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I T A Item No.

= Initial ( Small ) = Transition ( Medium ) = Advance ( Big ) No.

Audit Check List The Management System of Occupational Safety and Health (SMK3) Regulation of Minister of Manpower Number : 05/MEN/1996
I Criteria No. T A Audit Finding Items S/C

4 5

= Conformance = Non Conformance Verification

Elements and Sub Elements criteria ( Permenaker No.05/MEN/1996, Attachment-II )

Finding TS/NC

Note : S : Sesuai / C : Conformance, TS : Tidak Sesuai / NC : Non Conformance

Page - 1of 21 I T A Item No. 1 1.1 1 1.1.1 = Initial ( Small ) = Transition ( Medium ) = Advance ( Big )

Attachment-1/Proc.LPD1-IDP-0008 4 5 = Conformance = Non Conformance

Audit Check List The Management System of Occupational Safety and Health (SMK3) Regulation of Minister of Manpower Number : 05/MEN/1996
Criteria No. T A

No.

Elements and Sub Elements criteria ( Permenaker No.05/MEN/1996, Appendix-II ) COMMITMENT AND POLICY Occupational Safety and Health Policy There is an occupational safety and health policy in writing, dated and clearly state the objective of occupational safety and health and company commitment in improving the occupational safety & health performance. Policy signed by entrepreneur and or manager. Policy is arranged by entrepreneur and or manager after by consultation process with representative of worker. Company communicate the occupational safety and health policy to all workers, visitor, contractors, customer and supplier with exactly procedure. If required, special policy is arride for problem of specially occupational safety and health. Occupational safety and health policy and other special policies are reviewed periodically to secure that they reflect with modification happened in legislation.

Audit Finding Items

S/C

Finding TS/NC Mjr Mnr

Verification

1.1.1

1.1.1

1.1.1

2 3

1.1.2 1.1.3

1.1.2 1.1.3 1.1.3

1.1.4

1.1.4

1.1.5

1.1.5

1.1.5

1.1.6

1.1.6

1.2 Responsibility and Authority to be Action 7 1.2.1 Responsibility and authority to take action and report to all personel's concerned in company which have been determined that they should be disseminated and document. 1.2.1 1.2.1

Designation of responsibility of occupational safety and 1.2.2 1.2.2 health should pursuant to legislation. Note : S : Sesuai / C : Conformance, TS : Tidak Sesuai / NC : Non Conformance

1.2.2

1.2.2

Page-2 of 21 I T A Item No. 9 = Initial ( Small ) = Transition ( Medium ) = Advance ( Big )

Audit Check List The Management System of Occupational Safety and Health (SMK3) Regulation of Minister of Manpower Number : 05/MEN/1996
Criteria No. T A 1.2.3

4 5

= Conformance = Non Conformance

No. 1.2.3

Elements and Sub Elements criteria ( Permenaker No.05/MEN/1996, Attachment-II ) Job unit manager in any company responsible for occupational safety and health performance to their job unit. Company obtain some suggestions from experts in the occupational safety and health derived from inside and outside the company. Officer who is responsible for handling emergency to get training and is given identity card in order to be recognize by all people within the company. Occupational safety and health performance entered in to company annual report or as level as other report. Job unit manager is given information on their responsible for contractor's manpower and other persons entered work place. Responsibility to maintain and distribute the latest information concerning the legislation of occupational safety and health have been determined. System of occupational safety and health is executed. Manager is fully responsible for to secure Management.

Audit Finding Items

S/C

Finding TS/NC Mjr Mnr

Verification

10

1.2.4

1.2.4

1.2.4

1.2.4

11

1.2.5

1.2.5

1.2.5

1.2.5

12

1.2.6

1.2.6

13

1.2.7

1.2.7

1.2.7

14

1.2.8

1.2.8

1.2.8

15

1.2.9

1.2.9

1.2.9

1.3 Review and Evaluation 16 1.3.1 Manager should review the implementation of the management system of K3 periodically to evaluate suitability and effectiveness of management system of K3. If applicable, review result entered into management action planning. 1.3.1

17

1.3.2

1.3.2

18 1.3.3 Review result is recorded and documented 1.3.3 1.3.3 Note : S : Sesuai / C : Conformance, TS : Tidak Sesuai / NC : Non Conformance

1.3.3

Page-3 of 21 I T A Item No. = Initial ( Small ) = Transition ( Medium ) = Advance ( Big )

Audit Check List The Management System of Occupational Safety and Health (SMK3) Regulation of Minister of Manpower Number : 05/MEN/1996
Criteria No. T A

4 5

= Conformance = Non Conformance

No. 1.4

Elements and Sub Elements criteria ( Permenaker No.05/MEN/1996, Attachment-II ) Involvement and Consultation with Manpower Involving manpower and consultation scheduling with representing company designated to be documented. It is made a simple procedure for consultation concerning modifications which have the implication of occupational safety and health. Pursuant to company legislation have establish of P2K3. Head of P2K3 is manager or top manager. Secretary of P2K3 is an Expert of K3 pursuant to legislation. P2K3 concentrated to activity for developing policy and procedure to control the risk. P2K3 held regular meeting and its result is disseminated in the workplace. P2K3 report their activities regularly according to legislation. If required. Performed the formation of work groups and selected of represent manpower designated as who is responsible for occupational safety and health in the workplace and to them is given training under the effective legislation.

Audit Finding Items

S/C

Finding TS/NC Mjr Mnr

Verification

19

1.4.1

1.4.1

1.4.1

1.4.1

20

1.4.2

1.4.2

1.4.2

21 22 23

1.4.3 1.4.4 1.4.5

1.4.3 1.4.4 1.4.5

1.4.3 1.4.4 1.4.5

1.4.3 1.4.4 1.4.5

24

1.4.6

1.4.6

1.4.6

1.4.6

25

1.4.7

1.4.7

1.4.7

1.4.7

26

1.4.8

1.4.8

1.4.8

1.4.8

27

1.4.9

1.4.9

1.4.9

28

1.4.10 If work groups have establish, that manpower is given information on work group structure.

1.4.10 1.4.10

Note : S : Sesuai / C : Conformance, TS : Tidak Sesuai / NC : Non Conformance

Page- 4 of 21 I T A Item No. 2 2.1. 29 2.1.1 = Initial ( Small ) = Transition ( Medium ) = Advance ( Big )

Audit Check List The Management System of Occupational Safety and Health (SMK3) Regulation of Minister of Manpower Number : 05/MEN/1996
Page- 5 of 21 Criteria No. I T A

4 5

= Conformance = Non Conformance

No.

Elements and Sub Elements criteria ( Permenaker No.05/MEN/1996, Attachment-II ) DOCUMENTATION STRATEGY Strategi Plan of Occupational Safety and Health. Competence officer have identified and evaluate potential dangerous and occupational safety and health risk related to operation. Strategy plan of occupational safety and health of company have bee determined and applied to control potential dangerous and occupational safety and health risk which have been identified, related to operation. Special plan related to product, process, project or certain workplace have been made. The plan is based upon to potential dangerous and incident, and recording of occupational safety and health in advance. The plan determine the objective of occupational safety and health of company is measurable, determine priority and provide any resources. Management System Manual of K3 Management System Manual of K3 including policy, objective, plan and procedure of occupational safety and health and determine the responsibility of occupational safety and health for all levels in company. If requested a special manual related related to product, process or certain workplace have made.

Audit Finding Items

S/C

Finding TS/NC Mjr Mnr

Verification

2.1.1

2.1.1

30

2.1.2

2.1.2

31

2.1.3

2.1.3

32

2.1.4

2.1.4

33

2.1.5

2.1.5

2.2. 34 2.2.1

2.2.2

35

2.2.2

2.2.2

Note : S : Sesuai / C : Conformance, TS : Tidak Sesuai / NC : Non Conformance

Page- 5 of 21 I T A Item No. 36 = Initial ( Small ) = Transition ( Medium ) = Advance ( Big )

Audit Check List The Management System of Occupational Safety and Health (SMK3) Regulation of Minister of Manpower Number : 05/MEN/1996
Criteria No. T A 2.2.3

4 5

= Conformance = Non Conformance

No. 2.2.3

Elements and Sub Elements criteria ( Permenaker No.05/MEN/1996, Attachment-II ) Management System Manual of K3 easy to be obtained by all personnels in company. Information Dissemination of Occupational Safety and Health. Information on activity and problem of occupational safety and health distributed systematically to all company worker. Recording information of occupational safety and health is maintained and provided to all manpower and other persons coming to workplace. DESIGN REVIEW AND CONTRACT Design Review Procedure documented to consider dangerous identification and evaluation the risk performed at stage doing design or redesign. Procedure documented to consider dangerous identification and evaluation the risk performed at stage doing design or redesign. Competence officer have determine to perform verification that design meet the requirement of determined occupational safety and health.

Audit Finding Items

S/C

Finding TS/NC Mjr Mnr

Verification

2.3.

37

2.3.1

2.3.1

2.3.1

2.3.1

38

2.3.2

2.3.2

3 3.1. 39 3.1.1

3.1.1

3.1.1

40

3.1.2

3.1.2

3.1.2

41

3.1.3

3.1.3

3.1.3

42

All alterations and design modification which have implication of identied occupational safety and health, documented, reviewed and approved by authorized officer before implementation. Note : S : Sesuai / C : Conformance, TS : Tidak Sesuai / NC : Non Conformance

3.1.4

3.1.4

Page - 6 I T A Item No. = Initial ( Small ) = Transition ( Medium ) = Advance ( Big )

Audit Check List The Management System of Occupational Safety and Health (SMK3) Regulation of Minister of Manpower Number : 05/MEN/1996
Criteria No. T A

4 5

= Conformance = Non Conformance

No. 3.2.

Elements and Sub Elements criteria ( Permenaker No.05/MEN/1996, Attachment-II ) Contract Review Procedure documented should able to identity and evaluate potential dangerous occupational safety and health environment and society, where the procedure is used during supplying goods and service in any contact. Dangerous identification and risk evaluation is executed is executed at contract review by competence personnel Review contracts to secure that supplier can meet requirement of occupational safety and health for customer Contract review recording is maintained and documented DOCUMENT CONTROL Approval and Issuing Document. Occupational safety and health document have identity of status, authority, date of issue and date of modification Document distribution receiver attached in the document Document of occupational safety and health of latest edition is kept in determined place. Out of date document immediately removed of its using while out of date document deposited for the certain necessary is given special sign. Alteration and Modification of Document

Audit Finding Items

S/C

Finding TS/NC Mjr Mnr

Verification

43

3.2.1

3.2.1

3.2.1

44

3.2.2

3.2.2

3.2.2

45

3.2.3

3.2.3

46

3.2.4 4 4.1

3.2.4

47

4.1.1

4.1.1

4.1.1

48 49

4.1.2 4.1.3

4.1.2

4.1.2 4.1.3

50

4.1.4

4.1.4

4.2

Note : S : Sesuai / C : Conformance, TS : Tidak Sesuai / NC : Non Conformance

Page - 7 of 21 I T A Item No. 51 = Initial ( Small ) = Transition ( Medium ) = Advance ( Big )

Audit Check List The Management System of Occupational Safety and Health (SMK3) Regulation of Minister of Manpower Number : 05/MEN/1996
Criteria No. T A 4.2.1 4.2.1

4 5

= Conformance = Non Conformance

No. 4.2.1

Elements and Sub Elements criteria ( Permenaker No.05/MEN/1996, Attachment-II ) There is a system to make and approve the alteration of occupational safety and health document. If possibly is given any reason the happened alteration and written in document or its attachment. There is document control procedure or list of all document attached to status of each document, in effort to prevent the use of former document. PURCHASING Spesification of purchasing for goods and service There is a procedure documented that can secure that technical spesification and other information relevant to occupational safety and health have been examined before decision to buy. Purchase specification for each facilities of production, chemical substance or service should be completed by spesification according to the requirement of valid legislation and occupational safety and health standard. Consultation with potential manpower influenced during purchasing decision is performed if the requirement of occupational safety and health attached in in purchase spesification. Training demand, supplier for self-protector tool and alteration of work procedure need to be considered before purchaseing and reviewed before purchasing and using production facility and chemical materials.

Audit Finding Items

S/C

Finding TS/NC Mjr Mnr

Verification

52

4.2.2

4.2.2

53

4.2.3

4.2.3

5 5.1 54 5.1.1

5.1.1

5.1.1

5.1.1

55

5.1.2

5.1.2

5.1.2

56

5.1.3

5.1.3

5.1.3

57

5.1.4

5.1.4

Note : S : Sesuai / C : Conformance, TS : Tidak Sesuai / NC : Non Conformance

Page - 8 of 21 I T A Item No. = Initial ( Small ) = Transition ( Medium ) = Advance ( Big )

Audit Check List The Management System of Occupational Safety and Health (SMK3) Regulation of Minister of Manpower Number : 05/MEN/1996
Criteria No. T A

4 5

= Conformance = Non Conformance

No. 5.2

Elements and Sub Elements criteria ( Permenaker No.05/MEN/1996, Attachment-II ) Verification System For Goods and Service To be Bought. Goods and service which have been bought that it is examined the suitability with purchase spesification. Control for goods and Service Supplied Customers Goods and service which have been bought prior to use first identified potential dangerous and evaluated its risk. The Recording is maintained to examine this procedure. Product is available by costomer can be clearly identified WORKING SAFETY BASED ON MANAGEMENT SYSTEM OF K3. Work System Competence officer have identify potential dangerous and have evaluated issuing risk of any work process. If effort to control risks required that the effort is determined by controlling level. There is a work procedure documented and if required applied any system "Work permit" for high risk job. Procedure or work guidance to manage safety all risks identified it id documented.

Audit Finding Items

S/C

Finding TS/NC Mjr Mnr

Verification

58

5.2.1

5.2.1

5.2.1

5.2.1

5.3 59 5.3.1

5.3.1

60

5.3.2 6

5.3.2

6.1 61 6.1.1

6.1.1

6.1.1

6.1.1

62

6.1.2

6.1.2

6.1.2

6.1.2

63

6.1.3

6.1.3

6.1.3

6.1.3

64

6.1.4

6.1.4

6.1.4

65

Compliance with regulation standard and implemention 6.1.5 6.1.5 provision attention to during developing or performing procedure modification or work manual. Note : S : Sesuai / C : Conformance, TS : Tidak Sesuai / NC : Non Conformance

6.1.5

6.1.5

Page - 9 of 21 I T A Item No. 66 = Initial ( Small ) = Transition ( Medium ) = Advance ( Big )

Audit Check List The Management System of Occupational Safety and Health (SMK3) Regulation of Minister of Manpower Number : 05/MEN/1996
Criteria No. T A 6.1.6 6.1.6

4 5

= Conformance = Non Conformance

No. 6.1.6

Elements and Sub Elements criteria ( Permenaker No.05/MEN/1996, Attachment-II ) Work procedure and work instruction is made by competence officer by input of manpower requisited to do duties and procedure is ratified by officer designated Self-protector tool is available if required and used correctly and maintained always in condition available for use. Self-protector tool used is assured have been stated usable under standard and or legislation is valid. The effort to control the risk reviewed if it happened any alteration in work process. Controlling It is executed any control to secure that each jobs is performed safely and follow each procedure and work guidance which have been determined. Every persons is suprevised under their capability level and duty risk level Supervisor participate in dangerous identification and made effort to control. Supervisor participated in report and investigation of disease cause of work and accident, and is obligate to delivery report and suggestions to manager. Supervisor participate and in consultation process.

I 6.1.7

Audit Finding Items

S/C

Finding TS/NC Mjr Mnr

Verification

67

6.1.7

6.1.7

6.1.7

6.1.7

68

6.1.8

6.1.8

6.1.8

6.1.8

69

6.1.9

6.1.9

6.1.9

6.1.9

6.2. 70 6.2.1.

6.2.1

6.2.1

6.2.1

71

6.2.2

6.2.2

6.2.2

72

6.2.3

6.2.3

6.2.3

73

6.2.4

6.2.4

6.2.4

74

6.2.5

6.2.5

6.2.5

Note : S : Sesuai / C : Conformance, TS : Tidak Sesuai / NC : Non Conformance

Page - 10 of 21 I T A Item No. = Initial ( Small ) = Transition ( Medium ) = Advance ( Big )

Audit Check List The Management System of Occupational Safety and Health (SMK3) Regulation of Minister of Manpower Number : 05/MEN/1996
Criteria No. T A

4 5

= Conformance = Non Conformance

No. 6.3.

Elements and Sub Elements criteria ( Permenaker No.05/MEN/1996, Attachment-II ) Selection and Placement of Personnel Certain duties requirement including health requirement identitied and used to select and placement for manpower Assigment of work should be based upon capability and skill level who have been owned by respective mapower. Scope of Work Company perform the evaluation of scope of work to know the regions required the limitation of incoming permit. There control on places with limitation of incoming permit Facilities and service is available in the standard and technical guidance. Signs on safety and emergency door sign should is installed according to standard and technical guidance. Maintaining, Repairmeent and Alteration on Product Facility. Scheduling of examination and maintaining of production facility and equipment including safety tools verification and requirement determined by legislation, standard technical guidance. all notes containing detailed data of activity of examination, maintaining, correction and alterations performed on workplace should be kept and maintained.

Audit Finding Items

S/C

Finding TS/NC Mjr Mnr

Verification

75

6.3.1

6.3.1

6.3.1

76

6.3.2

6.3.2

6.3.2

6.3.2

6.4. 77 6.4.1

6.4.1

6.4.1

6.4.1

78 79

6.4.2 6.4.3

6.4.2 6.4.3

6.4.2 6.4.3

6.4.2 6.4.2

80

6.4.4

6.4.4

6.4.4

6.4.4

6.5.

81

6.5.1

6.5.1

6.5.1

82

6.5.2

6.5.2

6.5.2

6.5.2

Note : S : Sesuai / C : Conformance, TS : Tidak Sesuai / NC : Non Conformance

Page - 11of 21 I T A Item No. 83 = Initial ( Small ) = Transition ( Medium ) = Advance ( Big )

Audit Check List The Management System of Occupational Safety and Health (SMK3) Regulation of Minister of Manpower Number : 05/MEN/1996
Criteria No. T A 6.5.3 6.5.3

4 5

= Conformance = Non Conformance

No. 6.5.3

Elements and Sub Elements criteria ( Permenaker No.05/MEN/1996, Attachment-II ) Production facility should registered that it has a valid certificate. Treatment, repairment and each alterations should be performed by competent personnel. If possibly, production facility shall be modified should under effective legislation requirement. There is maintaining demand procedure including condition on equipments with not good safety condition and need immediately to be repaired soon. There is any signing system for equipment which is already unsafely if it is used or unusable anymore If required, it performed the application of lock out system to prevent that production facility not swicth on anymore. Procedure for status signing to secure that production equipment in safely condition to be operated. Service If company contracted to provide a service under the standard and occupational safety and health law, that it is neccesary arrange procedure to secure that sevice meet the requirement.

I 6.5.3

Audit Finding Items

S/C

Finding TS/NC Mjr Mnr

Verification

84

6.5.4

6.5.4

6.5.4

6.5.4

85

6.5.5

6.5.5

6.5.5

86

6.5.6

6.5.6

6.5.6

6.5.6

87

6.5.7

6..5.7 6.5.7 6.5.8 6.5.8

6.5.7 6.5.8

88

6.5.8

89

6.5.9

6.5.9

6.5.9

6.6. 90 6.6.1

6.6.1

6.6.1

91

It company is given a service through contract and ser6.6.2 vice under the standard and occupational safety and health legislation, that it is neccesary arranged the procedure to secure that providing service meet the requirement. Note : S : Sesuai / C : Conformance, TS : Tidak Sesuai / NC : Non Conformance

6.6.2

6.6.2

Page - 12 of 21 I T A Item No. = Initial ( Small ) = Transition ( Medium ) = Advance ( Big )

Audit Check List The Management System of Occupational Safety and Health (SMK3) Regulation of Minister of Manpower Number : 05/MEN/1996
Criteria No. T A

4 5

= Conformance = Non Conformance

No. 6.7.

Elements and Sub Elements criteria ( Permenaker No.05/MEN/1996, Attachment-II ) Readiness for Handling Emergency Potential emergency (inside or outside workplace) have been identified and emergency procedure have been documented. Emergency procedure is tested and reviewed routinely by competent officer. Manpower get instruction and training on emergency procedure in accordance with risk level. Emergency handling officer is given a special training Emergency instruction and relate to emergency is shown clearly/bold and known by all company's employees. Tool and emergency dangerous sign system is checked, tested and maintained periodically. Suitability, placement and convinence to get emergency tool have been evaluated by competent officer. First Aid for Accident Company have evaluated of PPPK tool and secure that PPK system available meet standard and technical guidance is effective. PPPK officer have been trained and designated under legislation. MONITORING STANDARD

Audit Finding Items

S/C

Finding TS/NC Mjr Mnr

Verification

92

6.7.1

6.7.1

6.7.1

6.7.1

93

6.7.2

6.7.2

6.7.2

94

6.7.3

6.7.3

6.7.3

6.7.3

95 96

6.7.4 6.7.5

6.7.3 6.7.5

6.7.3 6.7.5

6.7.3 6.7.5

97

6.7.6

6.7.6

6.7.6

98

6.7.7

6.7.7

6.7.7

6.8. 99 6.8.1

6.8.1

6.8.1

6.8.1

100 6.8.2

6.8.2

6.8.2

6.8.2

Note : S : Sesuai / C : Conformance, TS : Tidak Sesuai / NC : Non Conformance

Page - 13 of 21 I T A Item No. = Initial ( Small ) = Transition ( Medium ) = Advance ( Big )

Audit Check List The Management System of Occupational Safety and Health (SMK3) Regulation of Minister of Manpower Number : 05/MEN/1996
Criteria No. T A

4 5

= Conformance = Non Conformance

No. 7.1.

Elements and Sub Elements criteria ( Permenaker No.05/MEN/1996, Attachment-II ) Dangerous examination Workplace inspection and method of work is performed regularly. Inspection is executed together by assistant manager and reprensent of manpower who have obtained training on the identification of potential dangerous. Inspection seek some inputs from officer who implementing duties in the workplace to be checked. Check list of workplace have arranged to be used during inspection. Inspection report is submitted to manager and P2K3 in according to demand. Corrective action is monitored to determine its effectiveness. Scope of Work Monitoring The workplace environment monitoring is performed regularly and it result is recorded and maintained. The working environment monitoring including physical, chemical, biology, radiation and phychological. Inspection Equipment, Measurement and Testing

Audit Finding Items

S/C

Finding TS/NC Mjr Mnr

Verification

101 7.1.1

7.1.1

7.1.1

7.1.1

102 7.1.2

7.1.2

7.1.2

103 7.1.3

7.1.3

7.1.3

104 7.1.4

7.1.4

7.1.4

105 7.1.5

7.1.5

106 7.1.6

7.1.6

7.2. 107 7.2.1

7.2.1

7.2.1

7.2.1

108 7.2.2

7.2.2

7.2.2

7.2.2

7.3. 109 7.3.1

There is a sysstem documented on identification, calibra tion, maintaining and violance for check up tools, measure and testing concering health and safety. Note : S : Sesuai / C : Conformance, TS : Tidak Sesuai / NC : Non Conformance

7.3.1

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Audit Check List The Management System of Occupational Safety and Health (SMK3) Regulation of Minister of Manpower Number : 05/MEN/1996
Criteria No. T A 7.3.2

4 5

= Conformance = Non Conformance

No.

Elements and Sub Elements criteria ( Permenaker No.05/MEN/1996, Attachment-II ) Tool is maintained and calibrated by competent officer. Health Monitoring. According to legislation, manpower health employing in the workplace containing dangerous should be monitored Company have identify condition where general check up need to be performed and have perform the system to assist this check up. General check up is performed by physician designated under legislation. Company provide an occupational health service under legislation. Record on health monitoring is made under legislation REPORTING AND IMPROVEMENT FOR DEFICIENCY. Emergency Reporting There is a procedure for dangerous resource report and personnel need to be informed on dangerous resources report process of occupational safety and health. Incident Report. There is documented procedure which secure that all accidents and disease cause of work and incident in the workplace is reported.

Audit Finding Items

S/C

Finding TS/NC Mjr Mnr

Verification

110 732 7.4. 111 7.4.1

7.4.1

7.4.1

112 7.4.2

7.4.2

7.4.2

113 7.4.3

7.4.3

7.4.3

7.4.3

114 7.4.4

7.4.4

7.4.4

7.4.4

115 7.4.5 8 8.1. 116 8.1.1

7.4.5

7.4.5

7.4.5

8.1.1

8.1.1

8.1.1

8.2. 117 8.2.1

8.2.1

8.2.1

Note : S : Sesuai / C : Conformance, TS : Tidak Sesuai / NC : Non Conformance

Page - 15 of 21 I T A Item No. = Initial ( Small ) = Transition ( Medium ) = Advance ( Big )

Audit Check List The Management System of Occupational Safety and Health (SMK3) Regulation of Minister of Manpower Number : 05/MEN/1996
Criteria No. T A 8.2.2 8.2.2

4 5

= Conformance = Non Conformance

No.

Elements and Sub Elements criteria ( Permenaker No.05/MEN/1996, Attachment-II ) Accident and disease cause of work is reported as determined by legislation. Occupational Accident Investigation. Company have a procedure for accident investigation and disease caused of work being reported. Investigation and prevention of occupational accident is performed by the officer or K3 expert who has been trained. Investigation report contained suggestion and schedule implementing corrective effort. Responsibility is given to officer designated to implement corrective action relating to investigation report. Corrective action is discussed with manpower in the place of occurred accident. Effectiveness corrective actions is monitored. Handling problem.

I 8.2.2

Audit Finding Items

S/C

Finding TS/NC Mjr Mnr

Verification

118 8.2.2

8.3. 119 8.3.1

8.3.1

8.3.1

8.3.1

120 8.3.2

8.3.2

8.3.2

121 8.3.3

8.3.3

122 8.3.4

8.3.4

123 8.3.5

8.3.5

8.3.5

124 8.3.6 8.4. 125 8.4.1

8.3.6

There is procedure to handle the problem of occupational 8.4.1 safety and health issue and pursuant to legislation. Manpower is given information on handling problem of occupational safety and health and receive the information of its completion progress. MATERIAL MANAGEMENT AND ITS TRANSFER. 8.4.2

8.4.1

8.4.1

126 8.4.2

8.4.2

8.4.2

Note : S : Sesuai / C : Conformance, TS : Tidak Sesuai / NC : Non Conformance

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Audit Check List The Management System of Occupational Safety and Health (SMK3) Regulation of Minister of Manpower Number : 05/MEN/1996
Criteria No. T A

4 5

= Conformance = Non Conformance

No. 9.1.

Elements and Sub Elements criteria ( Permenaker No.05/MEN/1996, Attachment-II ) Manually and Mechanically Handling. There is a procedure to identify potential dangerous and to evaluate the risk related to manually and mechanically handling. Identification and evaluation are executed by competent officer. Company applies and reviews the method of risk control related to manually and mechanically handling. Procedure for handling material including prevention method of damage, spilling and leackage. Transportation, Storage and Disposal Systems. There is the procedure securing that material stored and transferred by safely method under the valid legislation. There is the procedure describing the requirement of material control which may broken and out of date. There is the procedure to secure that material is throw out by safely method under the legislation. Dangerous Materials. Company have document the procedure concerning violance, handling and transfer of dangerous goods under the legislation, standard and technical guidance requirements.

Audit Finding Items

S/C

Finding TS/NC Mjr Mnr

Verification

127 9.1.1

9.1.1

9.1.1

9.1.1

128 9.1.2

9.1.2

9.1.2

9.1.2

129 9.1.3

9.1.3

9.1.3

130 9.1.4

9.1.4

9.2. 131 9.2.1

9.2.1

9.2.1

9.2.1

132 9.2.2

9.2.2

133 9.2.3

9.2.3

9.2.3

9.2.3

9.3. 134 9.3.1

9.3.1

9.3.1

9.3.1

Note : S : Sesuai / C : Conformance, TS : Tidak Sesuai / NC : Non Conformance

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Audit Check List The Management System of Occupational Safety and Health (SMK3) Regulation of Minister of Manpower Number : 05/MEN/1996
Criteria No. T A 9.3.2 9.3.2

4 5

= Conformance = Non Conformance

No.

Elements and Sub Elements criteria ( Permenaker No.05/MEN/1996, Attachment-II ) Data sheet for comprehensive Material Safety for dangerous material should simple be obtained. There is a system to identity and giving lable to dangerous materials. Warning sign attached under the requirement of legislation and valid standard. There is the procedure documented on handling for safe dangerous materials. Officer who is handling dangerous materials is given training on safely handling method. COLLECTING AND USING DATA Occupational Safety and Health Record.

I 9.3.2

Audit Finding Items

S/C

Finding TS/NC Mjr Mnr

Verification

135 9.3.2

136 9.3.3

9.3.3

9.3.3

9.3.3

137 9.3.4

9.3.4

9.3.4

9.3.4

138 9.3.5

9.3.5

9.3.5

139 9.3.6

9.3.6

9.3.6

10 10.1.

140 10.1.1 Company have the procedure to identify, collect, file, maintain and store notes of occupational safety and health. 141 10.1.2 Law, regulation, standard and technical guidance relevant to maintained at the place easy to be reached. 142 10.1.3 There is a procedure determined the requirement to keep confidential records. 143 10.1.4 Records concerning review and check up is maintained 144 10.1.5 Records for occupational accident compensation and rehabilitation is maintained.

10.1.1 10.1.1 10.1.1

10.1.2 10.1.2 10.1.2

10.1.3 10.1.3

10.1.4 10.1.5 10.1.5

Note : S : Sesuai / C : Conformance, TS : Tidak Sesuai / NC : Non Conformance

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Audit Check List The Management System of Occupational Safety and Health (SMK3) Regulation of Minister of Manpower Number : 05/MEN/1996
Criteria No. T A

4 5

= Conformance = Non Conformance

No. 10.2.

Elements and Sub Elements criteria ( Permenaker No.05/MEN/1996, Attachment-II ) Data and Report of Occupational Safety and Health.

Audit Finding Items

S/C

Finding TS/NC Mjr Mnr

Verification

145 10.2.1 Data for latest occupational safety and health. collective. 146 10.2.2 Routine Report of occupational safety and health performance and is made and disseminated within company 11 11.1. MANAGEMENT SYSTEM AUDIT OF K3. Management System Internal Audit of K3

10.2.1 10.2.1

10.2.2

147 11.1.1 Management system Audit of K3 scheduled is performed to examine the adjustment and to determine, what the activity is effective. 148 11.1.2 Management System Internal Audit of K3 is performed by competent officer and independent in company. 149 11.1.3 Audit report is distributed to management and other officer concerned. 150 11.1.4 Deficiency founded during audit prioritied an monitored to secure its implemented corrective action. 12 12.1 DEVELOPING OF SKILL AND CAPABILITY. Training Strategy

11.1.1

11.1.2

11.1.3

11.1.4

151 12.1.1 Training demand analysis including the requirement of occupational safety and have been performed.

12.1.1

152 12.1.2 Training plan of occupational safety and health have 12.1.2 12.1.2 arranged for all levels in companies. Note : S : Sesuai / C : Conformance, TS : Tidak Sesuai / NC : Non Conformance

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Audit Check List The Management System of Occupational Safety and Health (SMK3) Regulation of Minister of Manpower Number : 05/MEN/1996
Criteria No. T A 12.1.3 12.1.3

4 5

= Conformance = Non Conformance

No.

Elements and Sub Elements criteria ( Permenaker No.05/MEN/1996, Attachment-II )

Audit Finding Items

S/C

Finding TS/NC Mjr Mnr

Verification

153 12.1.3 Training should consider the defference of capability level and educational background. 154 12.1.4 Training is performed by person or body who have capabality and adequate experience and accredited by valid legislation. 155 12.1.5 There is facility and resource are available for the implementation of effective training. 156 12.1.6 Company documented and stored record all training. 157 12.1.7 Evaluation is performed for each training sessions to secure the increase continually. 158 12.1.8 Training program is reviewed regularly to secure that remain is relevant and effective. 12.2. Training for Management and Supervisor.

12.1.4 12.1.4

12.1.5 12.1.5

12.1.6 12.1.6 12.1.7

12.1.8

159 12.2.1 Executive management member and manager participate in training including the explanation on law obligatory and principles and implementation of occupational safety and health. 160 12.2.2 Manager and supervisor receive training under the their role and responsibility. 12.3. Training for Manpower

12.2.1 12.2.1 12.2.1

12.2.2 12.2.2 12.2.2

161 12.3.1 Training is given to all manpowers including a new manpower and mutationed that they can implement their duties in safely

12.3.1 12.3.1 12.3.1

Note : S : Sesuai / C : Conformance, TS : Tidak Sesuai / NC : Non Conformance

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Audit Check List The Management System of Occupational Safety and Health (SMK3) Regulation of Minister of Manpower Number : 05/MEN/1996
Criteria No. T A

4 5

= Conformance = Non Conformance

No.

Elements and Sub Elements criteria ( Permenaker No.05/MEN/1996, Attachment-II )

Audit Finding Items

S/C

Finding TS/NC Mjr Mnr

Verification

162 12.3.2 Training is given to all manpowers it in their workplace happened any alteration for production facilities or process 163 12.3.3 If applicable, it is given refreshing training to all employees. 12.4. Training for Introduction for Visitor and Contractor

12.3.2 12.3.2 12.3.3

164 12.4.1 Company have orientation program for all manpowers with policy material input and occupational safety and health procedure. 165 12.4.2 There is the procedure determined the requirement to present briefing to visitors and partners for secure the safety and health. 12.5. Training for Special skill.

12.4.1 12.4.1 12.4.1

12.4.2 12.4.2

166 12.5.1 Company have system to secure discipline of the requirement license or qualification pursuant to legislation to implemented the work or to operate the equipment.

12.5.1 12.5.1 12.5.1

Note : S : Sesuai / C : Conformance, TS : Tidak Sesuai / NC : Non Conformance