DAFTAR PROSEDUR DAN FORM

No. Dok: Form/CR-03/03

No No Prosedur No Prosedur NEW No. Form No. Form NEW

1 HR-01
Form/HR-01/01-01
Form/HR-01/01-02
Form/HR-01/01-03
Form/HR-01/02
Form/HR-01/03
Form/HR-01/04
2 HR-02
Form/HR-02/01
Form/HR-02/01a
Form/HR-02/01b
Form/HR-02/02
Form/HR-02/03
Form/HR-02/03
Form/HR-02/04
Form/HR-02/05
Form/HR-02/06
Form/HR-02/07
Form/HR-02/08
Form/HR-02/09
Form/HR-02/10
Form/HR-02/11
3 HR-03
4 HR-04
Form/HR-04/01
Form/HR-04/02
Form/HR-04/03
Form/HR-04/04
Form/HR-04/05
Form/HR-04/06
5 HR-04-01
Form/HR-04-01/01
Form/HR-04-01/02
6 HR-04-02
Form/HR-04-02/01
7 HR-04-03 Pros/HR-04-02
HR-04-04
Form/HR-04-04/01
HR-04-05
HR-04-06
Form/HR-04-06/01
Form/HR-04-06/02
8 HR-05
HR-05-01
HR-05-02
Form/HR-05/01
HR-05-03
Form/HR-05-03/01
HR-05-04
HR-05-05
HR-05-06
9 HR-06
Form/HR-06/01
Form/HR-06/02
Form/HR-06/03
No No Prosedur No Prosedur NEW No. Form No. Form NEW
Form/HR-06/04
Form/HR-06/05
Form/HR-06/06
Form/HR-06/07
Form/HR-06/08
10 HR-06-01
11 HR-07
Form/HR-07/01
HR-07-01 Pros/HR-07-03
12
Form/HRD-07-03/01
Form/HRD-07-03/02
Form/HR-07-01/01 Form/HRD-07-03/03
Form/HRD-07-03/04
13 HR-07-02
Form/HR-07-02/01
Form/HR-07-02/02
14 HR-07-03
Form/HR-07-03/01
Form/HR-07-03/02
HR-07-04
HR-07-05
Form/HR-07-05/01
15 HR-08
Form/HR-08/01
Form/HR-08/02
Form/HR-08/03
Form/HR-08/04
16 HR-08-01
Form/HR-08-01/01
Form/HR-08-01/01-01
Form/HR-08-01/02
Form/HR-08-01/02a
Form/HR-08-01/02b
Form/HR-08-01/03
Form/HR-08-01/04
Form/HR-08-01/04
Form/HR-08-01/05
Form/HR-08-01/06
Form/HR-08-01/07
Form/HR-08-01/08
Form/HR-08-01/09
Form/HR-08-01/10
HR-08-02
HR-09
HR-09-01
HR-09-02
HR-09-03
HR-10
HR-10-01
AFTAR PROSEDUR DAN FORM

Nama Prosedur/Form

Man Power Planning

Production Manpower Request
Non Production Manpower Request
Buffer Manpower Request
Manpower Planning Form
Job Description Form
Job Analysis
Rekrutmen, Seleksi, dan Penempatan Karyawan
Application Form
Application Form for Staff
Application form in job fair
Interview Result
Psycho test
Psycho test a
Employee Contract
……
Statement Letter
User Tes Result
Induction Sheet
MCU Letter
Staff up Recrutment Approval Form
Pass Verification
Pengurusan Ijin Tenaga Kerja Asing
Pelayanan Administrasi Kepersonaliaan
Exit Interview
Catatan Pembinaan Karyawan
Form Dinas Luar
Form Dinas Luar Negeri
Form Pengunduran diri
Employee Resignation Form (for Manager level)
Pengambilan Cuti
Kartu Absensi
Form izin tidak dibayar
Pengendalian Waktu Kerja Saat Over Time
Voluntary OT
Pemutusan Hubungan Kerja
Prosedur Permintaan Seragam
Form Permintaan Seragam
Prosedur Pengunduran Diri
Prosedur Perubahan Shift
Form Kerja Shift
Form Permohonan Penyediaan Makan
Pembelian & Pengadaan Barang
Pengelolaan Kamera Digital
Permintaan Sepatu B-Grade
Material Request Form
Pengurusan Keluar Masuk Karyawan dan Barang
Checklist Standard Security
Penerimaan Paket dan Barang
Serah Terima Kunci
Prosedur Aliran SPM
Pelatihan Karyawan
Training Matrix
Multi-Function Worker Training Plan
Attendance List
 Nama Prosedur/Form
Training/Socialization Report
External Training Submission Form
Flowchart Ijin Pemakaian Ruang Training
Training Plan
Training Agreement
Balai Latihan Kerja
Komunikasi
Employee questionaire
Keluhan dan Saran

Form Keluhan
Kuesioner Pre-Investigasi
Monthly Grievance
CPA
LKS Bipartit
List of LKS Bipartit Members
Minute of Meeting LKS Bipartit
P2K3L
List of P2K3L Members
Minute of Meeting P3K3L
Penerimaan Tamu
Pembinaan Karyawan
Form SP
Pelaksanaan Evaluasi Kinerja
Non Staff Evaluation Form
Staff Evaluation Form
Post Test Pasca Probation
Team Leader Evaluation
Promosi dan Mutasi
Form Promosi
Form Profil Individu
Form Perubahan gaji (idem)
Form Perubahan gaji pass probation (idem)
Form Perubahan gaji per dept (idem)
Mutation Form
Testing for Supervisor promotion level-English
Testing for Supervisor promotion level-CoC
Internal Interview Report
Internal Recruitment Request
Promosi dalam MasaTraining
Form Usulan Perubahan Job Grade
Job Grade Guidelines
Revisi Perubahan Jobgrade
Penugasan Antar Group
Keamanan
Memasuki Restrictied Area
Pemantauan Catatan Kepolisian
Penanganan Gangguan Keamanan
Comben
Jaminan Pelayanan Kesehatan
BUSINESS PROCESS NO. PROSEDUR NO. PROSEDUR NO. REVISI
NAMA PROSEDUR
(INDUK) (TURUNAN) 0 1 2 3 4 5
MANAGEMENT Pros/MR-01 Mgmnt Review 3
REVIEW (MR) Corp.

n Pros/EHS-01 TS Identifikasi & Evaluasi Aspek Dampak K3L 3

(Hazard Identification Risk Assesment) Corp.
Evaluasi Perundangan & Persyrtn Lainnya
Pros/ESH-02 TS 4
(Evaluation Legislation & Other Requirement) Corp.
Pros/ESH-03 pH Promosi Kesehatan 2
(Health Promotion) Corp.
EAP
Pros/ESH-04 TS 2
(Employee Assistance
Pengendalian Dokumen Pragram) Corp.
Pros/ESH-05 TS 1
(Control of Document) Corp.
Pros/ESH-06 SAM Limbah B3 2
(Hazardous Waste)
Kontrol Energi Corp./ LOTO
Berbahaya
Pros/ESH-07 WDP 2
(Control of Hazardous Energy) Corp.
Pros/ESH-07-01 WDP 2
Keselamatan Kerja Kelistrikan
(Electrical Safety) Corp.
Pros/ESH-07-02 WDP Keselamatan Pemeliharaan 2
(Maintenance Safety)
Pros/ESH-07-03 WDP 2
Link. Kerja Umum
(General Work Environment) Corp.
Pros/ESH-07-04 Management Lalulintas & Kendaraan 2
(Trafic Vehicle Management)
Pros/ESH-07-05 WDP Keselamatan Laser 0
(Laser Safety)
Pros/ESH-07-06 WDP Silinder Gas Bertekanan 0
(Cylinder Gas Pressure)
Sistem Mnjmn KesehatanCorp.
Kerja
Pros/ESH-08 PH 2
(Occupational Health Mgnt Sytem) Corp.
TB Program 2
Pros/ESH-08-01 PH
Corp.
Wanita Hamil
Pros/ESH-08-02 TS 1
(Pregnant Women) Corp.
Pros/ESH-09 Alat Pelindung Diri - PPE 2
(Personal
PengamanProtective
Mesin Equipment) Corp.
Pros/ESH-10 WDP 2
(Machine Guarding) Corp.
Pros/ESH-11 WDP Perlindungan Kerja di Ketinggian 3
(Fall Protection) Corp.
Pros/ESH-12 PH Penyakit Akibat Kerja 2
(Injuri Illness Mgnt System) Corp.

Chemical Mngmnt Program

Pros/ESH-13 PH 1
Corp.
Pros/ESH-14 PH Paparan Kebisingan di Lokasi Kerja 2
(Occupational Noise Expossure) Corp.
Pros/ESH-15 PH Mgnt Tekanan Panas 2
(Heat Stress Management) Corp.
Pros/ESH-15-01 PH 2
Aklimatisasi
Ergonomic Program
Pros/ESH-16 2
Corp.
Pros/ESH-17 WDP Kerja di Ruang Terbatas 3
(Confined Space)
Infection Control
Pros/ESH-18 pH 2
Corp.
Blood Borne Pathogen
Pros/ESH-18-01 PH 2
Corp.
Pros/ESH-18-02 PH HIV AIDS
2
Corp.
Pros/ESH-19 Manajemen Keselamatan Kebakaran 2
(Fire Safety Management) Corp.
Pros/ESH-19-01 WDP Ijin Kerja dgn Api 1
(Hot Work Permit)
Pros/ESH-20 Kesiap Siagaan & Tanggap Darurat

Pros/ESH-20-01 WDP Pengendalian Keadaan Darurat Kebakaran 2

Corp
Pros/ESH-20-02 Tanggap Darurat Kecelakaan, Sakit & Keracunan 1
Corp.
Pros/ESH-20-03 SAM ESH-20-03 Tumpahan Bahan Kimia 2
(Spills Of Chemical) Corp.
Pros/ESH-20-04 WDP Tanggap Darurat Gempa Bumi 2
Corp.
Pros/ESH-20-05 Penanganan Gangguan Keamanan 1
Corp.
Pros/ESH-20-06 WDP Tanggap Darurat Banjir 1
Corp.
Pros/ESH-20-07 Tanggap Darurat Mobil Ambulance 2
Corp.
Pros/ESH-20-08 PH Triage 1 2
Corp.
 Pros/ESH-20-09 Tanggap Darurat Flu Burung 1
Corp.
Pros/ESH-20-10 PH P3K 2
Corp.
Pros/ESH-20-11 PH Tanggap Darurat Angin Ribut 1
Corp.
Pros/ESH-20-12 MASIH KOSONG
Pros/ESH-20-13 PH Tanggap Darurat Flu Babi 1
(Influenza A - H1N1) Corp.
Pros/ESH-20-14 PH Penanganan Hysteria Massal 2
Corp.
Pros/ESH-21 Pemantauan Pengukuran 2
(Occupational Exposure Limit) Corp.
Pros/ESH-21-01 Pngukurn Kbsngn Link Krj Dosis Personel
(Eccupational Noise Exsposure) Corp.
Pros/ESH-21-02 PH Pengukuran Tekanan Panas 2
(HEAT STRESS) Corp.
Pros/ESH-21-03 PH Pengukuran Sinar Ultra Violet 2
(Measurement of Ultraviolet) Corp.
Pros/ESH-21-04 PH Pengukuran Getaran di Link Krj 2
(Vibration Measurements The Work) Corp.
Pros/ESH-21-05 PH Pengukuran Kadar Bhn Kimia di Udara Lingk Krj 2
(Air Quality Monitoring) Corp.
Pros/ESH-21-06 PH 1
Biological Biomonitoring
Pros/ESH-21-07 Ph Pengukuran Kadar Debu Total Debu Respirable 2
(Measurement of Dust) Corp.
Pros/ESH-21-08 PH Pengukuran Air minum Air bersih 1
(Measurement of Drinking Water & Clean Water)
Pros/ESH-21-09 PH Pengukuran Iluminasi 2
(Measurement of Illumination) Corp.
Pros/ESH-21-10 SAM Asbestos 2
Corp.
Pros/ESH-21-11 WDP Radiasi 2
(Radiation) Corp.
Pros/ESH-21-12 PH Pengukuran Ventilasi 2
Measurement of Ventilation) Corp.
Pros/ESH-22 2
Ktdkssian Tndkn Prbkn & Pencghn
(Nonconformity, Prevention & Corrective Action) Corp.
Pros/ESH-23 WDP Investigasi & Pelaporan Kecelakaan Kerja 5
(Acident Investigation and Reporting) Corp.
Pros/ESH-23-01 WDP Latihan Observasi Optimalisasi Keselamatan_LOOK_BBS 0
(Behavior Base Safety) Corp.
Pros/ESH-24 Pengendalian Catatan 2
(Record Control) Corp.
Pros/ESH-25 Audit Internal 3
(Internal Audit) Corp.
Pros/ESH-25-01 PH Pengelolaan Kantin 1
(Canteen Management) Corp.
Pros/ESH-26 TS Pelecehan Perlakuan Tidak Layak 3
Harrasment & Abuse Corp.
Pros/ESH-27 SAM Tangki Penyimpanan 0
(Storage Tanks)
Pros/ESH-28 SAM Bahan Berbahaya 0
(Hazardous Material) Corp.
Pros/ESH-29 SAM Limbah Padat 0
(Solid Waste)
Pros/ESH-29-01 SAM Pengembalian Scraps ke Vendor 0
(Scrap Return to Vendor) Corp.
Pros/ESH-30 SAM Emisi Udara 0
(Air Emissions)
Pros/ESH-31 SAM PCB 0
(Polychlorinated Biphenyls) Corp.
Pros/ESH-32 SAM Pengelolaan Sampah Domestik 0
(Domestik Waste) Corp.
Pros/ESH-33 SAM Limbah Cair 0
(Waste Water ) Corp.
Pros/ESH-34 PH Perlindungan Pernafasan 0
(Respiratory Protection)
CORPORATE Pros/CR-01
RESPONSIBILITY
Pros/CR-02
Penyusunan MPP
(Man Power Planning) Corp.
Rekruitment, Hiring & Personal Development
Corp.
Rekruit & Evaluasi Performance Tenaga Kerja Asing
(Recruitment and Performance Evaluation for Expat) Corp.
Pengurusan Izin Penggunaan Tenaga Kerja Asing
(Working Permit for Expat) Corp.
Pelayanan Administrasi Kepersonaliaan
(HR Administration) Corp.
Permintaqan Sepatu
(Shoes Requaest)
Pemutusan Hubungan Kerja
(Mass Termination) Corp.
Promosi
(Promotion) Corp
Pengajuan & Pelaksanaan Lembur
(Overtime Implementation)
Pengambilan Cuti
(Taking Leave) Corp.
Demosi
(Demotion) Corp.
Penugasan Antar Group
(Assignment Within Group) Corp.
Pemberitahuan Surat Teguran & Surat Peringatan
Corp.
Pembelian & Pengadaan Barang
(Purchasing & Procurement)
Pengelolaan Camera Digital
(Mgnt of Camera Digital) Corp.
Penghapusan Penghancuran Sepatu
(ShoesComponent Removal)
Pengamanan Keluar Masuk Krywn & Barang
(Check in/out Management for Employess and Goods)
Penerimanaan Surat, Paket, & Barang
(Receiving Packages and Goods)
Serah Terima Kunci
(Key Handover)
Pelatihan Karyawan
(Employee Training) Corp.

Training Centre
Komunikasi Ekternal Internal
(External / Internal Comunication) Corp.

P2K3L

Peminjaman Kendaraan Perusahaan

Keluhan dan Saran Baru

(Complaints and Suggestions) Corp.
Lembaga Kerjasama LKS Bipartit
(Bipartite LKS - Teamwork Training) Corp.
Penerimaan Tamu
(Reception)
Pelaksanaan Evaluasi Kinerja
(Performance Management) Corp.
Penanganan Gangguan Keamanan
(Security) Corp.
Izin Memasuki Restricted Area
(Entering Restrictied Area)
Pemantauan Catatan Kepolisian
 NIKE CODE LEADERSHIP STANDARD

NO. CLS CODE

1 LABOUR ( M )
1 Employment is Voluntary ( Kerja Tanpa Paksaan ) CLS-M-01
2 Employees Are at Least Age 16 ( Karyawan Berusia 16 Thn Atau Lebih ) CLS-M-02
3 Contractor Does Not Discriminate ( Kontraktor Tidak Diskriminatif ) CLS-M-03
4 Freedom Of Association ( Kebebasan Berserikat ) CLS-M-04
5 Compensation Is Timely Paid ( Konpensasi Dibayar Tepat Waktu ) CLS-M-05
6 Harassment/Abuse Not Tolerated ( Pelecehan / Kekerasan Tidak Diperbolehkan ) CLS-M-06
7 Working Hours Are Not Excessive ( Jam Kerja Tidak Berlebihan ) CLS-M-07
8 Regular Employment ( Ketentuan Kerja Reguler ) CLS-M-08
9 Implementation ( Penerapan ) CLS-M-09

2 HSE - PUBLIC HEALTH ( PH )

1 Occupational Health Management (Manajemen Kesehatan Kerja) CLS-PH-01
2 Sanitation (Sanitasi) CLS-PH-02
3 Drinking Water (Air Minum) CLS-PH-03
4 Dormitory Management ( Pengelolaan Asrama ) CLS-PH-04
5 Canteen Management (Manajemen Kantin ) CLS-PH-05
6 Child Care Facility Management (Manajemen Perlindungan Anak) CLS-PH-06
3 HSE - OCCUPATIONAL SAFETY HEALTH ( SH )