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I = Initial ( Small ) Audit Check List T = Transition ( Medium ) The Management System of Occupational Safety and Health (SMK3) 4 = Co A = Advance ( Big ) Regulation of Minister of Manpower Number : 05/MEN/1996 5 = Non Item Elements and Sub Elements criteria Criteria No. Finding No. No. ( Permenaker No.05/MEN/1996, Attachment-II ) I T A Audit Finding Items S/C TS/NC Note : S : Sesuai / C : Conformance, TS : Tidak Sesuai / NC : Non Conformance
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Checklist SMK3[1]. 02

Dec 01, 2014

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Nurcahyo Kusumo
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Page 1: Checklist SMK3[1]. 02

I = Initial ( Small ) Audit Check List T = Transition ( Medium ) The Management System of Occupational Safety and Health (SMK3) 4 = Conformance

A = Advance ( Big ) Regulation of Minister of Manpower Number : 05/MEN/1996 5 = Non Conformance

Item Elements and Sub Elements criteria Criteria No. FindingNo. No. ( Permenaker No.05/MEN/1996, Attachment-II ) I T A Audit Finding Items S/C TS/NC Verification

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

Page 2: Checklist SMK3[1]. 02

Page - 1of 21 Attachment-1/Proc.LPD1-IDP-0008

I = Initial ( Small ) Audit Check List T = Transition ( Medium ) The Management System of Occupational Safety and Health (SMK3) 4 = Conformance

A = Advance ( Big ) Regulation of Minister of Manpower Number : 05/MEN/1996 5 = Non Conformance

Item Elements and Sub Elements criteria Criteria No. FindingNo. No. ( Permenaker No.05/MEN/1996, Appendix-II ) I T A Audit Finding Items S/C TS/NC Verification

Mjr Mnr1 COMMITMENT AND POLICY

1.1 Occupational Safety and Health Policy

1 1.1.1 There is an occupational safety and health policy in 1.1.1 1.1.1 1.1.1

writing, dated and clearly state the objective of occupa- tional safety and health and company commitment in improving the occupational safety & health performance.

2 1.1.2 Policy signed by entrepreneur and or manager. 1.1.2

3 1.1.3 Policy is arranged by entrepreneur and or manager after 1.1.3 1.1.3 by consultation process with representative of worker.

4 1.1.4 Company communicate the occupational safety and 1.1.4 health policy to all workers, visitor, contractors, cus- tomer and supplier with exactly procedure.

5 1.1.5 If required, special policy is arride for problem of spe- 1.1.5 1.1.5 cially occupational safety and health.

6 1.1.6 Occupational safety and health policy and other special 1.1.6 policies are reviewed periodically to secure that they reflect with modification happened in legislation.

1.2 Responsibility and Authority to be Action

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

8 1.2.2 Designation of responsibility of occupational safety and 1.2.2 1.2.2 1.2.2

Page 3: Checklist SMK3[1]. 02

health should pursuant to legislation.Note : S : Sesuai / C : Conformance, TS : Tidak Sesuai / NC : Non Conformance

Page-2 of 21

I = Initial ( Small ) Audit Check List T = Transition ( Medium ) The Management System of Occupational Safety and Health (SMK3) 4 = Conformance

A = Advance ( Big ) Regulation of Minister of Manpower Number : 05/MEN/1996 5 = Non Conformance

Item Elements and Sub Elements criteria Criteria No. FindingNo. No. ( Permenaker No.05/MEN/1996, Attachment-II ) I T A Audit Finding Items S/C TS/NC Verification

Mjr Mnr9 1.2.3 Job unit manager in any company responsible for occu- 1.2.3

pational safety and health performance to their job unit.

10 1.2.4 Company obtain some suggestions from experts in the 1.2.4 1.2.4 1.2.4 occupational safety and health derived from inside and outside the company.

11 1.2.5 Officer who is responsible for handling emergency to get 1.2.5 1.2.5 1.2.5training and is given identity card in order to be recognizeby all people within the company.

12 1.2.6 Occupational safety and health performance entered in 1.2.6 to company annual report or as level as other report.

13 1.2.7 Job unit manager is given information on their responsi- 1.2.7 1.2.7 ble for contractor's manpower and other persons entered work place.

14 1.2.8 Responsibility to maintain and distribute the latest infor- 1.2.8 1.2.8 mation concerning the legislation of occupational safety and health have been determined. System of occupa- tional safety and health is executed.

15 1.2.9 Manager is fully responsible for to secure Management. 1.2.9 1.2.9

1.3 Review and Evaluation

16 1.3.1 Manager should review the implementation of the mana- 1.3.1 gement system of K3 periodically to evaluate suitability and effectiveness of management system of K3.

17 1.3.2 If applicable, review result entered into management 1.3.2 action planning.

Page 4: Checklist SMK3[1]. 02

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

Page-3 of 21

I = Initial ( Small ) Audit Check List T = Transition ( Medium ) The Management System of Occupational Safety and Health (SMK3) 4 = Conformance

A = Advance ( Big ) Regulation of Minister of Manpower Number : 05/MEN/1996 5 = Non Conformance

Item Elements and Sub Elements criteria Criteria No. FindingNo. No. ( Permenaker No.05/MEN/1996, Attachment-II ) I T A Audit Finding Items S/C TS/NC Verification

Mjr Mnr1.4 Involvement and Consultation with Manpower

19 1.4.1 Involving manpower and consultation scheduling with re- 1.4.1 1.4.1 1.4.1 presenting company designated to be documented.

20 1.4.2 It is made a simple procedure for consultation concer- 1.4.2 1.4.2 ning modifications which have the implication of occu- pational safety and health.

21 1.4.3 Pursuant to company legislation have establish of P2K3. 1.4.3 1.4.3 1.4.3

22 1.4.4 Head of P2K3 is manager or top manager. 1.4.4 1.4.4 1.4.4

23 1.4.5 Secretary of P2K3 is an Expert of K3 pursuant to 1.4.5 1.4.5 1.4.5 legislation.

24 1.4.6 P2K3 concentrated to activity for developing policy and 1.4.6 1.4.6 1.4.6 procedure to control the risk.

25 1.4.7 P2K3 held regular meeting and its result is disseminated 1.4.7 1.4.7 1.4.7 in the workplace.

26 1.4.8 P2K3 report their activities regularly according to 1.4.8 1.4.8 1.4.8 legislation.

27 1.4.9 If required. Performed the formation of work groups and 1.4.9 1.4.9 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.

Page 5: Checklist SMK3[1]. 02

28 1.4.10 If work groups have establish, that manpower is given 1.4.10 1.4.10 information on work group structure.

Note : S : Sesuai / C : Conformance, TS : Tidak Sesuai / NC : Non ConformancePage- 4 of 21

I = Initial ( Small ) Audit Check List T = Transition ( Medium ) The Management System of Occupational Safety and Health (SMK3) 4 = Conformance

A = Advance ( Big ) Regulation of Minister of Manpower Number : 05/MEN/1996 5 = Non ConformancePage- 5 of 21

Item Elements and Sub Elements criteria Criteria No. FindingNo. No. ( Permenaker No.05/MEN/1996, Attachment-II ) I T A Audit Finding Items S/C TS/NC Verification

Mjr Mnr2 DOCUMENTATION STRATEGY

2.1. Strategi Plan of Occupational Safety and Health.

29 2.1.1 Competence officer have identified and evaluate potential 2.1.1 2.1.1 dangerous and occupational safety and health risk related to operation.

30 2.1.2 Strategy plan of occupational safety and health of com- 2.1.2 pany have bee determined and applied to control poten- tial dangerous and occupational safety and health risk which have been identified, related to operation.

31 2.1.3 Special plan related to product, process, project or cer- 2.1.3 tain workplace have been made.

32 2.1.4 The plan is based upon to potential dangerous and inci- 2.1.4 dent, and recording of occupational safety and health in advance.

33 2.1.5 The plan determine the objective of occupational safety and health of company is measurable, determine prio- 2.1.5 rity and provide any resources.

2.2.

34 2.2.1 Management System Manual of K3 including policy, 2.2.2 objective, plan and procedure of occupational safety and health and determine the responsibility of occupational safety and health for all levels in company.

Management System Manual of K3

Page 6: Checklist SMK3[1]. 02

35 2.2.2 If requested a special manual related related to product, 2.2.2 process or certain workplace have made.

Note : S : Sesuai / C : Conformance, TS : Tidak Sesuai / NC : Non ConformancePage- 5 of 21

I = Initial ( Small ) Audit Check List T = Transition ( Medium ) The Management System of Occupational Safety and Health (SMK3) 4 = Conformance

A = Advance ( Big ) Regulation of Minister of Manpower Number : 05/MEN/1996 5 = Non Conformance

Item Elements and Sub Elements criteria Criteria No. FindingNo. No. ( Permenaker No.05/MEN/1996, Attachment-II ) I T A Audit Finding Items S/C TS/NC Verification

Mjr Mnr36 2.2.3 Management System Manual of K3 easy to be obtained 2.2.3

by all personnels in company.

2.3. Information Dissemination of Occupational Safety and Health.

37 2.3.1 Information on activity and problem of occupational safe- 2.3.1 2.3.1 2.3.1 ty and health distributed systematically to all company worker.

38 2.3.2 Recording information of occupational safety and health 2.3.2 is maintained and provided to all manpower and other persons coming to workplace.

3 DESIGN REVIEW AND CONTRACT

3.1.

39 3.1.1 Procedure documented to consider dangerous identifica- 3.1.1 3.1.1 tion and evaluation the risk performed at stage doing de- sign or redesign.

40 3.1.2 Procedure documented to consider dangerous identifica- 3.1.2 3.1.2 tion and evaluation the risk performed at stage doing de- sign or redesign.

41 3.1.3 Competence officer have determine to perform verification 3.1.3 3.1.3 that design meet the requirement of determined occupa- tional safety and health.

Design Review

Page 7: Checklist SMK3[1]. 02

42 3.1.4 All alterations and design modification which have impli- 3.1.4 cation of identied occupational safety and health, docu- mented, reviewed and approved by authorized officer before implementation.

Note : S : Sesuai / C : Conformance, TS : Tidak Sesuai / NC : Non ConformancePage - 6

I = Initial ( Small ) Audit Check List T = Transition ( Medium ) The Management System of Occupational Safety and Health (SMK3) 4 = Conformance

A = Advance ( Big ) Regulation of Minister of Manpower Number : 05/MEN/1996 5 = Non Conformance

ItemNo.

Elements and Sub Elements criteria Criteria No. FindingNo. ( Permenaker No.05/MEN/1996, Attachment-II ) I T A Audit Finding Items S/C TS/NC Verification

Mjr Mnr3.2. Contract Review

43 3.2.1 Procedure documented should able to identity and eva- 3.2.1 3.2.1 luate potential dangerous occupational safety and health environment and society, where the procedure is used during supplying goods and service in any contact.

44 3.2.2 Dangerous identification and risk evaluation is executed 3.2.2 3.2.2 is executed at contract review by competence personnel

45 3.2.3 Review contracts to secure that supplier can meet re- 3.2.3 quirement of occupational safety and health for customer

46 3.2.4 Contract review recording is maintained and documented 3.2.4

4 DOCUMENT CONTROL

4.1 Approval and Issuing Document.

47 4.1.1 Occupational safety and health document have identity 4.1.1 4.1.1of status, authority, date of issue and date of modification

48 4.1.2 Document distribution receiver attached in the document 4.1.2 4.1.2

49 4.1.3 Document of occupational safety and health of latest e- 4.1.3 dition is kept in determined place.

50 4.1.4 Out of date document immediately removed of its using 4.1.4

Page 8: Checklist SMK3[1]. 02

while out of date document deposited for the certain ne- cessary is given special sign.

4.2 Alteration and Modification of Document

Note : S : Sesuai / C : Conformance, TS : Tidak Sesuai / NC : Non ConformancePage - 7 of 21

I = Initial ( Small ) Audit Check List T = Transition ( Medium ) The Management System of Occupational Safety and Health (SMK3) 4 = Conformance

A = Advance ( Big ) Regulation of Minister of Manpower Number : 05/MEN/1996 5 = Non Conformance

Item Elements and Sub Elements criteria Criteria No. FindingNo. No. ( Permenaker No.05/MEN/1996, Attachment-II ) I T A Audit Finding Items S/C TS/NC Verification

Mjr Mnr51 4.2.1 There is a system to make and approve the alteration of 4.2.1 4.2.1

occupational safety and health document.

52 4.2.2 If possibly is given any reason the happened alteration 4.2.2 and written in document or its attachment.

53 4.2.3 There is document control procedure or list of all docu- 4.2.3 ment attached to status of each document, in effort to prevent the use of former document.

5

5.1

54 5.1.1 There is a procedure documented that can secure that 5.1.1 5.1.1 5.1.1 technical spesification and other information relevant to occupational safety and health have been examined be- fore decision to buy.

55 5.1.2 Purchase specification for each facilities of production, 5.1.2 5.1.2 chemical substance or service should be completed by spesification according to the requirement of valid legis- lation and occupational safety and health standard.

56 5.1.3 Consultation with potential manpower influenced during 5.1.3 5.1.3 purchasing decision is performed if the requirement of occupational safety and health attached in in purchase

PURCHASING

Spesification of purchasing for goods and service

Page 9: Checklist SMK3[1]. 02

spesification.

57 5.1.4 Training demand, supplier for self-protector tool and alte- 5.1.4 ration of work procedure need to be considered before purchaseing and reviewed before purchasing and using production facility and chemical materials.

Note : S : Sesuai / C : Conformance, TS : Tidak Sesuai / NC : Non ConformancePage - 8 of 21

I = Initial ( Small ) Audit Check List T = Transition ( Medium ) The Management System of Occupational Safety and Health (SMK3) 4 = Conformance

A = Advance ( Big ) Regulation of Minister of Manpower Number : 05/MEN/1996 5 = Non Conformance

Item Elements and Sub Elements criteria Criteria No. FindingNo. No. ( Permenaker No.05/MEN/1996, Attachment-II ) I T A Audit Finding Items S/C TS/NC Verification

Mjr Mnr5.2 Verification System For Goods and Service To be

58 5.2.1 Goods and service which have been bought that it is 5.2.1 5.2.1 5.2.1 examined the suitability with purchase spesification.

5.3 Control for goods and Service Supplied Customers

59 5.3.1 Goods and service which have been bought prior to use 5.3.1 first identified potential dangerous and evaluated its risk. The Recording is maintained to examine this procedure.

60 5.3.2 Product is available by costomer can be clearly identified 5.3.2

6 WORKING SAFETY BASED ON MANAGEMENT

6.1

61 6.1.1 Competence officer have identify potential dangerous 6.1.1 6.1.1 6.1.1 and have evaluated issuing risk of any work process.

62 6.1.2 If effort to control risks required that the effort is deter- 6.1.2 6.1.2 6.1.2 mined by controlling level.

63 6.1.3 There is a work procedure documented and if required 6.1.3 6.1.3 6.1.3

Bought.

SYSTEM OF K3.

Work System

Page 10: Checklist SMK3[1]. 02

applied any system "Work permit" for high risk job.

64 6.1.4 Procedure or work guidance to manage safety all risks 6.1.4 6.1.4 identified it id documented.

65 6.1.5 Compliance with regulation standard and implemention 6.1.5 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 ConformancePage - 9 of 21

I = Initial ( Small ) Audit Check List T = Transition ( Medium ) The Management System of Occupational Safety and Health (SMK3) 4 = Conformance

A = Advance ( Big ) Regulation of Minister of Manpower Number : 05/MEN/1996 5 = Non Conformance

Item Elements and Sub Elements criteria Criteria No. FindingNo. No. ( Permenaker No.05/MEN/1996, Attachment-II ) I T A Audit Finding Items S/C TS/NC Verification

Mjr Mnr66 6.1.6 Work procedure and work instruction is made by compe- 6.1.7 6.1.6 6.1.6

tence officer by input of manpower requisited to do duties and procedure is ratified by officer designated

67 6.1.7 Self-protector tool is available if required and used co- 6.1.7 6.1.7 6.1.7 rrectly and maintained always in condition available for use.

68 6.1.8 Self-protector tool used is assured have been stated 6.1.8 6.1.8 6.1.8 usable under standard and or legislation is valid.

69 6.1.9 The effort to control the risk reviewed if it happened any 6.1.9 6.1.9 6.1.9 alteration in work process.

6.2.

70 6.2.1. It is executed any control to secure that each jobs is 6.2.1 6.2.1 6.2.1 performed safely and follow each procedure and work guidance which have been determined.

71 6.2.2 Every persons is suprevised under their capability level 6.2.2 6.2.2 and duty risk level

72 6.2.3 Supervisor participate in dangerous identification and 6.2.3 6.2.3 made effort to control.

Controlling

Page 11: Checklist SMK3[1]. 02

73 6.2.4 Supervisor participated in report and investigation of di- 6.2.4 6.2.4 sease cause of work and accident, and is obligate to delivery report and suggestions to manager.

74 6.2.5 Supervisor participate and in consultation process. 6.2.5 6.2.5

Note : S : Sesuai / C : Conformance, TS : Tidak Sesuai / NC : Non ConformancePage - 10 of 21

I = Initial ( Small ) Audit Check List T = Transition ( Medium ) The Management System of Occupational Safety and Health (SMK3) 4 = Conformance

A = Advance ( Big ) Regulation of Minister of Manpower Number : 05/MEN/1996 5 = Non Conformance

Item Elements and Sub Elements criteria Criteria No. FindingNo. No. ( Permenaker No.05/MEN/1996, Attachment-II ) I T A Audit Finding Items S/C TS/NC Verification

Mjr Mnr6.3. Selection and Placement of Personnel

75 6.3.1 Certain duties requirement including health requirement 6.3.1 6.3.1

identitied and used to select and placement for manpower

76 6.3.2 Assigment of work should be based upon capability and 6.3.2 6.3.2 6.3.2 skill level who have been owned by respective mapower.

6.4.

77 6.4.1 Company perform the evaluation of scope of work to 6.4.1 6.4.1 6.4.1 know the regions required the limitation of incoming permit.

78 6.4.2 There control on places with limitation of incoming permit 6.4.2 6.4.2 6.4.2

79 6.4.3 Facilities and service is available in the standard and 6.4.3 6.4.3 6.4.2 technical guidance.

80 6.4.4 Signs on safety and emergency door sign should is ins- 6.4.4 6.4.4 6.4.4 talled according to standard and technical guidance.

6.5.

Scope of Work

Maintaining, Repairmeent and Alteration on Product Facility.

Page 12: Checklist SMK3[1]. 02

81 6.5.1 Scheduling of examination and maintaining of production 6.5.1 6.5.1 facility and equipment including safety tools verification and requirement determined by legislation, standard technical guidance.

82 6.5.2 all notes containing detailed data of activity of examina- 6.5.2 6.5.2 6.5.2 tion, maintaining, correction and alterations performed on workplace should be kept and maintained.

Note : S : Sesuai / C : Conformance, TS : Tidak Sesuai / NC : Non ConformancePage - 11of 21

I = Initial ( Small ) Audit Check List T = Transition ( Medium ) The Management System of Occupational Safety and Health (SMK3) 4 = Conformance

A = Advance ( Big ) Regulation of Minister of Manpower Number : 05/MEN/1996 5 = Non Conformance

Item Elements and Sub Elements criteria Criteria No. FindingNo. No. ( Permenaker No.05/MEN/1996, Attachment-II ) I T A Audit Finding Items S/C TS/NC Verification

Mjr Mnr83 6.5.3 Production facility should registered that it has a valid 6.5.3 6.5.3 6.5.3

certificate.

84 6.5.4 Treatment, repairment and each alterations should be 6.5.4 6.5.4 6.5.4 performed by competent personnel.

85 6.5.5 If possibly, production facility shall be modified should 6.5.5 6.5.5 under effective legislation requirement.

86 6.5.6 There is maintaining demand procedure including condi- 6.5.6 6.5.6 6.5.6 tion on equipments with not good safety condition and need immediately to be repaired soon.

87 6.5.7 There is any signing system for equipment which is al- ready unsafely if it is used or unusable anymore 6..5.7 6.5.7 6.5.7

88 6.5.8 If required, it performed the application of lock out system 6.5.8 6.5.8 6.5.8to prevent that production facility not swicth on anymore.

89 6.5.9 Procedure for status signing to secure that production 6.5.9 6.5.9 equipment in safely condition to be operated.

6.6. Service

Page 13: Checklist SMK3[1]. 02

90 6.6.1 If company contracted to provide a service under the 6.6.1 6.6.1 standard and occupational safety and health law, that it is neccesary arrange procedure to secure that sevice meet the requirement.

91 6.6.2 It company is given a service through contract and ser- 6.6.2 6.6.2 vice under the standard and occupational safety and health legislation, that it is neccesary arranged the pro- cedure to secure that providing service meet the requirement.

Note : S : Sesuai / C : Conformance, TS : Tidak Sesuai / NC : Non ConformancePage - 12 of 21

I = Initial ( Small ) Audit Check List T = Transition ( Medium ) The Management System of Occupational Safety and Health (SMK3) 4 = Conformance

A = Advance ( Big ) Regulation of Minister of Manpower Number : 05/MEN/1996 5 = Non Conformance

Item Elements and Sub Elements criteria Criteria No. FindingNo. No. ( Permenaker No.05/MEN/1996, Attachment-II ) I T A Audit Finding Items S/C TS/NC Verification

Mjr Mnr6.7. Readiness for Handling Emergency

92 6.7.1 Potential emergency (inside or outside workplace) have 6.7.1 6.7.1 6.7.1

been identified and emergency procedure have been do- cumented.

93 6.7.2 Emergency procedure is tested and reviewed routinely 6.7.2 6.7.2 by competent officer.

94 6.7.3 Manpower get instruction and training on emergency 6.7.3 6.7.3 6.7.3 procedure in accordance with risk level.

95 6.7.4 Emergency handling officer is given a special training 6.7.3 6.7.3 6.7.3

96 6.7.5 Emergency instruction and relate to emergency is shown 6.7.5 6.7.5 6.7.5clearly/bold and known by all company's employees.

97 6.7.6 Tool and emergency dangerous sign system is checked, 6.7.6 6.7.6 tested and maintained periodically.

98 6.7.7 Suitability, placement and convinence to get emergency 6.7.7 6.7.7 tool have been evaluated by competent officer.

Page 14: Checklist SMK3[1]. 02

6.8. First Aid for Accident

99 6.8.1 Company have evaluated of PPPK tool and secure that 6.8.1 6.8.1 6.8.1 PPK system available meet standard and technical guidance is effective.

100 6.8.2 PPPK officer have been trained and designated under 6.8.2 6.8.2 6.8.2 legislation.

7 MONITORING STANDARD

Note : S : Sesuai / C : Conformance, TS : Tidak Sesuai / NC : Non ConformancePage - 13 of 21

I = Initial ( Small ) Audit Check List T = Transition ( Medium ) The Management System of Occupational Safety and Health (SMK3) 4 = Conformance

A = Advance ( Big ) Regulation of Minister of Manpower Number : 05/MEN/1996 5 = Non Conformance

Item Elements and Sub Elements criteria Criteria No. FindingNo. No. ( Permenaker No.05/MEN/1996, Attachment-II ) I T A Audit Finding Items S/C TS/NC Verification

Mjr Mnr7.1.

101 7.1.1 Workplace inspection and method of work is performed 7.1.1 7.1.1 7.1.1

regularly.

102 7.1.2 Inspection is executed together by assistant manager 7.1.2 7.1.2 and reprensent of manpower who have obtained training on the identification of potential dangerous.

103 7.1.3 Inspection seek some inputs from officer who implemen- 7.1.3 7.1.3 ting duties in the workplace to be checked.

104 7.1.4 Check list of workplace have arranged to be used du- 7.1.4 7.1.4 ring inspection.

105 7.1.5 Inspection report is submitted to manager and P2K3 in 7.1.5 according to demand.

106 7.1.6 Corrective action is monitored to determine its effective- 7.1.6 ness.

Dangerous examination

Page 15: Checklist SMK3[1]. 02

7.2. Scope of Work Monitoring

107 7.2.1 The workplace environment monitoring is performed re- 7.2.1 7.2.1 7.2.1 gularly and it result is recorded and maintained.

108 7.2.2 The working environment monitoring including physical, 7.2.2 7.2.2 7.2.2 chemical, biology, radiation and phychological.

7.3.

109 7.3.1 There is a sysstem documented on identification, calibra 7.3.1 tion, maintaining and violance for check up tools, measu- re and testing concering health and safety.

Note : S : Sesuai / C : Conformance, TS : Tidak Sesuai / NC : Non ConformancePage - 14 of 21

I = Initial ( Small ) Audit Check List T = Transition ( Medium ) The Management System of Occupational Safety and Health (SMK3) 4 = Conformance

A = Advance ( Big ) Regulation of Minister of Manpower Number : 05/MEN/1996 5 = Non Conformance

Item Elements and Sub Elements criteria Criteria No. FindingNo. No. ( Permenaker No.05/MEN/1996, Attachment-II ) I T A Audit Finding Items S/C TS/NC Verification

Mjr Mnr110 732 Tool is maintained and calibrated by competent officer. 7.3.2

7.4. Health Monitoring.

111 7.4.1 According to legislation, manpower health employing in 7.4.1 7.4.1 the workplace containing dangerous should be monitored

112 7.4.2 Company have identify condition where general check 7.4.2 7.4.2 up need to be performed and have perform the system to assist this check up.

113 7.4.3 General check up is performed by physician designated 7.4.3 7.4.3 7.4.3 under legislation.

114 7.4.4 Company provide an occupational health service under 7.4.4 7.4.4 7.4.4 legislation.

115 7.4.5 Record on health monitoring is made under legislation 7.4.5 7.4.5 7.4.5

8 REPORTING AND IMPROVEMENT FOR DEFICIENCY.

Inspection Equipment, Measurement and Testing

Page 16: Checklist SMK3[1]. 02

8.1. Emergency Reporting

116 8.1.1 There is a procedure for dangerous resource report and 8.1.1 8.1.1 8.1.1 personnel need to be informed on dangerous resources report process of occupational safety and health.

8.2.

117 8.2.1 There is documented procedure which secure that all 8.2.1 8.2.1 accidents and disease cause of work and incident in the workplace is reported.

Note : S : Sesuai / C : Conformance, TS : Tidak Sesuai / NC : Non ConformancePage - 15 of 21

I = Initial ( Small ) Audit Check List T = Transition ( Medium ) The Management System of Occupational Safety and Health (SMK3) 4 = Conformance

A = Advance ( Big ) Regulation of Minister of Manpower Number : 05/MEN/1996 5 = Non Conformance

Item Elements and Sub Elements criteria Criteria No. FindingNo. No. ( Permenaker No.05/MEN/1996, Attachment-II ) I T A Audit Finding Items S/C TS/NC Verification

Mjr Mnr118 8.2.2 Accident and disease cause of work is reported as 8.2.2 8.2.2 8.2.2

determined by legislation.

8.3.

119 8.3.1 Company have a procedure for accident investigation 8.3.1 8.3.1 8.3.1 and disease caused of work being reported.

120 8.3.2 Investigation and prevention of occupational accident is 8.3.2 8.3.2 performed by the officer or K3 expert who has been trained.

121 8.3.3 Investigation report contained suggestion and schedule 8.3.3 implementing corrective effort.

122 8.3.4 Responsibility is given to officer designated to implement 8.3.4 corrective action relating to investigation report.

123 8.3.5 Corrective action is discussed with manpower in the 8.3.5 8.3.5

Incident Report.

Occupational Accident Investigation.

Page 17: Checklist SMK3[1]. 02

place of occurred accident.

124 8.3.6 Effectiveness corrective actions is monitored. 8.3.6

8.4.

125 8.4.1 There is procedure to handle the problem of occupational 8.4.1 8.4.1 8.4.1 safety and health issue and pursuant to legislation.

126 8.4.2 Manpower is given information on handling problem of 8.4.2 8.4.2 8.4.2 occupational safety and health and receive the informa- tion of its completion progress.

9 MATERIAL MANAGEMENT AND ITS TRANSFER.

Note : S : Sesuai / C : Conformance, TS : Tidak Sesuai / NC : Non ConformancePage - 16 of 21

I = Initial ( Small ) Audit Check List T = Transition ( Medium ) The Management System of Occupational Safety and Health (SMK3) 4 = Conformance

A = Advance ( Big ) Regulation of Minister of Manpower Number : 05/MEN/1996 5 = Non Conformance

Item Elements and Sub Elements criteria Criteria No. FindingNo. No. ( Permenaker No.05/MEN/1996, Attachment-II ) I T A Audit Finding Items S/C TS/NC Verification

Mjr Mnr9.1.

127 9.1.1 There is a procedure to identify potential dangerous and to evaluate the risk related to manually and mechanically 9.1.1 9.1.1 9.1.1 handling.

128 9.1.2 Identification and evaluation are executed by competent 9.1.2 9.1.2 9.1.2 officer.

129 9.1.3 Company applies and reviews the method of risk control 9.1.3 9.1.3 related to manually and mechanically handling.

130 9.1.4 Procedure for handling material including prevention me- 9.1.4 thod of damage, spilling and leackage.

9.2.

131 9.2.1 There is the procedure securing that material stored and 9.2.1 9.2.1 9.2.1

Handling problem.

Manually and Mechanically Handling.

Transportation, Storage and Disposal Systems.

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transferred by safely method under the valid legislation.

132 9.2.2 There is the procedure describing the requirement of ma- 9.2.2 terial control which may broken and out of date.

133 9.2.3 There is the procedure to secure that material is throw 9.2.3 9.2.3 9.2.3 out by safely method under the legislation.

9.3.

134 9.3.1 Company have document the procedure concerning vio- 9.3.1 9.3.1 9.3.1 lance, handling and transfer of dangerous goods under the legislation, standard and technical guidance requirements.

Note : S : Sesuai / C : Conformance, TS : Tidak Sesuai / NC : Non ConformancePage - 17 of 21

I = Initial ( Small ) Audit Check List T = Transition ( Medium ) The Management System of Occupational Safety and Health (SMK3) 4 = Conformance

A = Advance ( Big ) Regulation of Minister of Manpower Number : 05/MEN/1996 5 = Non Conformance

Item Elements and Sub Elements criteria Criteria No. FindingNo. No. ( Permenaker No.05/MEN/1996, Attachment-II ) I T A Audit Finding Items S/C TS/NC Verification

Mjr Mnr135 9.3.2 Data sheet for comprehensive Material Safety for 9.3.2 9.3.2 9.3.2

dangerous material should simple be obtained.

136 9.3.3 There is a system to identity and giving lable to 9.3.3 9.3.3 9.3.3 dangerous materials.

137 9.3.4 Warning sign attached under the requirement of 9.3.4 9.3.4 9.3.4 legislation and valid standard.

138 9.3.5 There is the procedure documented on handling for safe 9.3.5 9.3.5 dangerous materials.

139 9.3.6 Officer who is handling dangerous materials is given 9.3.6 9.3.6 training on safely handling method.

10

Dangerous Materials.

COLLECTING AND USING DATA

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10.1.

140 10.1.1 Company have the procedure to identify, collect, file, 10.1.1 10.1.1 10.1.1 maintain and store notes of occupational safety and health.

141 10.1.2 Law, regulation, standard and technical guidance rele- 10.1.2 10.1.2 10.1.2 vant to maintained at the place easy to be reached.

142 10.1.3 There is a procedure determined the requirement to keep 10.1.3 10.1.3 confidential records.

143 10.1.4 Records concerning review and check up is maintained 10.1.4

144 10.1.5 Records for occupational accident compensation and 10.1.5 10.1.5 rehabilitation is maintained.

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I = Initial ( Small ) Audit Check List T = Transition ( Medium ) The Management System of Occupational Safety and Health (SMK3) 4 = Conformance

A = Advance ( Big ) Regulation of Minister of Manpower Number : 05/MEN/1996 5 = Non Conformance

Item Elements and Sub Elements criteria Criteria No. FindingNo. No. ( Permenaker No.05/MEN/1996, Attachment-II ) I T A Audit Finding Items S/C TS/NC Verification

Mjr Mnr10.2.

145 10.2.1 Data for latest occupational safety and health. 10.2.1 10.2.1

collective.

146 10.2.2 Routine Report of occupational safety and health per- 10.2.2 formance and is made and disseminated within company

11 MANAGEMENT SYSTEM AUDIT OF K3.

11.1.

147 11.1.1 Management system Audit of K3 scheduled is performed 11.1.1 to examine the adjustment and to determine, what the activity is effective.

Occupational Safety and Health Record.

Data and Report of Occupational Safety and Health.

Management System Internal Audit of K3

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148 11.1.2 Management System Internal Audit of K3 is performed 11.1.2 by competent officer and independent in company.

149 11.1.3 Audit report is distributed to management and other 11.1.3 officer concerned.

150 11.1.4 Deficiency founded during audit prioritied an monitored to 11.1.4 secure its implemented corrective action.

12

12.1

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

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 ConformancePage - 19 of 21

I = Initial ( Small ) Audit Check List T = Transition ( Medium ) The Management System of Occupational Safety and Health (SMK3) 4 = Conformance

A = Advance ( Big ) Regulation of Minister of Manpower Number : 05/MEN/1996 5 = Non Conformance

Item Elements and Sub Elements criteria Criteria No. FindingNo. No. ( Permenaker No.05/MEN/1996, Attachment-II ) I T A Audit Finding Items S/C TS/NC Verification

Mjr Mnr153 12.1.3 Training should consider the defference of capability 12.1.3 12.1.3

level and educational background.

154 12.1.4 Training is performed by person or body who have capa- 12.1.4 12.1.4 bality and adequate experience and accredited by valid legislation.

155 12.1.5 There is facility and resource are available for the imple- 12.1.5 12.1.5 mentation of effective training.

156 12.1.6 Company documented and stored record all training. 12.1.6 12.1.6

157 12.1.7 Evaluation is performed for each training sessions to se- 12.1.7 cure the increase continually.

DEVELOPING OF SKILL AND CAPABILITY.

Training Strategy

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158 12.1.8 Training program is reviewed regularly to secure that re- 12.1.8 main is relevant and effective.

12.2.

159 12.2.1 Executive management member and manager participa- 12.2.1 12.2.1 12.2.1 te 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 12.2.2 12.2.2 12.2.2 role and responsibility.

12.3. Training for Manpower

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

Note : S : Sesuai / C : Conformance, TS : Tidak Sesuai / NC : Non ConformancePage - 20 of 21

I = Initial ( Small ) Audit Check List T = Transition ( Medium ) The Management System of Occupational Safety and Health (SMK3) 4 = Conformance

A = Advance ( Big ) Regulation of Minister of Manpower Number : 05/MEN/1996 5 = Non Conformance

Item Elements and Sub Elements criteria Criteria No. FindingNo. No. ( Permenaker No.05/MEN/1996, Attachment-II ) I T A Audit Finding Items S/C TS/NC Verification

Mjr Mnr162 12.3.2 Training is given to all manpowers it in their workplace

happened any alteration for production facilities or process 12.3.2 12.3.2

163 12.3.3 If applicable, it is given refreshing training to all 12.3.3 employees.

12.4.

164 12.4.1 Company have orientation program for all manpowers 12.4.1 12.4.1 12.4.1 with policy material input and occupational safety and health procedure.

165 12.4.2 There is the procedure determined the requirement to 12.4.2 12.4.2 present briefing to visitors and partners for secure the

Training for Management and Supervisor.

Training for Introduction for Visitor and Contractor

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safety and health.

12.5.

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

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

Training for Special skill.

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