
C
>
#
7
>
C
#
#
#
7
>
#
#
#
.
$
1
C
=
>
"!(
=
/
>
7
1
"!(
>
> ! #
>
>
"!(
='
='
&
&
>
>
7
Bab 5 – Ketentuan Umum Manajemen Pembinaan KSR
19
"!(
C
&
C
*
"!(
0
)
1
"
!
"!(
'
&
&
=
! # "!(
>
!
"!(
"!(
2
1
+
A
C
=
#
#
#
'
+
+
!
&
"!(
C
&
0
C
>
>
%>
)>
<
0
0
0
0
=
7#
1
'
BC
>
>
$
>
<
C
&
7
<
& #
'
='
>
BC
>
"
&
>
&
C
#
7
7
-
!
!
&C 7
> &
C
7!
(
(
<
& 3 ! $(.05 !0!
&3!
( &05 (B;0?05 !B( 0
Bab 5 – Ketentuan Umum Manajemen Pembinaan KSR
!& ";0
20
="
%
0
>
&3!
B;0A0505 B505.0505
"B!B90 05 0!A0(0"0
-
> &
%> &
&
'
B5'050 &05
(
!
B;0A0505 !$! 0;
"!(
(
(
7&
(
7 &
"!(
)> 9
C
"!(
3
+
- '
:
7
C
<
>
>
%>
)>
0
0
0
0
"
5
"
!
;
(
"
BC
+
-'
7
"
&
#
C
<
> 0
> 0
%> 0
4
C
C
C
+-
1
C
"!(
7
"!(
C
"!(
"!(
!
C
C
C
;
;
"!(
#
8
C
#
Bab 5 – Ketentuan Umum Manajemen Pembinaan KSR
21
6
1
BC
7(
0
>
>
>
>
#>
>
>
>
"
;
;
&
&
;
;
!
0
=
H
BC
"
>
,
&
C
>
>
>
>
>
#>
"
=
0
?
&
>
! C
>
7
1
!
C
C
<
!
7
*
;
C
?
<
!
!
Bab 5 – Ketentuan Umum Manajemen Pembinaan KSR
#
=! >
22
,
#
!#
!!(
0
1
)
)
&
2 )&3
<
.
)
-
/
)
-
< ) =
< ) =
'
8
7
"!(
"
"
!
!
=
7
;
'
)
5
,
B
7
!
"
%
<
'
>;
=
8
I >
7
< B5&05. .
"!(
< 5
0("0! '0 05.
/
;
: 0
7
#
-
'
"!(
'
%
)
,
/
:
"!(
"!(
5
!9
!;
0
!9
!;
"!(
-
)
-
Bab 6 – Kelengkapan Anggota
"
23
!
%
;
;
= !; >
!
-
7
"
#
%>
,
'
"!( ="50">
"5 &
"5 &
"5 '
"5 '
"50" 0
"50" 0
&
&
'
'
#
4
0
IIIIIIIIIIIIIII 4
IIIIIIIIIIIIIIIIIIII 46
0
IIIIIII II II 4
IIIIIIIIIIIII 46
"
0
IIIII 4
444
"
IIIII 46 444
"
"
'
'
5
'
5
< 4
<
'
5
/
'
5
'
>
"
= "5 & >
&
="5 '>
>
#
#
0
#
'
#
"!(
'
#
0
"!(
'
:
'
0
5
Bab 6 – Kelengkapan Anggota
0
"!(
25
,
#
8
(
!
%
0
)
&
"
"!(
,
"
7
"
'
1 (
#
"!(
#
"
>
>
%>
)>
8
,>
9
!
$
'
,4 J K
&
'
(
'
&
&
#
8
"!(
7
<
>
>
7
&
(
#
"
+"
>
7
"
"
'
7
&
'
,4 J K
>
%>
)>
8
,>
9
'
'
(
'
&
&
#
8
"!(
7
<
>
>
7
&
(
#
'
>
>
%>
)>
&
,>
9
"
7
"
"
'
"
7
&
'
'
'
(
'
8
Bab 7 - Ketentuan Lain
#
27
8
"!(
7
<
>
>
7
&
"
7
(
"
"
'
"
7
"
7
7
-
Bab 7 - Ketentuan Lain
28
/&/ 4
(*!)!
1
1
1
1$ 1
1
.
9
.
1
, >
"1
$
"1
.
!
$
$ 1
)*#
$
.
.
1
1
"1
1 1
:
Bab 8 - Penutup
"
'
' &773
29
LAMPIRAN
&'!
('& + &*
! &)
,&( &.
&/&*$
!* )
&
&
&/&*$
* )&*
*&* )%
% '( /&$&
!* ) )% * )&*
'( /&$&
%
Contoh : FORMULIR PENDAFTARAN
#( ) ) #
>>
5
7
0
< IIIIIIIIIIIIIIII
5
< IIIIIIIIIIIIII
< IIIIIIIIII
5 9
< IIIIIIIIIIIIII
< III IIIIIII
B
< IIIIIIIIIIIIII
0
< IIIIIIIIIIIIII
.
< IIIIIIIIIIIII
IIIIIIIIIIIIIIII
< IIIIIIIIIIIIII
0
"
< IIIIIIIIIIIIII
5
< IIIIIIIIIIIIII
5 D E
< IIIIIIIIIIIIII
!
5
Foto – foto
>
Dll, yang diperlukan.
Contoh Format :
#
!#
%
$ #
() ) # !
. ) '
)
- #
0 )
+#
)
@
-#
?
!
#
!
#)
!
!
%
# !
" (
'
>>>>
/AA6
#
$
!
(
)
Contoh :
LEMBAR LAPORAN KEGIATAN RELAWAN
Nama Relawan
:
Posisi
:
Keahlian /spesialisasi :
Tanggal
:
Waktu
:
Nama Kegiatan / Program / Penugasan
Lokasi Kegiatan
:
Jumlah Anggota Tim
:
:
Jumlah Sasaran / Target yang hadir :
Deskripsi Kegiatan :
.......................................................................................................................................................
.......................................................................................................................................................
.......................................................................................................................................................
.......................................................................................................................................................
.................................................................................................
Catatan / Saran
:
.......................................................................................................................................................
.......................................................................................................................................................
......................................................................................................................
Lain – Lain Yang Perlu
.........................................................................................................................................
Jakarta, tgl....................2006.
Relawan
.............................................
( TSR )
TENAGA
SUKARELA
Pedoman TSR PMI
DAFTAR ISI
!
#
$
%
',
!
)
,
) (
"
)
*.
) (
&
&
&
&
+
"
"
!
"
. )
"
$
"
*#
/
)
/
%1 1
)
%1 1
1
"
4
5
9
:
8
"
1 9
,
.
1
9$
"
$
) $
1$
&
&
"
&
+
0
2
3
4
/
"
6
' ;
"
"
*
"
"
!
,
$"
"
1
+
;
;
;
;
1
1 "
"
" ;
" ;
;
$"
)
$
9*
"
1
*
1
2
2
2
2
1
!
*
*
&
)
/
*#
%1 1
6
$
&
+
!
1
+
+
+
0
0
0
3
3
$
1,
1 $
"
3
4
1$
i
)
&
"
!
="!(>
!
= !(>
#
!(
!(
#
%
0
0
!(
"!(
#
!(
! #
!(
0
!(
!(
0& 1 0(
(
!
23
44) - 44+
&
%
44+4*"
"
)
7
+,
,
4) 6) "
/
(
)
++, 5
4
67 7+,
737+,
4 6,*"
7
"
7 7 27+,
"
27 +,
/!
44)
/!
$
&
7 27+,
-
(
/ !
5
+,
/6
7
%
),+
+7
!8
4 6% "
!
7
+,
5
)%79 "7 ++,
"
7
+,
D
%
)
,
/
:
6
+
"
$
"
!(
0
1 BC
>
1
)
!
)
1
(
.
"
< *#=
'1 . 1
1
.
#
;
# $ %
>
;
.
'1
'$
$ "
1
8
1$
9
"1 1 $
$
"
"1
0
!(
<
$
"
%
(
)
7
,
#
#
/
:
=
7
>
6
+
=
#
>
4
# &
0
'
!(
<
0&7 0(
#
%
*
&
.
!
)
#
,
/
#
:
!(
=;
"
>
7
&?
'@
2
)
#
!!(
#
!(
#
!(
%
)
,
(
"!(
;
"!(
0
#
#
"!(
!(
)*
#
?5
@
B
& +),
!
6
0
!(
#
0
'
#
#
*
*
&
.
!
#
*
!(
!(
%
?50
7
*
+
0
!(
<
#
'
" 0
+
'
* #
"
!(
<
7
%
&
<
*
+>)
"
3
)
!(
+
)
!(
!
(
7
+>)
'
'
'
#
'
"
4
)
,
) )
( !
#
- -(
0
0
;
7
#
!
= !(>
7
C
!(
! #
0
%
!(
7
<
!(
!(
!(
!(
!(
#
!(
!(
!(
!(
!(
&
!(
)
"
"
"
"
"
"
"
"
"
"
*
"
0
"
?
B
!
0
=
G
&
#
,
>
0
!(
&
'
'
D
"
'
+
>
!
= !(>
D
5
#
BC
#
&
!(
#
>
D
"
!(
&
"
!(
#
D
BC
#
"
'
!(
#
->
5
D
"
!(
5
)
%>
'
!$
!(
&
'
&
#
#
= !(>
#
!(
#
D
"
!(
)>
->
6
)
,
%
#
)
1
%
.
+
- !(
'
##
!(
&
7 "
(
/
$
!
0
=
>
+
#
!(
#
!(
!
!
7
#
'
7
7
!
=
7
>
#
"
!
&
!
7
7
$
$
0?)
1 1
#
1
1
*#
7
)
#
#
<
C
'
0
!(
#
#
#
=#
>
7
C
0
!(
!(
C
7
C
7
!(
(
1
%
0
+
!(
$
"
7
!(
%
)
"!(
&
?
'
0?)
&
'
$
(
"!(
!(
< .
'
.
! # 0
#'
1 1
1
1
$
*#
7&
7
=6 8
7"
>
9
8
)
'
:
1
%
!
+
$
.
%
'
0
!(
*
:
&
>
5
!
7D
!
7
!(
#
*
>
#
*
<
*
=$'>
#
%>
)>
,>
7
L
=!'>
*
=#
>
>
7
<
>
>
>
>
>
#>
>
>
>
>
7
0
BC
(
;
0
#
!
!
!7 (D; =(
&
&
>
D
;
>
*
#
*
#
0?
1
*#
7
9
)
% > !(
/
- :
'
> &
7
'
!(
7
7
(
7
=
*
=
<
>
'
D
(
>
> &
7
!(
'
=;
&
>
%>
7
7
'
&
)> !
7
7
!(
&
> &
7
&
!(
7
'
'
7
!(
7
7
=
'
D
<
(
>
> &
7
&
'
'
!(
)>
7
&
,> !
!(
'
&
75
7
> &
!(
7
'
'
!(
&
7
7
> &
7
'
'
!(
0?
1
*#
10
)
%>
7
)> !
!(
'
&
;
!
5
!(
0
7
&
0
!(
&
0
B+
&
7 '
7'
*
+
+
-
!
> !
! #
#
=
>
!(
> &
7
#
=
>
C
#
=
'
#
-
>
&
&
%>
)>
!
> 0
!(
-
>
=
%>
)>
#
>
C
7
#
&
> !
#
>
&
=
#
<
>
> &
> (
> '
0?
1
*#
= ! >
7
=
>
11
)
>
!
> 0
>
>
>
>
> &
=
>
1!
!
&'
" 0
0
= 0 & >
%> &
'
&
&
<
>
>
> 0
> "
)> &
$
-'
#
1
%
+
C
0
!(
0
!(
<
( #
*
&
%
)
"
"
,
/
"
'
7
D
*
*
*
0
(
"!(
>
B( 0 0 =
:
6
' D0
90!
0?
1
"
="
*#
12
)
(
(
>
!
?
+
"
(
7
!
(
.
+
>
!(
=
#
>
%>
>
#
&
&
7
9
(
9
)>
-9
9
5
(
#
#
-
(
!
;
!
"
(
#
(
!
C
"!(
-
7
-
/
'
!(
1
C
#
#
!(
*
.
$
1
C
=
>
=
>
7
!(
/
1
!(
0
! #
!(
='
='
&
&
>
>
7
!(
0
)
1
"
0?
C
1
!(
*#
'
&
13
)
!
&
=
! #
!(
>
!
!(
$
2
!(
1
'
+
A
C
=
#
#
#
'
+
(
!
!(
C
!(
0
C
>
>
%>
)>
3
0
0
0
0
0
<
"
5
$
!
=
7D
1
+
>
:
'
7
C
<
>
>
%>
)>
0
0
0
0
"
5
"
!
;
(
"
BC
+
-'
C
9
>
>
%>
4
0
0
0
&
#
<
C
C
C
-
7
"
"
-
"
!
1
7
,
C
7
!(
!(
&
'
C
!(
!(
C
!
C
C
0?
1
*#
14
)
;
;
!(
#
8
7
C
#
6
1
BC
7(
0
>
>
%>
)>
,>
/>
:>
"
;
;
&
&
;
!
0
=
>
,
H
C
>
>
%>
)>
,>
/>
*
"
*
0
?
&
"
=
>
! C
C
:>
7
1
!
C
C
<
!
7
*
(
"
8
;
C
0?
1
*#
15
)
,
#
!#
!!(
A
!(
' :)
<
-
> (
> ;
%>
)>
7
!
-
'
> (
> ;
!(
7
*
!(
7
%>
!(
)>
!(
)
<
.
)
-
/
)
-
< ) =
< ) =
"
#
)
> &
> " 0 !(
*
!(
" 0
%> 0
0
&
)> '
2?)
7
#
"
$
0
"
!(
!(
" 0
&
7
'
<
16
)
#
)
'
5
<
<
#
D$ $
=
0
5
;
;7 >
<
7
>
=
7
0
<
<
.
7
<
&
=
>
44
'
"
2?)
$
"
17
)
/&/ 4
(*!)!
1 1
1$ 1
1
$
'
.
$
"1
"1
!
$
$
$ 1
"
.
1
9
*#
$
1
1
, >
.
1
1 $
"1
1 $
Jakarta, 2007
3?
$
18
LAMPIRAN
@(
@
$
5
7
0
)
!>>>
< IIIIIIIIIIIIIIII
5
< IIIIIIIIIIIIII
< IIIIIIIIII
5 9
< IIIIIIIIIIIIII
< III IIIIIII
B
< IIIIIIIIIIIIII
0
< IIIIIIIIIIIIII
.
< IIIIIIIIIIIII
IIIIIIIIIIIIIIII
< IIIIIIIIIIIIII
0
"
< IIIIIIIIIIIIII
5
< IIIIIIIIIIIIII
5 D E
< IIIIIIIIIIIIII
!
5
#
&
# !
(
$
1;
%
7
)
"
:#
)(
) ?
@
) #
!
(
?
!
#
9 )
#
!
-
>
>
>
!
'
@
;5
*
"
C
D$(
; ( B30; 0! &0 0 & . 50"05 5
" "!( &05 !(
0
(
M
A
(
% 0
7
(
M
M
A
)
(
'
7&
M
A
0
,
(
/
0
M
M
7
!
0
;
*
IIIIIIII
*
#
(
:
7
(
6 &
M
(
#M
A
+ 0
M
A
4 0
M
A
0
7
M
Catatan :
Kuesioner ini dapat dikembangkan pertanyaan – pertanyaannya oleh Pengurus, staf
sesuai kebutuhan.
)
IDENTIFIKASI KEBUTUHAN
SOSIALISASI / PUBLIKASI
PENDAFTARAN
0
7
!(
PMI PUSAT
PMI DAERAH
TSR PMI
PUSAT
TSR PMI
DAERAH
•
•
•
PMI CABANG
TSR PMI
CABANG
SATGANA
KEGIATAN
YANSOSKESMAS
KEGIATAN
PEMBINAAN DAN
PENGEMBANGAN
&'!
('& + &*
)
)
!
!
A
A
$"
@
8
Contoh Format :
#
!#
@
!
%
$ #
() ) # !
. ) '
%
)
#
)
- #
0 )
+#
!
#
!
!
%
?
-#
#)
# !
" (
'
>>>>
/AA6
#
$
!
(
)
Contoh :
LEMBAR LAPORAN KEGIATAN RELAWAN
Nama Relawan
:
Posisi
:
Keahlian /spesialisasi :
Tanggal
:
Waktu
:
Nama Kegiatan / Program / Penugasan
Lokasi Kegiatan
:
Jumlah Anggota Tim
:
:
Jumlah Sasaran / Target yang hadir :
Deskripsi Kegiatan :
.............................................................................................................................................
.............................................................................................................................................
.............................................................................................................................................
.............................................................................................................................................
.........................................................................................................................................
Catatan / Saran
:
.............................................................................................................................................
.............................................................................................................................................
..........................................................................................................................................
Lain – Lain Yang Perlu
.........................................................................................................................................
Jakarta, tgl....................2006.
Relawan
.............................................
RELAWAN
( KSR )
KORPS
SUKARELA
i
Pedoman KSR PMI
DAFTAR ISI
!
" "
$
#
'
!
(
"
)
"
)*#
"
"
/
+
+
+
+
-
)*#
*
%1 1
)
&
*
/
)*#
"
*.
$
!
&
,
) (
)
!
%
1 "
*
*
&
+
)
)
)*#
)*#
%1 1
"
&
+
-
1
$
6
!
%
1
"
)*#
)*#
$
0
0
0
0
2
2
3
3
4
5
5
5
5
7
7
8 1
&
"
8
*
$
.
!
"
9
:
&
+
-
1
,
.
"
1
& )
9
) $
1
) $
&
&
&
+
+
+
+
0
3
4
4
4
i
Pedoman KSR PMI
DAFTAR ISI
"
"
' ;
$
6
&
+
0
2
3
4
/
"
*
"
;
$
1
1 "
"
" ;
$
"
1
*
)
1,
1 $
1
1
)
1
)
!
/
*
"
)
)
)
"
!
$
;
4
5
5
&7
&7
&
&&
&&
&&
&+
&-
*
*
&
/
"
;
$"
)
!
"
"
"
$"
;
;
;
"
&&&&&3
&3
&3
&3
&5
1$
ii
Pedoman KSR PMI
!
"
#
$
%
&
'
"!(
)
"!(
*
&
+),
,
#
-
*
&
.
!
/
"!(
"!(
"!(
"!(
0& 1 0(
(
!
23
44) - 44+
&
%
44+4*"
"
)
7
+,
,
4) 6) "
/
(
)
++, 5
4
67 7+,
737+,
4 6,*"
7
"
7 7 27+,
"
27 +,
/!
44)
/!
$
&
7 27+,
-
(
/ !
5
+,
/6
7
%
),+
+7
!8
4 6% "
!
7
+,
5
)%79 "7 ++,
"
7
+,
"!(
0
"!(
Bab 1 - Pendahuluan
1
Pedoman KSR PMI
"!(
0
'
"
'
%
"!(
0
! #
'
"!(
"!(
9
%
)
,
/
:
6
+
"
$
"
"
"
"
!
"!(
;
Bab 1 - Pendahuluan
2
Pedoman KSR PMI
!
' .
1$
$
<
$
1
.
(
"
)*#
#
# $ %
=
1$
(
1$
$
"
7
%
)
,
/
&
0
"
:
6
+
5
"!(
0
#
"
4
!
" !
# &
%
!
#
!
'
!
!
"!(
"!(
"
"
"
"
<
=& ";0 >
.
$
)
-
"!(
!
0
"!(
=
>
Bab 2 - Pengertian, Hak dan Kewajiban
3
#
)*
!!(
#
!
"!(
?5
<
@
A
B
6
%,
"!(
!;
%
)
,
*
*
&
.
!
0
"!(
#
/
:
=
> "!(
6
%
+
"!(
#
%
#)
'
'
"!(
+
&
*
5
)
=%,
+
>
#)
"!(
"!(
'
'
"!(
"!(
"!(
'
Bab 3 - Keanggotaan
4
,
( !
#
.
) )
)
#
- -(
(
$
>
>
%>
)>
"!(
*
;
;
;
;
<
'
7;
7
8
"!(
/
%4
- (
"
'
!
(
(
#
"!(
<
>
'
>
%>
)>
"!(
(
(
"!(
,>
'
"
"!(
<
> "
"!(
>
%>
)>
=
,>
>
"!(
/>
'
"!(
Bab 4 - Organisasi dan Struktur
5
)
. )
#
( !
) ) #)
!#
!
STRUKTUR ORGANISASI KSR
DI TINGKAT CABANG
PENGURUS PMI
PUSAT
PIMPINAN
INSTANSI PUSAT
PENGURUS PMI
DAERAH
PIMPINAN INSTANSI
PROPINSI
PENGURUS PMI
CABANG
PIMPINAN INSTANSI
KABUPATEN/KOTA
UNIT
Markas Cabang
UNIT
Perguruan Tinggi
UNIT
Masyarakat umum
UNIT
Instansi
$
$
Bab 4 - Organisasi dan Struktur
6
/
)
#
( !
) ) #)
Pembina KSR
Pembina Teknis KSR
KOMANDAN KSR
WK.KOMANDAN KSR
SEKERTARIS
Seksi
BENDAHARA
Seksi
Seksi
A N G G O T A
Seksi
KSR
$
$
'
<
•
0
+
>
C
>
"!(
&
C
'
%>
"!(
C
"!(
)>
,>
/>
(
&
'
#
D
"!(
Bab 4 - Organisasi dan Struktur
7
7
>
>
%>
)>
,>
/>
:>
6>
>
>
%>
)>
,>
7
"!(
&
0
&
5
"
7
7
7D
"
&
!
D
75
#
"
"!(
>
>
%>
)>
,>
0
<
7
"!(
!
#
*
&
.
!
"!(
>
>
%>
0
"!(
'
Bab 4 - Organisasi dan Struktur
8
,
%
#
#)
1
%
- .
+
-'
#)
!
=
#
>
#
<
>
>
#
=
#
>
#
!
<
>
>
%>
)>
0
?
"
D
!
&
&
;
"!(7 $
( "!( !(
=
(
9
!
9
!
'
> &
"!(
(
"!( '
#
<
"!(
"!(
*
/ $
%
'
*
"!(
Bab 5 – Ketentuan Umum Manajemen Pembinaan KSR
9
0
"!(
! #
'
"!(
7
7
"!(
2
&'!
+
( (
&'
!)&*
&
(*,&-)& &*
('(
&,
&
(*$! ! &*
.& ' ('(
Bab 5 – Ketentuan Umum Manajemen Pembinaan KSR
10
+
1
%
"!(
.
3 -
+
>
;
'
>
),
4
*
=
=
%>
4 E ),F 8 ;>
C
4
#
#
48
'
>
"!(
)>
'
#
"
0
"!(
,>
'
-
/>
"!(
!
"!(
>
&
44:
"!(
"!(
>
"!(
7
%>
=" 0>
&
&
!
#
"!(
"!(
Bab 5 – Ketentuan Umum Manajemen Pembinaan KSR
44:
11
/
+
.
$
"
9
= >
= ">
(! >
"
#
"
=
0
'
&
=& >
;
!7 (
D
;
=?
?
!
=(D;>
>
!
)
"
!7(
#
= >
= ">
= (! >
"
(
!
D
?
0
;
"
;
=?
!
= ! >
=(D;>
>
!0(
&
0
+
;
!
=&
#
> "!( &
<
'
!
(
&
#
$
!
2
+
5
=
><
C
=
0
=
C
> < $9
#
-
><
=
" &
(!
-
>
Bab 5 – Ketentuan Umum Manajemen Pembinaan KSR
12
4
)
5
'
&
0
!
&
6
"!(
"!(
#
'
"!(
#
7
'
=
"!(
7
>
)
!
!
!
5
"!(
7
*
( #
7
( #
7
% * /
"!(
( #
'
&
7
7
7
8
+
#)
,
'&) ,& &
('&*)
( ) -
(
!!(
&*%
&
! )
!! !
% $
!
)
#) 9
: )
):
!
!
& () '&) .&*
,
(*!$&
&* &
'&)
( &'
,
'&)
(
( ) -
&'
&
&
! )
% $
!!
"
)
:
(*!$& &*
)
Bab 5 – Ketentuan Umum Manajemen Pembinaan KSR
!
!"
):
!
13
'
:
1
%
&
.
-
'
"!(
%
"
7
7
"
/
'
#
#
=
>
7
&
'
>
&
7
'
7
"!(
7
7
(
<
*
=
#
>
>
&
7
'
"!(
=;
&
>
%>
7
7
'
)>
&
!
7
7
"!(
Bab 5 – Ketentuan Umum Manajemen Pembinaan KSR
14
'
+
>
&
"!(
7
&
7
'
'
"!(
7
7
7
<
=
>
&
#
7
>
&
'
'
"!(
)>
7
&
,>
!
"!(
'
&
3
>
&
"!(
'
7
7
&
7
'
"!(
>
&
7
7
&
'
'
"!(
%>
7
)>
!
"!(
'
#
>
-
&
+
(
7
=
>
>
0
;
-
$
0
7
7
*
) ' >
!
#
=
>
>
! #
"!(
&
7
=
Bab 5 – Ketentuan Umum Manajemen Pembinaan KSR
#
#
<
>
15
C
#
-
=
>
'
;
&
44:
%>
)>
'
7
)
>
0
"!(
-
>
=
%>
)>
#
>
C
7
#
&
44:>
3
3
>
!
#
>
=
&
#
<
= ! >
&
(
'
7
=
>
>
)
=
>
9)
0
>
>
%>
)>
>
!
&'
" 0
0
&
= 0 & >
%>
&
'
&
&
<
>
>
> 0
> "
)>
&
Bab 5 – Ketentuan Umum Manajemen Pembinaan KSR
16
+
>
0
=
#
>
%>
"!(
>
#
&
&
7
9
(
)>
9
-9
9
5
(
#
#
!
(
;
!
"
(
#
(
!
C
"!(
-
7
-
5
>
>
'
"!(
'
7
:
&
(
) ):
#)
'
! )
! &)
,&( &.
&/&*$
*&* )% * )&*
'( /&$&
(*$! !
!* ) & &
&/&*$
(*$! ! !* )
)%
* )&* % '( /&$&
-
-
Bab 5 – Ketentuan Umum Manajemen Pembinaan KSR
%
&)$&*&
($ &)&* ('&0&*&*
+ &' ,&* ('&0&*&*
( (.&)&*
($ &)&* ( / *&&*
,&* (*$( /&*$&*
17
-'
#
1
%
7
7
7
'
;
7&
7
7
.
"!(
7
7
7;
7
#
7
"!(
/
#
*
"
>
>
%>
'
"
-'
#
<
"
( #
0 #
7
G
;
'
0
8
"
=
$
- '
)>
' D0
> B( 0 0 =
"
(
,>
0
=
A
90!
>
7
(
!
#
'
!
(
>
*
!
/>
?
'
=
>
:>
6>
"!(
-
&
.
!
9
+>
Bab 5 – Ketentuan Umum Manajemen Pembinaan KSR
18
4>
>
>
%>
"
"!(
(
-
&
"
!
"
;
-"
&
=
"
#
# *
>
&
*
" 1
1
%
C
#
#
*
"!(
<
>
C
>
#
7
>
C
#
#
#
7
>
#
#
#
.
$
1
C
=
>
"!(
=
/
>
7
1
"!(
>
> ! #
>
>
"!(
='
='
&
&
>
>
7
Bab 5 – Ketentuan Umum Manajemen Pembinaan KSR
19
"!(
C
&
C
*
"!(
0
)
1
"
!
"!(
'
&
&
=
! # "!(
>
!
"!(
"!(
2
1
+
A
C
=
#
#
#
'
+
+
!
&
"!(
C
&
0
C
>
>
%>
)>
<
0
0
0
0
=
7#
1
'
BC
>
>
$
>
<
C
&
7
<
& #
'
='
>
BC
>
"
&
>
&
C
#
7
7
-
!
!
&C 7
> &
C
7!
(
(
<
& 3 ! $(.05 !0!
&3!
( &05 (B;0?05 !B( 0
Bab 5 – Ketentuan Umum Manajemen Pembinaan KSR
!& ";0
20
="
%
0
>
&3!
B;0A0505 B505.0505
"B!B90 05 0!A0(0"0
-
> &
%> &
&
'
B5'050 &05
(
!
B;0A0505 !$! 0;
"!(
(
(
7&
(
7 &
"!(
)> 9
C
"!(
3
+
- '
:
7
C
<
>
>
%>
)>
0
0
0
0
"
5
"
!
;
(
"
BC
+
-'
7
"
&
#
C
<
> 0
> 0
%> 0
4
C
C
C
+-
1
C
"!(
7
"!(
C
"!(
"!(
!
C
C
C
;
;
"!(
#
8
C
#
Bab 5 – Ketentuan Umum Manajemen Pembinaan KSR
21
6
1
BC
7(
0
>
>
>
>
#>
>
>
>
"
;
;
&
&
;
;
!
0
=
H
BC
"
>
,
&
C
>
>
>
>
>
#>
"
=
0
?
&
>
! C
>
7
1
!
C
C
<
!
7
*
;
C
?
<
!
!
Bab 5 – Ketentuan Umum Manajemen Pembinaan KSR
#
=! >
22
,
#
!#
!!(
0
1
)
)
&
2 )&3
<
.
)
-
/
)
-
< ) =
< ) =
'
8
7
"!(
"
"
!
!
=
7
;
'
)
5
,
B
7
!
"
%
<
'
>;
=
8
I >
7
< B5&05. .
"!(
< 5
0("0! '0 05.
/
;
: 0
7
#
-
'
"!(
'
%
)
,
/
:
"!(
"!(
5
!9
!;
0
!9
!;
"!(
-
)
-
Bab 6 – Kelengkapan Anggota
"
23
!
%
;
;
= !; >
!
-
7
"
#
%>
,
'
"!( ="50">
"5 &
"5 &
"5 '
"5 '
"50" 0
"50" 0
&
&
'
'
#
4
0
IIIIIIIIIIIIIII 4
IIIIIIIIIIIIIIIIIIII 46
0
IIIIIII II II 4
IIIIIIIIIIIII 46
"
0
IIIII 4
444
"
IIIII 46 444
"
"
'
'
5
'
5
< 4
<
'
5
/
'
5
'
>
"
= "5 & >
&
="5 '>
>
#
#
0
#
'
#
"!(
'
#
0
"!(
'
:
'
0
5
Bab 6 – Kelengkapan Anggota
0
"!(
25
,
#
8
(
!
%
0
)
&
"
"!(
,
"
7
"
'
1 (
#
"!(
#
"
>
>
%>
)>
8
,>
9
!
$
'
,4 J K
&
'
(
'
&
&
#
8
"!(
7
<
>
>
7
&
(
#
"
+"
>
7
"
"
'
7
&
'
,4 J K
>
%>
)>
8
,>
9
'
'
(
'
&
&
#
8
"!(
7
<
>
>
7
&
(
#
'
>
>
%>
)>
&
,>
9
"
7
"
"
'
"
7
&
'
'
'
(
'
8
Bab 7 - Ketentuan Lain
#
27
8
"!(
7
<
>
>
7
&
"
7
(
"
"
'
"
7
"
7
7
-
Bab 7 - Ketentuan Lain
28
/&/ 4
(*!)!
1
1
1
1$ 1
1
.
9
.
1
, >
"1
$
"1
.
!
$
$ 1
)*#
$
.
.
1
1
"1
1 1
:
Bab 8 - Penutup
"
'
' &773
29
LAMPIRAN
&'!
('& + &*
! &)
,&( &.
&/&*$
!* )
&
&
&/&*$
* )&*
*&* )%
% '( /&$&
!* ) )% * )&*
'( /&$&
%
Contoh : FORMULIR PENDAFTARAN
#( ) ) #
>>
5
7
0
< IIIIIIIIIIIIIIII
5
< IIIIIIIIIIIIII
< IIIIIIIIII
5 9
< IIIIIIIIIIIIII
< III IIIIIII
B
< IIIIIIIIIIIIII
0
< IIIIIIIIIIIIII
.
< IIIIIIIIIIIII
IIIIIIIIIIIIIIII
< IIIIIIIIIIIIII
0
"
< IIIIIIIIIIIIII
5
< IIIIIIIIIIIIII
5 D E
< IIIIIIIIIIIIII
!
5
Foto – foto
>
Dll, yang diperlukan.
Contoh Format :
#
!#
%
$ #
() ) # !
. ) '
)
- #
0 )
+#
)
@
-#
?
!
#
!
#)
!
!
%
# !
" (
'
>>>>
/AA6
#
$
!
(
)
Contoh :
LEMBAR LAPORAN KEGIATAN RELAWAN
Nama Relawan
:
Posisi
:
Keahlian /spesialisasi :
Tanggal
:
Waktu
:
Nama Kegiatan / Program / Penugasan
Lokasi Kegiatan
:
Jumlah Anggota Tim
:
:
Jumlah Sasaran / Target yang hadir :
Deskripsi Kegiatan :
.......................................................................................................................................................
.......................................................................................................................................................
.......................................................................................................................................................
.......................................................................................................................................................
.................................................................................................
Catatan / Saran
:
.......................................................................................................................................................
.......................................................................................................................................................
......................................................................................................................
Lain – Lain Yang Perlu
.........................................................................................................................................
Jakarta, tgl....................2006.
Relawan
.............................................
( TSR )
TENAGA
SUKARELA
Pedoman TSR PMI
DAFTAR ISI
!
#
$
%
',
!
)
,
) (
"
)
*.
) (
&
&
&
&
+
"
"
!
"
. )
"
$
"
*#
/
)
/
%1 1
)
%1 1
1
"
4
5
9
:
8
"
1 9
,
.
1
9$
"
$
) $
1$
&
&
"
&
+
0
2
3
4
/
"
6
' ;
"
"
*
"
"
!
,
$"
"
1
+
;
;
;
;
1
1 "
"
" ;
" ;
;
$"
)
$
9*
"
1
*
1
2
2
2
2
1
!
*
*
&
)
/
*#
%1 1
6
$
&
+
!
1
+
+
+
0
0
0
3
3
$
1,
1 $
"
3
4
1$
i
)
&
"
!
="!(>
!
= !(>
#
!(
!(
#
%
0
0
!(
"!(
#
!(
! #
!(
0
!(
!(
0& 1 0(
(
!
23
44) - 44+
&
%
44+4*"
"
)
7
+,
,
4) 6) "
/
(
)
++, 5
4
67 7+,
737+,
4 6,*"
7
"
7 7 27+,
"
27 +,
/!
44)
/!
$
&
7 27+,
-
(
/ !
5
+,
/6
7
%
),+
+7
!8
4 6% "
!
7
+,
5
)%79 "7 ++,
"
7
+,
D
%
)
,
/
:
6
+
"
$
"
!(
0
1 BC
>
1
)
!
)
1
(
.
"
< *#=
'1 . 1
1
.
#
;
# $ %
>
;
.
'1
'$
$ "
1
8
1$
9
"1 1 $
$
"
"1
0
!(
<
$
"
%
(
)
7
,
#
#
/
:
=
7
>
6
+
=
#
>
4
# &
0
'
!(
<
0&7 0(
#
%
*
&
.
!
)
#
,
/
#
:
!(
=;
"
>
7
&?
'@
2
)
#
!!(
#
!(
#
!(
%
)
,
(
"!(
;
"!(
0
#
#
"!(
!(
)*
#
?5
@
B
& +),
!
6
0
!(
#
0
'
#
#
*
*
&
.
!
#
*
!(
!(
%
?50
7
*
+
0
!(
<
#
'
" 0
+
'
* #
"
!(
<
7
%
&
<
*
+>)
"
3
)
!(
+
)
!(
!
(
7
+>)
'
'
'
#
'
"
4
)
,
) )
( !
#
- -(
0
0
;
7
#
!
= !(>
7
C
!(
! #
0
%
!(
7
<
!(
!(
!(
!(
!(
#
!(
!(
!(
!(
!(
&
!(
)
"
"
"
"
"
"
"
"
"
"
*
"
0
"
?
B
!
0
=
G
&
#
,
>
0
!(
&
'
'
D
"
'
+
>
!
= !(>
D
5
#
BC
#
&
!(
#
>
D
"
!(
&
"
!(
#
D
BC
#
"
'
!(
#
->
5
D
"
!(
5
)
%>
'
!$
!(
&
'
&
#
#
= !(>
#
!(
#
D
"
!(
)>
->
6
)
,
%
#
)
1
%
.
+
- !(
'
##
!(
&
7 "
(
/
$
!
0
=
>
+
#
!(
#
!(
!
!
7
#
'
7
7
!
=
7
>
#
"
!
&
!
7
7
$
$
0?)
1 1
#
1
1
*#
7
)
#
#
<
C
'
0
!(
#
#
#
=#
>
7
C
0
!(
!(
C
7
C
7
!(
(
1
%
0
+
!(
$
"
7
!(
%
)
"!(
&
?
'
0?)
&
'
$
(
"!(
!(
< .
'
.
! # 0
#'
1 1
1
1
$
*#
7&
7
=6 8
7"
>
9
8
)
'
:
1
%
!
+
$
.
%
'
0
!(
*
:
&
>
5
!
7D
!
7
!(
#
*
>
#
*
<
*
=$'>
#
%>
)>
,>
7
L
=!'>
*
=#
>
>
7
<
>
>
>
>
>
#>
>
>
>
>
7
0
BC
(
;
0
#
!
!
!7 (D; =(
&
&
>
D
;
>
*
#
*
#
0?
1
*#
7
9
)
% > !(
/
- :
'
> &
7
'
!(
7
7
(
7
=
*
=
<
>
'
D
(
>
> &
7
!(
'
=;
&
>
%>
7
7
'
&
)> !
7
7
!(
&
> &
7
&
!(
7
'
'
7
!(
7
7
=
'
D
<
(
>
> &
7
&
'
'
!(
)>
7
&
,> !
!(
'
&
75
7
> &
!(
7
'
'
!(
&
7
7
> &
7
'
'
!(
0?
1
*#
10
)
%>
7
)> !
!(
'
&
;
!
5
!(
0
7
&
0
!(
&
0
B+
&
7 '
7'
*
+
+
-
!
> !
! #
#
=
>
!(
> &
7
#
=
>
C
#
=
'
#
-
>
&
&
%>
)>
!
> 0
!(
-
>
=
%>
)>
#
>
C
7
#
&
> !
#
>
&
=
#
<
>
> &
> (
> '
0?
1
*#
= ! >
7
=
>
11
)
>
!
> 0
>
>
>
>
> &
=
>
1!
!
&'
" 0
0
= 0 & >
%> &
'
&
&
<
>
>
> 0
> "
)> &
$
-'
#
1
%
+
C
0
!(
0
!(
<
( #
*
&
%
)
"
"
,
/
"
'
7
D
*
*
*
0
(
"!(
>
B( 0 0 =
:
6
' D0
90!
0?
1
"
="
*#
12
)
(
(
>
!
?
+
"
(
7
!
(
.
+
>
!(
=
#
>
%>
>
#
&
&
7
9
(
9
)>
-9
9
5
(
#
#
-
(
!
;
!
"
(
#
(
!
C
"!(
-
7
-
/
'
!(
1
C
#
#
!(
*
.
$
1
C
=
>
=
>
7
!(
/
1
!(
0
! #
!(
='
='
&
&
>
>
7
!(
0
)
1
"
0?
C
1
!(
*#
'
&
13
)
!
&
=
! #
!(
>
!
!(
$
2
!(
1
'
+
A
C
=
#
#
#
'
+
(
!
!(
C
!(
0
C
>
>
%>
)>
3
0
0
0
0
0
<
"
5
$
!
=
7D
1
+
>
:
'
7
C
<
>
>
%>
)>
0
0
0
0
"
5
"
!
;
(
"
BC
+
-'
C
9
>
>
%>
4
0
0
0
&
#
<
C
C
C
-
7
"
"
-
"
!
1
7
,
C
7
!(
!(
&
'
C
!(
!(
C
!
C
C
0?
1
*#
14
)
;
;
!(
#
8
7
C
#
6
1
BC
7(
0
>
>
%>
)>
,>
/>
:>
"
;
;
&
&
;
!
0
=
>
,
H
C
>
>
%>
)>
,>
/>
*
"
*
0
?
&
"
=
>
! C
C
:>
7
1
!
C
C
<
!
7
*
(
"
8
;
C
0?
1
*#
15
)
,
#
!#
!!(
A
!(
' :)
<
-
> (
> ;
%>
)>
7
!
-
'
> (
> ;
!(
7
*
!(
7
%>
!(
)>
!(
)
<
.
)
-
/
)
-
< ) =
< ) =
"
#
)
> &
> " 0 !(
*
!(
" 0
%> 0
0
&
)> '
2?)
7
#
"
$
0
"
!(
!(
" 0
&
7
'
<
16
)
#
)
'
5
<
<
#
D$ $
=
0
5
;
;7 >
<
7
>
=
7
0
<
<
.
7
<
&
=
>
44
'
"
2?)
$
"
17
)
/&/ 4
(*!)!
1 1
1$ 1
1
$
'
.
$
"1
"1
!
$
$
$ 1
"
.
1
9
*#
$
1
1
, >
.
1
1 $
"1
1 $
Jakarta, 2007
3?
$
18
LAMPIRAN
@(
@
$
5
7
0
)
!>>>
< IIIIIIIIIIIIIIII
5
< IIIIIIIIIIIIII
< IIIIIIIIII
5 9
< IIIIIIIIIIIIII
< III IIIIIII
B
< IIIIIIIIIIIIII
0
< IIIIIIIIIIIIII
.
< IIIIIIIIIIIII
IIIIIIIIIIIIIIII
< IIIIIIIIIIIIII
0
"
< IIIIIIIIIIIIII
5
< IIIIIIIIIIIIII
5 D E
< IIIIIIIIIIIIII
!
5
#
&
# !
(
$
1;
%
7
)
"
:#
)(
) ?
@
) #
!
(
?
!
#
9 )
#
!
-
>
>
>
!
'
@
;5
*
"
C
D$(
; ( B30; 0! &0 0 & . 50"05 5
" "!( &05 !(
0
(
M
A
(
% 0
7
(
M
M
A
)
(
'
7&
M
A
0
,
(
/
0
M
M
7
!
0
;
*
IIIIIIII
*
#
(
:
7
(
6 &
M
(
#M
A
+ 0
M
A
4 0
M
A
0
7
M
Catatan :
Kuesioner ini dapat dikembangkan pertanyaan – pertanyaannya oleh Pengurus, staf
sesuai kebutuhan.
)
IDENTIFIKASI KEBUTUHAN
SOSIALISASI / PUBLIKASI
PENDAFTARAN
0
7
!(
PMI PUSAT
PMI DAERAH
TSR PMI
PUSAT
TSR PMI
DAERAH
•
•
•
PMI CABANG
TSR PMI
CABANG
SATGANA
KEGIATAN
YANSOSKESMAS
KEGIATAN
PEMBINAAN DAN
PENGEMBANGAN
&'!
('& + &*
)
)
!
!
A
A
$"
@
8
Contoh Format :
#
!#
@
!
%
$ #
() ) # !
. ) '
%
)
#
)
- #
0 )
+#
!
#
!
!
%
?
-#
#)
# !
" (
'
>>>>
/AA6
#
$
!
(
)
Contoh :
LEMBAR LAPORAN KEGIATAN RELAWAN
Nama Relawan
:
Posisi
:
Keahlian /spesialisasi :
Tanggal
:
Waktu
:
Nama Kegiatan / Program / Penugasan
Lokasi Kegiatan
:
Jumlah Anggota Tim
:
:
Jumlah Sasaran / Target yang hadir :
Deskripsi Kegiatan :
.............................................................................................................................................
.............................................................................................................................................
.............................................................................................................................................
.............................................................................................................................................
.........................................................................................................................................
Catatan / Saran
:
.............................................................................................................................................
.............................................................................................................................................
..........................................................................................................................................
Lain – Lain Yang Perlu
.........................................................................................................................................
Jakarta, tgl....................2006.
Relawan
.............................................