QHF-150-204-01 <2.

0> 26-Mar-15 Prepared Checked Approve

JIND-CQMS
PRE-QUALIFICATION QUESTIONNAIRE
Engineering, Procurement, Construction

- Organization Name : - Contract Number :

- Address : - Contract Title :
- Phone & Fax : - Contract Periode :
- Contract Owner : - Location :
- Date : - Scope of Work :

Related Explanation
Description Yes / No
Clause (By Identifying Attachment)

4.2.2 QUALITY MANUAL / QUALITY PLAN

Quality Manual is established and
documented in GSB-MQHSE-01. it is
1. is established, documented, socialized, implemented and maintained ? Yes maintained and socualized by IMS
Online
Quality Manual is issued based on ISO
9001:2015, ISO 14001:2015, OHSAS
18001:2007 (GSB-MQHSE-01 1.1
2. fulfills the ISO 9001 requirements ? Yes Pendahuluan)

Quality Manual is understood by the

managerial level (GSB-MQHSE-01 1.2
3. is understood by managerial levels of the audited section / function ? Yes Tujuan)
4.2.3 CONTROL OF DOCUMENTS
The prosedure is established and
documented in GSB-PQHSE-I1.5
Prosedur Pengendalian Dokumen. And
1. is its procedure established, documented, and socialized ? Yes its socialized by IMS Online and emails

All document is listed in GSB-Form-03

Master List of Document, and its revision
is listed in GSB-Form-35 Daftar Detail
Dokumen. The list is implemented by
every department in PT Gerbang
2. is there list of documents and is the list implemented ? Yes Saranabaja
The procedure is implemented and
maintained by all department in PT
3. is the overall of the procedure implemented and maintained ? Yes Gerbang Saranabaja
4.2.4 CONTROL OF RECORDS
The procedure is established in GSB-
PQHSE-I1.6 Prosedur Pengendalian
Rekaman. It is socialized by using IMS
1. is its procedure established, documented, and socialized ? Yes Online
The record is listed and implemented in
2. is there list of records and is the list implemented ? Yes GSB-Form-38 Catalogue of Record.
The procedure is implemented and
maintained by all department in PT
3. is the overall of the procedure implemented and maintained ? Gerbang Saranabaja
5.3 QUALITY POLICY
The Quality Policy is prepared and
1. is prepared and signed by top management ? Yes signed by President Director
2. is appropriate to the goal of the organization; nature, scale and impacts The Quality Policy is issued in
Yes
of its activities, facilities, products and services ? accordance to the goal of organization
3. includes commitment to comply with applicable legal requirements
Yes
and with other requirements ?
4. provides the framework for setting and reviewing Quality objectives,
Yes
targets and programs ?
5. is documented, implemented, maintained, reviewed (included as agenda
Yes
of management review), and revised as needed ?
6. is communicated to all persons working for/on behalf of the organization
Yes
and understood by the persons ? (check by samples)
7. is available to the public ?
- QUALITY ASPECTS IDENTIFICATION, ASSESSMENT AND CONTROL
1. is the documented procedure established / socialized ?
2. are the identification, assessment, and control implemented to the
Related Explanation
Description Yes / No
Clause (By Identifying Attachment)

4.2.2 QUALITY MANUAL / QUALITY PLAN

physical, chemical, biological, physiological, and phsycological ?
organization's activities, facilities, products, and services ?
(check the contribution of the auditee's section / function)
3. is the identification consider :
- routine and non routine activities ?
- past time, present time, and future time ?
and factors of aspects/hazards :
- physical, chemical, biological, physiological, and phsycological ?
- quality aspects ?
4. Does the assessment consider legal and other requirements, probability,
and severity level ?
5. Does the establishment of objectives, targets, and programs consider
legal and other requirements, important aspects and the impacts,
alternative of technology, financial, operational and business
requirements, stakeholders' point of view/feed back ?
- LEGAL AND OTHER REQUIREMENTS IDENTIFICATION AND REVIEW

The procedure is establised in GSB-

PQHSE-I2.2 Prosedur Identifikasi dan
Evaluasi Kepatuhan Peraturan
Perundangan serta Persyaratan K3L And
1. is the documented procedure established / socialized ? Yes its socialized by IMS Online and emails

2. are the identification and review implemented to the organization's The identification and review is
implemented in GSB-PQHSE-I2.2
activities, facilities, products, and services ? Yes Prosedur Identifikasi dan Evaluasi
Kepatuhan Peraturan Perundangan serta
(check the contribution of the auditee's section / function) Persyaratan K3L Point 1 Tujuan

The identification and review is

3. Does the identification consider international, national, and other legals implemented in GSB-PQHSE-I2.2
Yes Prosedur Identifikasi dan Evaluasi
& requirements ? Kepatuhan Peraturan Perundangan serta
Persyaratan K3L Point 4 Referensi

The review is stated in GSB-Form-108

4 is the up to date legal and other requirements periodically reviewed Identifikasi dan Evaluasi Pemenuhan
Yes Kepatuhan Terhadap Peraturan
by accessing the relevant sources ? Perundangan dan Persyaratan K3 dan
Lingkungan
The socialization is implemented in GSB-
is the applicable legal and other requirements socialized to all related PQHSE-I2.2 Prosedur Identifikasi dan
5 Yes Evaluasi Kepatuhan Peraturan
Perundangan serta Persyaratan K3L
section / function managers, persons, and interested parties ? Point 6 Flowchart

The evaluation is implemented in is

implemented in GSB-PQHSE-I2.2
is evaluation of the compliance conducted to ensure the concistency ? Prosedur Identifikasi dan Evaluasi
Kepatuhan Peraturan Perundangan serta
Persyaratan K3L Point 2 Ruang Lingkup
6. Yes and Poin 6 Flowchart
5.4.1 OBJECTIVES, TARGETS AND PROGRAMME(S)
1. are documented objectives, targets and programme(s) [ OTP ]
OTP Procedure is established in GSB-
established, socialized and understood by related employees ? Yes PQHSE-I1.4 Prosedur Rapat Tinjauan
Manajemen
(check by samples)
2. is there OTP SMART (specific, measurable, accountable, reasonable, The report is stated in Management
Yes
and time framed) ? Review Meeting Report
3. is the OTP concistent with the Quality policy including commitments to
fulfilment of customer's and interested parties' requirements, prevention The consistency is stated in
Yes
of / OHS risks / quality risks / environmental pollution / compliance risks, and Management Review Meeting Report
compliance with applicable legal and other requirements ?
The evaluation and follow up is stated in
4. is the OTP periodically evaluated and the non conformity (if any) Management Review Meeting Report
Yes
which held twice a year every 6 (six)
followed up with corrective / preventive action ? months
5.5.1 RESPONSIBILITY AND AUTHORITY
The organization structure, roles,
are organization structure, roles, responsibility and authority defined, responsibility and authority are defined
Yes
and documented by Organization
documented and communicated in order to facilitate QMS ? Structure and Job Description
Related Explanation
Description Yes / No
Clause (By Identifying Attachment)

4.2.2 QUALITY MANUAL / QUALITY PLAN

5.5.2 MANAGEMENT REPRESENTATIVE
Management Representative is assigned
and appointed by President Director with
1. are there Quality representatives assigned and socialized ? Yes Appointment Letter
2. are the Quality Committees established and socialized ?
5.5.3 CONSULTATION AND COMMUNICATION
The procedure is established and
documented in GSB-PQHSE-I2.3
Prosedur Komunikasi,Partisipasi, dan
1. is its procedure established, documented, and socialized ? Yes Konsultansi

We maintain the communication and

consultation by using communication
media (email, WA, pamplet, ad banner)
and regular meeting (weekly and
monthly meeting, Management review
meeting, and Annual Performance
2. is the procedure implemented and maintained ? Yes Evaluation and Wotk Program Meeting)
5.6 MANAGEMENT REVIEW
1. is the Management Review periodically conducted and attended by Management Review Meeting is
top management, management representatives and other function of Yes conducted twice a year evey 6 (six)
months and attended by all top
Quality representatives ? management, MR, and Head
2. is the Management Review appropriately implemented ? Yes Department
6.1 PROVISION OF RESOURCES

The essential resources for human

are the resources essential to establish, implement, maintain and improve resources is stated in GSB-PQHSE-S1.1
Penerimaan Karyawan and specialized
skill for the position is stated in the Job
Description;
to develop and evaluate employee's skill
the QMS (human resources and specialized skills, organizational is stated in GSB-PQHSE-S1.2 Training
Yes Karyawan and GSB-PQHSE-S1.3
Penilaian Karyawan;
the organizational infrastructure is stated
infrastructure, technology and financial) that relevant to the audtee in Organization Structure;
while the needs to the procurement of
outsourced specialized skill personnel,
as well as technology and provision are
stated in GSB-PQ-C3.1 Seleksi and
section / fuction responsibilities available ?
Pembelian Produk-Jasa and GSB-PQ-
C3.2 Evaluasi Subcont & Supplier
6.2.2 COMPETENCE, AWARENESS AND TRAINING
The competence procedure is stated in
GSB-PQHSE-S1.1 Penerimaan
1. is procedure for competence, awareness and training established /
Karyawan and GSB-PQHSE-S1.3
Penilaian Karyawan;
Yes Awareness procedure is stated in GSB-
PQHSE-I2.3 Prosedur
Komunikasi,Partisipasi, dan Konsultansi;
socialized ? Training procedure is stated in GSB-
PQHSE-S1.3 Penilaian Karyawan

2. is Quality-related training need :

Established in GSB-Form-63 Kebutuhan

- identified and planned ? Pelatihan and GSB-Form-64 Matrix
Yes Training
Established in GSB-Form-99 Daftar
- implemented ? Yes Pelatihan

Established in GSB-Form-98 Evaluasi

- evaluated ? Pelatihan GSB-Form-100 Evaluasi
Yes Pelaksanaan Pelatihan

- recorded ? All documents are recorded and stored

Yes in HRD Department
and Quality induction program for new employee, guest, and subcon:
Quality induction is held in by HRD,
HSE, and QMS. Lampiran : bukti
- established and implemented ? Yes pelaksanaan induksi HRD
7.0 PRODUCT REALIZATION /
OPERATIONAL CONTROL
Related Explanation
Description Yes / No
Clause (By Identifying Attachment)

4.2.2 QUALITY MANUAL / QUALITY PLAN

The procedures are stated in:

GSB-PQHSE-I2.4 Pengendalian
Operasional,
is the documented procedures for operational (production / function GSB-PQHSE-C6.1 Persiapan Fabrikasi-
Potong Plat SS,
GSB-PQHSE-C6.2 Persiapan Fabrikasi-
Potong Profil SS,
GSB-PQHSE-C6.3 Fabrikasi SS,
GSB-PQHSE-C6.7 Fabrikasi Built-Up
Beam,
GSB-PQHSE-C6.4 Painting SS,
GSB-PQHSE-C11.1Persiapan Fabrikasi-
Potong Plat PV,
operational) socialized, implemented and maintained ? Yes GSB-PQHSE-C11.2 Persiapan
Fabrikasi-Potong Profil PV,
GSB-PQ-C11.3 Fabrikasi PV,
GSB-PQHSE-C9.1 Perencanaan dan
Pengendalian proyek PV,
GSB-PQHSE-C2.1 Perencanaan Proyek
SS,
GSB-PQHSE-C2.2 Pengendalian Proyek
SS,
(attach list of all applicable procedures) GSB-PQHSE-C2.3 Persiapan Erection
SS,
GSB-PQHSE-C2.4 Erection SS.

- CONTROL OF QUALITY
are the procedures for control of the items below established, The procedure is stated in GSB-PQHSE-
Yes
documented, socialized, implemented, and maintained ? S3.2 Inspeksi Hasil Kerja Produksi,
The procedure is stated in GSB-PQHSE-
- control of quality refer to quality operational control procedures ? Yes S3.2 Inspeksi Hasil Kerja Produksi,
(attach list of all applicable procedures)
8.2 MONITORING AND MEASUREMENT / GENERAL
is the procedure for monitoring and measurement established, Yes It is stated in GSB-PQHSE-I2-6
socialized, implemented and maintained ? Pemantauan dan Pengukuran

It is stated in GSB-PQHSE-I2-6
- monitoring and measurement schedule ? Yes Pemantauan dan Pengukuran and
recorded in GSB-Form-211 Jadwal Jenis
Pengukuran Lingkungan

It is stated in GSB-PQE-I1.7
Performance Measurement and GSB-
- monitoring of achievement ? Yes PQHSE-I1.4 Rapat Tinjauan Manajemen
and recorded in GSB-Form-131 Hasil
Evaluasi Sasaran Mutu, and
Management Review Report

It is stated in GSB-PHSE-I2.2 Identifikasi

dan Evaluasi Kepauhan Peraturan
Perundangan Serta Persyaratan K3L
and recorded in GSB-Form-108 Daftar
- monitoring of compliance with legal and other requirements ? Yes
identifikasi dan evaluasi peraturan
perundangan serta persyaratan lainnya,
and GSB-Form-123 pemantauan
perubahan & penyesuaian kepatuhan
perundangan dan persyaratan K3L

It is stated in GSB-PHS-I2.7 Investigasi

Insiden and GSB-PQHSE-I2.3 Prosedur
Komunikasi,Partisipasi, dan Konsultansi
- statistic of incident rate and the socialization ? Yes and recorded in GSB-Form-214 Laporan
Insiden; and socialized by various
communication media (email, phone,
hardcopy, Whatsapp, meetings, etc.)
It is stated in GSB-PQ-S3.1 Kalibrasi dan
- control of monitoring and measurement equipment ? Yes Verifikasi Alat Ukur and recordedin GSB-
Form-56 Schedule of Calibration
8.3 CONTROL OF NONCONFORMITY
is the procedure for control of nonconformity established, socialized, The procedure is stated in GSB-PQHSE-
Yes
implemented and maintained ? I1.8 Corective Action

It is stated in GSB-PHS-I2.7 Investigasi

Insiden and recorded in GSB-Form-214
- accident and incident ? Yes Laporan Insiden
Related Explanation
Description Yes / No
Clause (By Identifying Attachment)

4.2.2 QUALITY MANUAL / QUALITY PLAN

It is stated in GSB-PQHSE-I1.8
Corective Action and recorded in GSB-
Form-45 Corrective Action Report, GSB-
Form-58 Non-Conforming Report, and
GSB-Form-131 Evaluasi Hasil Ssaran
- non conformity / incompliance? Yes Mutu dan K3L
8.2.2 INTERNAL AUDIT
is the procedure for internal audit established, socialized, The procedure is stated in GSB-PQHSE-
Yes
implemented and maintained ? I1.3. Audit Internal
It is recorded in GSB-Form-46 Register
- is audit report available ? Yes Laporan Audit Internal / Eksternal
It is recorded in GSB-Form-45 Corrective
Action Report and GSB-Form-46
Register Laporan Audit Internal /
- are corrective/preventive actions completed ? Yes Eksternal
It is recorded in GSB-Form-43 Jadwall
- site / work area visit Yes Audit Internal

It is recorded in GSB-Form-45 Corrective

Action Report and GSB-Form-46
Register Laporan Audit Internal /
* work attitude ? Yes Eksternal
It is recorded in GSB-Form-45 Corrective
Action Report and GSB-Form-46
Register Laporan Audit Internal /
* Quality symbol and signs ? Yes Eksternal
It is recorded in GSB-Form-45 Corrective
Action Report and GSB-Form-46
Register Laporan Audit Internal /
* Quality aspects ? Yes Eksternal
8.5.2/3 CORRECTIVE / PREVENTIVE ACTION
is the procedure for corrective / preventive action established, The procedure is stated in GSB-PQHSE-
Yes
socialized, implemented and maintained ? I1.8 Corective Preventive Action