No : FRM/AIC/QMS/02/01

FORMULIR
Rev : 00
Tgl : 11 Maret 2014
DOKUMEN RETENSI
Hal : 1 of 1

DEPARTEMEN : Procurement

Penyimpanan Distribusi File

No. Nama Dokumen Waktu Rangkap
PIC Tempat 1 2 3 4
(tahun/bulan)
Head Office
1 PR 24 bulan Officer Lemari file 2 Proc Acc
2 PO 24 bulan Officer Lemari file 2 Proc Acc
Dokumen Tender :
RKS
Undangan
3 Berita Acara Aanwijzing 36 bulan Lemari file 1 Proc
Surat Negosiasi
Persetujuan
SPK / Kontrak
Unit
4 SRR 12 bulan Cost Control Lemari file 2 Proc Site
5 PR 24 bulan Cost Control Lemari file 2 Proc Site
6 SJ 12 bulan Cost Control Lemari file 3 Proc Site Acc
7 Bin Card 12 bulan Storeman Lemari file 1 Site

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 No : FRM/AIC/QMS/02/01
FORMULIR
Rev : 00
Tgl : 11 Maret 2014
DOKUMEN RETENSI
Hal : 1 of 1

DEPARTEMEN : Operation

Penyimpanan Distribusi File

No. Nama Dokumen Waktu Rangkap
PIC Tempat 1 2 3 4
(tahun/bulan)

1 Form PRP Inspection 6 bulan QC Lemari Office Site 1 Site

2 Form OPRP Incoming Material 6 bulan QC Lemari Office Site 1 Site

Form OPRP Pencucian Sayur QC, Storeman,

3 6 bulan Lemari Office Site 1 Site
Buah Cook Helper

4 Form CCP Cooking 6 bulan Chef, Cook Lemari Office Site 1 Site

Form OPRP Pemantauan Suhu

5 6 bulan QC, Storeman Lemari Office Site 1 Site
Chiller Freezer

6 Form OPRP Thawing 6 bulan Chef, Butcher Lemari Office Site 1 Site

Form OPRP Pencucian

7 6 bulan Steward Lemari Office Site 1 Site
Peralatan
Form Penyimpanan Sampel Ahli Gizi,
8 6 bulan Lemari Office Site 1 Site
Makanan Distribusi
Form Pengecekan Suhu Bain
9 6 bulan Distribusi Lemari Office Site 1 Site
Marie
Form Pengecekan Suhu Hot
10 6 bulan Service Lemari Office Site 1 Site
Trolley

11 Form Berita Acara Receiving 6 bulan QC, Storeman Lemari Office Site 1 Site

Form Berita Acara Cost Control,

12 6 bulan Lemari Office Site 1 Site
Pemusnahan Storeman
13 Standar Recipe - Chef Kitchen area 1 Site
Lemari Office
14 Standar Diet - Ahli Gizi 1 Site
Gizi
Lemari Office
15 Standar Makanan Cair/Sonde - Ahli Gizi 1 Site
Gizi

16 CFBF / Complaint Customer QC Lemari Office Site 1 Site

12 bulan
17 SIR / Form Penilaian Resiko QC Lemari Office Site 1 Site
12 bulan

18 Incident Report QC Lemari Office Site 1 Site

12 bulan
19 Evaluasi Sisa Makan Pasien QC, Ahli Gizi Lemari Office Site 1 Site
6 bulan
20 Summary Laporan QC QC Lemari Office Site 1 Site
12 bulan

21 Audit Internal QC Lemari Office Site 1 Site

24 bulan
22 Audit Eksternal QC Lemari Office Site 1 Site
24 bulan

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DOKUMEN RETENSI

DEPARTEMEN : Hygiene & Quality Assurance

Penyimpanan
No. Nama Dokumen Waktu Rangkap
PIC Tempat
(tahun/bulan)
Lemari Office
1 Internal Audit 24 bulan QA Officer 2
HQA
Lemari Office
2 Eksternal Audit 24 bulan QA Officer 1
HQA
Lemari Office
3 Vendor Evaluation 12 bulan QA Officer 2
HQA
Lemari Office
4 Quality Target 12 bulan QA Officer 2
HQA
Lemari Office
5 Customer Complaint (SIR) 12 bulan QA Officer 2
HQA
Lemari Office
6 Management Review 12 bulan QA Officer 1
HQA
Lemari Office
7 Microbiological Test 12 bulan QA Officer 2
HQA
Lemari Office
8 Traceability 12 bulan QA Officer 1
HQA
Lemari Office
9 Summary QC 12 bulan QA Officer 2
HQA
 No : FRM/AIC/QMS/02/01
Rev : 00
Tgl : 11 Maret 2014
NSI
Hal : 1 of 1

Distribusi File
1 2 3 4

QA Site

QA

QA Proc

QA Site

QA Site

QA

QA Site

QA

QA Site

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DOKUMEN RETENSI

DEPARTEMEN : Human Capital

Penyimpanan Distribusi
No. Nama Dokumen Waktu Rangkap
PIC Tempat 1
(tahun/bulan)
 No : FRM/AIC/QMS/02/01
Rev : 00
Tgl : 11 Maret 2014
Hal : 1 of 1

Distribusi File

2 3 4

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 No : FRM/AIC/QMS/02/01
FORMULIR
Rev : 00
Tgl : 11 Maret 2014
DOKUMEN RETENSI
Hal : 1 of 1

DEPARTEMEN : Corporate Gizi

Penyimpanan Distribusi File

No. Nama Dokumen Waktu Rangkap
PIC Tempat 1 2 3 4
(tahun/bulan)

Form DPMP (Daftar Lemari dept. Cost

1 1 thn Gizi 3 AGRS AG AIC
Permintaan Makan Pasien) Gizi unit Control

Lemari dept.
2 Form Kitchen Order 1 thn Gizi & Cook 2 Asli Cook FC. Gizi
Gizi unit
Form Spesial Meal/ pasien Lemari dept. Pasien/
3 Sekali Pakai Gizi 1
baru Gizi unit Customer
Lemari office
4 Form Pengiriman & Clear Up 1bln Service 1 Service
unit
Lemari dept.
5 Form Meal Check 3 bln Gizi & QC 2 QC Gizi
Gizi unit
Lemari dept.
6 Form Distribusi Makanan 1 bln Gizi 1 AGRS Service
Gizi unit
Lemari dept. Pasien/
7 Form Sticker Menu 1 bln Gizi 2 AG AIC
Gizi unit Customer

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DOKUMEN RETENSI

DEPARTEMEN : Corporate Chef

Penyimpanan Distribusi
No. Nama Dokumen Waktu Rangkap
PIC Tempat 1
(tahun/bulan)
 No : FRM/AIC/QMS/02/01
Rev : 00
Tgl : 11 Maret 2014
Hal : 1 of 1

Distribusi File

2 3 4

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DOKUMEN RETENSI

DEPARTEMEN : Marketing

Penyimpanan Distribu

No. Nama Dokumen Waktu Rangkap

PIC Tempat 1
(tahun/bulan)

Head Office
1 Form CSI 24 bulan Admin Mkt Lemari Mkt HO 1 MKT
2 Proposal PQ 24 bulan Admin Mkt Lemari Mkt HO 1 MKT
3 Proposal Penawaran 24 bulan Admin Mkt Lemari Mkt HO 1 MKT
4 24 bulan Lemari Mkt HO 1
Proposal Admin & Technical Admin Mkt MKT
5 Kontrak Project Admin Mkt Lemari Mkt HO 1 MKT
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Rev : 00
Tgl : 11 Maret 2014
Hal : 1 of 1

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DOKUMEN RETENSI

DEPARTEMEN : HSE

Penyimpanan Distribusi
No. Nama Dokumen Waktu Rangkap
PIC Tempat 1
(tahun/bulan)
Head Office
1 Emergency Response Plan 3 tahun HSE Officer Lemari HSE HO 2 HSE
2 Form Incident Report 3 tahun HSE Officer Lemari HSE HO 1 HSE
3 Form Investigation Report 3 tahun HSE Officer Lemari HSE HO 1 HSE
4 Form Risk Assessment 1 tahun HSE Officer Lemari HSE HO 1 HSE
5 Form Daftar Hadir Meeting 1 tahun HSE Officer Lemari HSE HO 1 HSE
6 Form CHESM 2 tahun HSE Officer Lemari HSE HO 1 HSE
 No : FRM/AIC/QMS/02/01
Rev : 00
Tgl : 11 Maret 2014
Hal : 1 of 1

Distribusi File

2 3 4

Site

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DOKUMEN RETENSI

DEPARTEMEN : Accounting

Penyimpanan Distribusi
No. Nama Dokumen Waktu Rangkap
PIC Tempat 1
(tahun/bulan)
 No : FRM/AIC/QMS/02/01
Rev : 00
Tgl : 11 Maret 2014
Hal : 1 of 1

Distribusi File

2 3 4

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DOKUMEN RETENSI

DEPARTEMEN : Finance

Penyimpanan Distribusi
No. Nama Dokumen Waktu Rangkap
PIC Tempat 1
(tahun/bulan)
 No : FRM/AIC/QMS/02/01
Rev : 00
Tgl : 11 Maret 2014
Hal : 1 of 1

Distribusi File

2 3 4

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