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Facility Name: Date: Dgll.>01b. \.\ar,y'b

ADMINISTRANON
T
2 Business License
3 lzin Mendirikqn Bangunan _,/ Building Construction Permit
4 lzin Gongguon (HO) d Disturbance Permit
5
5
hJ
HUMAN RESOURCES
7
I
Company Policies (Child labor / Discrimination / Harrassment / Forced '-abor)
9 lklon Lowongon Kerjo / Form Perm ;sition f.orms
10 Serikat Pekerjo
Bersamo
{ Worker's union
11 Perjonjion Kerjo
G-
J Collective Bargaining Agreement [rf applicable]
1> LKS Biportite
+3 Pencototon partite committee to Locar Labor'office
14 Wroffi*olo Biportite , R-riodic Report for Bipartite committee
15 Wajib Lopor TenogaKerjo V ,
Obligatory Manpower Report
15 Pendoftoron PKWT U i'' ''; i, Employmentco pp
I1;
):6
19 Su*ontrokorBerado di Perusohoon \/ tn-hou@
ACCOUNTING
'20 Upoh Minimum
27
22
23 Rekop lom Kerjo _6ffiffii;---
Tima Record.s
_
24
25
76

27 BPJS Ketenogokerjaon (Pembayorun) V

Social Security Payment (List/Attachment)
28
?!!.s.(:s"!1ty
(P,"^bovor:n),,
,= 7
29 JPK Mondiri (Pemboyoron/Peijonjian Kerjo Somo/Rekomendosi Disnoker) >

HEATTH AND SAFETY

f* !@ Fi re-fighti ng train ing
31 Troining Evokuosi Evacuation training
32 Training P3K (Pe mboyo ro n/Sffij lnternal First Aid Training (List/Certificate)
x Troining APD PPE Training
34 Training penongonon bohon kimio
35 P2K3 Pencototan
35 P2K3 (Laporani
37 ployment/Annual)
39 Uji Air Minum DrinHng Water Test
4o' SIPA _- Permit
4| it*:". R"r.rt
42 uji |PAL Waste Water Testing
143 ne List Summary
w
l4s liin Penongkol Petir \/
cal lndustrial Permit
Lighting nr.este.lnffii
i46
47 tjin Boiler / SIO V
48 ljin Kompresor
49
io :li, frr*:ift / So Y ror*lift tndusrrialpermitTEE;itoTlffiE
n Sertifiket
52 Kebisingcn
Tes
r,,esel a m
-
ato n Ke boko ro n
Noise Testing rleport
bohciyo
ls3i Anoliso Poteisi _ Risk Asj!14gg'1/Hazard Asse.smen-i'
liin TPS 83,r Doftor r\4u-otdn temporary War-le stor.geErmi-ffifri76ll--
H inspeksi Tohunoh Alorm , -nnual Alarm h:'.4pection

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