Instructions

If this supplier is new to the on-line EHS system

Supplier must complete sections 1.0 - 3.0 on the Profile tab
Supplier must complete all questions on the PreScreen tab
GE Sourcing requestor must complete section 4.0 on the Profile tab
1.0 Supplier Address / Contact Answer
Supplier Name: PT. Kenertec Power System
Street Address: Jl. Raya Anyer KM. 122. Desa Gunung Sugih Ciwandan
City Cilegon
State Banten
Postal Code 42447
Country: Indonesia

Manufacture name (if it is different than supplier's name):

Street Address:
City
State
Postal Code
Country:
Contact person name:
Phone#
Email

2.0 Manufacture site employee Information

Number of Employees (manufacture site): (Ask Pak Rano)
Number of shift per day: 2 Shift
Past three years injury rate: (Ask Pak Ade)
Past three years Lost Workday Case Rate (those involving restricted work or days away (Ask Pak Ade)
from work)
Age of the youngest of employee in years working at the site (number only): 18 Years

3.0 Manufacture site Description:

Size of facility: 290.000 M2
Number of building on site: 2 (Office & Mess)
Number of years at this location: Since 2016
Describe the function of this facility(such as, fabrication, warehouse, sales office, etc): - workshop consist 4 line for each line have cutting process untill finishing
process of black tower (before blasting & Painting).
- 4 Blasting Room, 14 Painting Room
- 2 Painting Storage Area
- Open Area for Storage of Section before delivery = 240.000 M2
- 1 Office for official activity, make report, etc
- 1 Mess for korean people
Do you have certification such as ISO 14001, OHSAS 18001, SA 8000 Yes

4.0 Sourcing Information (to be completed by GE Sourcing Contact

Person)
Is this a New or Existing supplier? (Existing supplier means supplier has GE vendor Existing
code)

Is the supplier an active supplier? (If this is a New supplier, please select "Yes") Yes

Is this supplier a direct or indirect material supplier? Indirect

If this is a direct material supplier for PARTS, please specify the type of supplier(type A, B,
or C). If not a direct material supplier, leave blank.
If this is a type C direct material supplier, does the supplier manufacture any parts to GE
drawings? If this is not a type C direct material supplier, leave blank.
If this is a direct material supplier for CHEMICALS, please specify the type of
Chemicals(type A, B, C, or D). If not a direct material supplier, leave blank.
If this is an indirect material supplier, does the supplier manufacture any items to GE's No
drawings or carry GE logo? If this is not an indirect material supplier, leave blank.
Is the supplier an aggregator/broker for other suppliers?
Is this a subtier supplier? If yes, select applicable options below
More than 50% of supplier output goes to GE
The purchase is related to a transfer of work from GE
GE has directed or selected use of this subtier supplier
A GE or affiliate trademark is affixed to the product
Name of GE sourcing contact person(First name Last name):
Instructions
1. Answer each question (Yes, No or NA)
2. Use the Validation Notes column to record explanations for any No or NA answer or where further details are required
3. Do not edit any other cells in the spreadsheet

Validation Notes
(Include specific
Answer
No. EHS Checklist explanation or example to support your
(Y/N/NA)
No or NA answer or provide details
where necessary)

Is there a person professionally trained in Environmental, Health & Safety (EHS) employed at
Yes
1 or supporting the company/facility? Mr Ade Hendra & Mr. Faedullah
Does your company have all environmental permits required to conduct operations (current or Yes
2 proposed) at the facility? Environmental Permits from governments
We don't have SMK3
Does your company have all health and safety permits required to conduct operations (current No (Management System of EHS from
3 or proposed) at the facility? government)

Does your company have all local fire code authorizations? (Applicable fire requirements may Yes Pemeriksaan oleh Kantor Pemadam
4 be contained in the building code or general building construction or operating permit.) Kebakaran - Pemkot Cilegon
During the last 5 years has the company operated without any serious injuries resulting in Yes 3 monthly report to Government
5 death? If the company had a death please answer "no" and provide details. (Disnaker)
During the last 5 years, has your company operated without any serious injuries? A serious
injury is one that requires hospitalization for more than 24 hours. If you have had serious Yes 3 monthly report to Government
6 injury cases in this period, please answer "No" and provide details. (Disnaker)
During the last 5 years, has the company been free of Fine and Violations notices from
Government agencies? If the company received such notices, please answer "No" and Yes
7 provide details. NA

Is the site soils or groundwater free of chemical contamination? If there has been any
investigation of, or remediation of the soil or water at the facility (Include investigations by a Yes Report of Examination Result for Clean
8 government authority or other parties; such as potential investors). Water (Underground water)

No. Labor Practice Checklist

1 Does you company hire all of its employees at or above local minimum age? Yes SOP-HGWT-01
Does your company stricitly avoid the use of prison labor or any workers subject to the control
Yes
2 of the penal system or otherwise under compulsion to work?
Does the company maintain a written statement or policy protecting the employees from
Yes
3 human trafficking?