Preliminary Checklist: No Name Position Email Phone/Mobile
Preliminary Checklist: No Name Position Email Phone/Mobile
2. Contact Persons
No Name Position Email Phone/Mobile
1. Herfian ISO & Business [email protected] 082111365601
Wijaya Proccess Spv
2. Nursanti Office & Facility [email protected]
Akbar Manager
3.
3. EMPLOYEES
Education Age
No. Function Number
<SLA D3 S1 >S1 <35 ≥35
Organic
1 Board of Director
2 GM
3 Senior Manager
4 Junior Manager
5 Staff (office)
6 Staff (Site)
Unorganic / Contractor
1 ................
2 ................
TOTAL
4. Products/Services
No Product/Services/Activities Remarks
1. Authorized Distributor of Heavy Equpment
Item Q H S E Remarks
Policy ☐≥ 50% ☐≥ 50% ☐≥ 50% ☐≥ 50%
☐< 50% ☐< 50% ☐< 50% ☐< 50%
☐N/A ☐N/A ☐N/A ☐N/A
Objective ☐≥ 50% ☐≥ 50% ☐≥ 50% ☐≥ 50%
☐< 50% ☐< 50% ☐< 50% ☐< 50%
☐N/A ☐N/A ☐N/A ☐N/A
Manual ☐≥ 50% ☐≥ 50% ☐≥ 50% ☐≥ 50%
☐< 50% ☐< 50% ☐< 50% ☐< 50%
☐N/A ☐N/A ☐N/A ☐N/A
Aspect Impact / ☐≥ 50% ☐≥ 50% ☐≥ 50% ☐≥ 50%
Hazard Identification ☐< 50% ☐< 50% ☐< 50% ☐< 50%
☐N/A ☐N/A ☐N/A ☐N/A
Programs ☐≥ 50% ☐≥ 50% ☐≥ 50% ☐≥ 50%
☐< 50% ☐< 50% ☐< 50% ☐< 50%
☐N/A ☐N/A ☐N/A ☐N/A
Procedure ☐≥ 50% ☐≥ 50% ☐≥ 50% ☐≥ 50%
☐< 50% ☐< 50% ☐< 50% ☐< 50%
☐N/A ☐N/A ☐N/A ☐N/A
Work Instruction ☐≥ 50% ☐≥ 50% ☐≥ 50% ☐≥ 50%
☐< 50% ☐< 50% ☐< 50% ☐< 50%
☐N/A ☐N/A ☐N/A ☐N/A
Form-form ☐≥ 50% ☐≥ 50% ☐≥ 50% ☐≥ 50%
☐< 50% ☐< 50% ☐< 50% ☐< 50%
☐N/A ☐N/A ☐N/A ☐N/A
Record implemention ☐≥ 50% ☐≥ 50% ☐≥ 50% ☐≥ 50%
system ☐< 50% ☐< 50% ☐< 50% ☐< 50%
☐N/A ☐N/A ☐N/A ☐N/A
Applicable Code/ ☐≥ 50% ☐≥ 50% ☐≥ 50% ☐≥ 50%
Identification/ ☐< 50% ☐< 50% ☐< 50% ☐< 50%
Specification
Head Office/
No Branch/ Unit/Section Location/Address Remarks
Site/Plant
...........................
(. . . . . . . . . . . . . . . . . . . . . . . . . .) (. . . . . . . . . . . . . . . . . . . . . . . . . .)
Client Consultant/Marketing
Note:
Please attach:
- The company profile
- The organization structure & scope of organization will be developed/implemented
- Picture of the company's business processes in general