Doc.

No: RM/HSE/FORM/2
HEALTH, SAFETY &
ENVIRONMENTAL
MANAGEMENT SYSTEM –
FORMS
PT. SAROHA TRANSPORT
Revision: 0
ABADI
Issued Date: 22 Oktober 2022

CORRECTIVE/PREVENTIVE ACTION REQUEST

CPAR NO.: GR-2/CPAR/01/22

To : Susilo Sources: (To be completed by the Issuer)

Management Representative √ Internal Audit – Management System
Client Complaint
Department : HSE
Others: ...................................

Category of Non-conformity
Issued by : Christian Frizt Gordon Lumban Gaol Major
√ Minor
Sign & Date : 22 Oktober 2022 Observation

Description of Non-Conformity(ies)/ Potential Issues: (To be completed by Auditee)

Problem: Tidak ditemukan penjadwalan dan dokumentasi konsultasi tenaga kerja
dengan wakil perusahaan, meskipun hal tersebut sudah tertuang di Manual SMK3 Dok.
No: STA/K3L/MAN/01.
SOP SAT/HSE/SOP /14 Komunikasi, Pasrtisipasi dan Konsultasi K3L
Location: PT. Saroha Transport Abadi
Objective Evident(s): Documented Information; Manual SMK3 Dok. No: STA/K3L/MAN/01.
SOP SAT/HSE/SOP /14 Komunikasi, Partisipasi dan Konsultasi K3L
Reference(s): PP 50/2012 - Kriteria 1.4.1
Corrective Action(s):

Root Cause(s):

Preventive Action(s):
Auditee/

Name & Sign:

Date of Completion:

Verification: Status :
Comment: Completed
Need to be followed up

Issuer/
Name & Sign:
Date: