Check List Internal Audit 18-19 July 2013

55
CHECKLIST AUDIT INTERNAL (HSE) SIEMENS (BATAM FABRICATION YARD) Elemen I Pembangunan dan Pemeliharaan Komitmen Sub. Elemen Kebijakan Keselamatan dan Kesehatan Kerja No Pertanyaan Check Keterangan NC C 1. Apakah terdapat kebijakan K3 / OHSAS 18001: 2007 / ISO 14001: 2004 yang tertulis, bertanggal, dan memiliki tujuan-tujuan K3 yang jelas ? Are there policies K3 / OHSAS 18001: 2007 / ISO 14001: 2004 is written, dated, and has a K3 objectives clear? 2. Apakah kebijakan ditandatangani oleh pimpinan tertinggi ? Is the policy signed by the top leaders? 3. Kebijakan disusun melalui proses konsultasi antara wakil tenaga kerja dan pimpinan perusahaan ? Bukti obyektif : Catatan di dalam form notulen rapat P2K3 Atau di dalam notulen rapat tinjauan manajemen Wawancara dengan salah satu anggota P2K3 Policies are prepared through a process of consultation between representatives of labor and business leaders? Objective evidence: • Note in the minutes of the meeting form P2K3 • Or in the minutes of the management review meeting • Interview with one of the members P2K3 4. Kebijakan telah dikomunikasikan kepada seluruh tenaga kerja, tamu, kontraktor, pelanggan dan pemasok melalui cara yang tepat, sebagai contoh : Melalui briefing/pelatihan Melalui penyebaran di papan-papan pengumuman Disertakan bersamaan dengan guest card Melalui brosur Policy has been communicated to the entire workforce, guests, contractors, customers and suppliers through the right way, for example: • Through briefings / training • Through the deployment on notice boards • Supplied along with guest card • Through brochures C 5. Apakah diperlukan kebijakan khusus, TBC Page 1 of 55

Transcript of Check List Internal Audit 18-19 July 2013

Page 1: Check List Internal Audit 18-19 July 2013

CHECKLIST AUDIT INTERNAL (HSE)SIEMENS (BATAM FABRICATION YARD)

Elemen I Pembangunan dan Pemeliharaan KomitmenSub. Elemen Kebijakan Keselamatan dan Kesehatan Kerja

No PertanyaanCheck

KeteranganNC C

1. Apakah terdapat kebijakan K3 / OHSAS 18001: 2007 / ISO 14001: 2004 yang tertulis, bertanggal, dan memiliki tujuan-tujuan K3 yang jelas ?Are there policies K3 / OHSAS 18001: 2007 / ISO 14001: 2004 is written, dated, and has a K3 objectives clear?

2. Apakah kebijakan ditandatangani oleh pimpinan tertinggi ?Is the policy signed by the top leaders?

3. Kebijakan disusun melalui proses konsultasi antara wakil tenaga kerja dan pimpinan perusahaan ?Bukti obyektif : Catatan di dalam form notulen rapat P2K3 Atau di dalam notulen rapat tinjauan

manajemen Wawancara dengan salah satu anggota

P2K3Policies are prepared through a process of consultation between representatives of labor and business leaders? Objective evidence: • Note in the minutes of the meeting form P2K3 • Or in the minutes of the management review meeting • Interview with one of the members P2K3

4. Kebijakan telah dikomunikasikan kepada seluruh tenaga kerja, tamu, kontraktor, pelanggan dan pemasok melalui cara yang tepat, sebagai contoh : Melalui briefing/pelatihan Melalui penyebaran di papan-papan

pengumuman Disertakan bersamaan dengan guest card Melalui brosurPolicy has been communicated to the entire workforce, guests, contractors, customers and suppliers through the right way, for example: • Through briefings / training • Through the deployment on notice boards • Supplied along with guest card • Through brochures

C

5. Apakah diperlukan kebijakan khusus, apabila diperlukan apakah telah disusun dan disosialisasikan ?Do I need a special policy, if necessary if it has been prepared and disseminated?

TBC

Page 1 of 48

Page 2: Check List Internal Audit 18-19 July 2013

CHECKLIST AUDIT INTERNAL (HSE)SIEMENS (BATAM FABRICATION YARD)

6. Apakah kebijakan K3 / OHSAS 18001: 2007 / ISO 14001: 2004 dan kebijakan khusus lainnya telah ditinjau ulang ?Bukti obyektif : Catatan Rapat Tinjauan Manajemen Jadual Rapat Tinjauan Manajemen Pernyataan tertulis di dalam kebijakan

Are policies K3 / OHSAS 18001: 2007 / ISO 14001: 2004 and other specific policies have to be reviewed? Objective evidence: • Management Review Meeting Notes • Schedule Management Review Meeting • a written statement in the policy

Sub. Elemen Tanggung Jawab dan Wewenang Untuk BertindakNo Pertanyaan Check Keterangan

NC C7. Apakah terdapat uraian tanggung jawab K3 /

OHSAS 18001: 2007 / ISO 14001: 2004 seluruh bidang/bagian di dalam perusahaan ?Bukti Obyektif : Uraian tugas dan tanggung jawab

pimpinan Uraian tugas dan tanggung jawab bagian

K3 / OHSAS 18001: 2007 / ISO 14001: 2004 Uraian tugas dan tanggung jawab AK3 dan

P2K3Is there a description of responsibilities K3 / OHSAS 18001: 2007 / ISO 14001: 2004, the entire field / section in the company? Objective evidence: • Description of the duties and responsibilities of leadership • Description of duties and responsibilities section K3 / OHSAS 18001: 2007 / ISO 14001: 2004 • Description of the duties and responsibilities of AK3 and P2K3

8. Apakah perusahaan pernah mendapatkan saran-saran dari ahli K3 / OHSAS 18001: 2007 / ISO 14001: 2004 yang berasal dari dalam maupun luar perusahaan ?Bukti Obyektif : Dokumen tertulis/laporan hasil konsultasi Rapat P2K3 yang mendatangkan nara

sumber dari luar/dalamDoes the company ever get suggestions from experts K3 / OHSAS 18001: 2007 / ISO 14001: 2004, which comes from inside and outside the company? Objective evidence: • A written document / report the results of the consultation • Meeting P2K3 that brings speakers from outside / inside

No Pertanyaan Check KeteranganNC C

Page 2 of 48

Page 3: Check List Internal Audit 18-19 July 2013

CHECKLIST AUDIT INTERNAL (HSE)SIEMENS (BATAM FABRICATION YARD)

9. Apakah sudah terdapat petugas keadaan darurat yang telah dilatih ?Bukti Obyektif : Tanda khusus petugas Daftar nama petugas Wawancara dengan salah satu petugas Dokumen pelatihan Jadual latihan keadaan darurat

Does there have been emergency personnel who have been trained? Objective evidence: • A special officer • List the name of the officer • Interview with one of the officers • Document training • The scheduled emergency drills

10. Apakah laporan Kinerja K3 / OHSAS 18001: 2007 / ISO 14001: 2004 perusahaan telah disusun ?Bukti Obyektif : Indikator kinerja perusahaan Laporan kinerja K3 / OHSAS 18001: 2007 /

ISO 14001: 2004 perusahaan

Is the performance report K3 / OHSAS 18001: 2007 / ISO 14001: 2004 company has developed? Objective evidence: • The performance of the company • Performance reports K3 / OHSAS 18001: 2007 / ISO 14001: 2004 company

11. Siapa yang bertanggung jawab untuk mengawasi tenaga kerja kontraktor ?Apakah sudah ada dalam uraian tanggung jawab personil tersebut ?

Who is responsible for overseeing the contractor workforce? Is there in the description of the personnel responsibilities?

12. Siapa yang bertanggung jawab untuk memelihara dan mendistribusikan informasi peraturan perundangan K3 / OHSAS 18001: 2007 / ISO 14001: 2004 yang terbaru ?Apakah sudah ada dalam uraian tanggung jawab personil tersebut ?

Who is responsible for maintaining and distributing information legislation K3 / OHSAS 18001: 2007 / ISO 14001: 2004 is the latest? Is there in the description of the personnel responsibilities?

Page 3 of 48

Page 4: Check List Internal Audit 18-19 July 2013

CHECKLIST AUDIT INTERNAL (HSE)SIEMENS (BATAM FABRICATION YARD)

Sub. Elemen Tinjauan Ulang dan Evaluasi

No Pertanyaan Check KeteranganNC C

13. Apakah sudah pernah dilakukan tinjauan ulang Sistem Manajemen K3 / OHSAS 18001: 2007 / ISO 14001: 2004 ?Bukti Obyektif : Jadual Tinjauan Manajemen Catatan Rapat Tinjauan Manajemen Daftar hadir kegiatan Tinjauan Manajemen Prosedur Tinjauan Manajemen Is've never done a review of K3 Management System / OHSAS 18001: 2007 / ISO 14001: 2004? Objective evidence: • Schedule Management Review • Management Review Meeting Notes • Register attend Management Review activities • Management Review Procedure

Sub. Elemen Keterlibatan dan Konsultasi dengan Tenaga KerjaNo Pertanyaan Check Keterangan

NC C14. Apakah ada kegiatan konsultasi terhadap

perubahan-perubahan yang mempunyai implikasi terhadap K3 / OHSAS 18001: 2007 / ISO 14001: 2004 ?Bukti Obyektif : Prosedur tertulis Penjadualan Konsultasi Personil yang ditunjuk

is there a consultation on changes have implications for K3 / OHSAS 18001: 2007 / ISO 14001: 2004? Objective evidence: • Written procedures • Scheduling Consultation • Personnel designated

No Pertanyaan Check KeteranganNC C

15. Apakah P2K3 sudah dibentuk dan disahkan sesuai dengan peraturan perundangan ?Bukti Obyektif : Surat pengesahan dari Depnaker Struktur organisasi P2K3 Uraian tugas dan tanggung jawab P2K3

Page 4 of 48

Page 5: Check List Internal Audit 18-19 July 2013

CHECKLIST AUDIT INTERNAL (HSE)SIEMENS (BATAM FABRICATION YARD)

Do P2K3 already established and approved in accordance with the laws and regulations?Objective evidence: • Letter of endorsement from the Department of Labour • The organizational structure P2K3 • Description of duties and responsibilities P2K3

16.Siapa ketua dan sekretaris P2K3 ? Apakah ketua P2K3 adalah pimpinan tertinggi dan sekretaris adalah AK3? Bukti Obyektif : Struktur organisasi P2K3 Penunjukan ahli K3 / OHSAS 18001: 2007 /

ISO 14001: 2004 perusahaanWho is the chairman and secretary of the P2K3? Is chairman of the P2K3 is the supreme leader and the secretary is AK3? Objective evidence: • The organizational structure P2K3 • Appointment of experts K3 / OHSAS 18001: 2007 / ISO 14001: 2004 company

17. Bagaimana P2K3 melakukan kegiatannya ? Apakah rutin (minimal sebulan sekali) ?Bukti obyektif : Hasil rapat P2K3 Daftar hadir kegiatan rapat P2K3 Laporan kegiatan ke Depnaker (minimal

tiga bulan sekali) Penyebaran hasil rapat P2K3 Apakah ada program kerja tahunanHow P2K3 do activities? Are regular (at least once a month)? Objective evidence: • The meeting P2K3 • List of meetings attended activities P2K3 • Activity report to the Department of Labour (minimum three months) • Dissemination of the results of the meeting P2K3 • Is there an annual work program

18. Apakah diperlukan kelompok-kelompok kerja

di setiap bagian dengan penanggung jawab K3

/ OHSAS 18001: 2007 / ISO 14001: 2004 yang

dipilih dari wakil tenaga kerja ?

Apabila diperlukan apakah struktur tersebut

telah disosialisasikan kepada tenaga kerja ?

Is necessary working groups in charge of each

section with K3 / OHSAS 18001: 2007 / ISO

14001: 2004 is chosen from representatives of

labor?

Where necessary if the structure has been

disseminated to the workforce?

Page 5 of 48

Page 6: Check List Internal Audit 18-19 July 2013

CHECKLIST AUDIT INTERNAL (HSE)SIEMENS (BATAM FABRICATION YARD)

19. Apakah telah dilakukan identifikasi dan

penilaian risiko ?

Bukti obyektif :

Form identifikasi bahaya dan penilaian

risiko

Prosedur tertulis

Petugas yang menilai

Has any identification and risk assessment?

Objective evidence:

• Form hazard identification and risk

assessment

• Written procedures

• Officers who assess

Page 6 of 48

Page 7: Check List Internal Audit 18-19 July 2013

CHECKLIST AUDIT INTERNAL (HSE)SIEMENS (BATAM FABRICATION YARD)

No Pertanyaan Check KeteranganNC C

Sub. Elemen Manual Sistem Manajemen K3 / OHSAS 18001: 2007 / ISO 14001: 2004 ?

No Pertanyaan Check KeteranganNC C

Sub. Elemen Penyebarluasan Informasi K3

No Pertanyaan Check Keterangan

Page 7 of 48

20. Apakah terdapat Manual SMK3 ? apabila ada

apakah terdapat :

Kebijakan ?

Tujuan ?

Rencana ?

Prosedur K3 / OHSAS 18001: 2007 / ISO

14001: 2004 ?

Is there SMK3 Manual? if there is there:

• Policy?

• Purpose?

• Plan?

• Procedures K3 / OHSAS 18001: 2007 / ISO

14001: 2004?

21. Apakah diperlukan Manual khusus yang

berkaitan dengan produk, proses, atau tempat

kerja tertentu?

Bukti obyektif :

Manual khusus berkaitan dengan suatu

proses, produk tertentu

Do I need a special Manual relating to

products, processes, or a particular

workplace?

Objective evidence:

• Manual specifically relates to a process,

specific product

22. Bagaimana Manual SMK3 disebarluaskan di

dalam perusahaan ? apakah mudah didapat

oleh semua tenaga kerja ?

How SMK3 Manual disseminated within the

company? is easily obtained by all workers

Bukti obyektif :

Daftar distribusi Manual SMK3

Observasi ke salah satu tempat

Wawancara dengan salah satu tenaga

kerja

Page 8: Check List Internal Audit 18-19 July 2013

CHECKLIST AUDIT INTERNAL (HSE)SIEMENS (BATAM FABRICATION YARD)

NC C23. Bagaimana informasi tentang kegiatan K3 /

OHSAS 18001: 2007 / ISO 14001: 2004

disebarluaskan ?

Bukti obyektif :

Prosedur tertulis

Metode yang sistematis

Implementasi di lapangan, misalnya

penempelan dipapan pengumuman,

How information about the activities K3 /

OHSAS 18001: 2007 / ISO 14001: 2004

disseminated?

Objective evidence:

• Written procedures

• systematic method

• Implementation in the field, such as an

announcement on the board attachment

24. Apakah catatan informasi K3 / OHSAS 18001:

2007 / ISO 14001: 2004 dipelihara dan

disediakan untuk tenaga kerja dan orang lain

yang datang di tempat kerja ?

Bukti obyektif :

Metode yang sistematis

Prosedur tertulis

Implementasi berupa sebagai contoh

brosur, buletin, dll

Is the information note K3 / OHSAS 18001:

2007 / ISO 14001: 2004 are maintained and

made available to workers and others who

come in the workplace?

Objective evidence:

• systematic method

• Written procedures

• Implementation of the form as an example of

brochures, newsletters, etc.

Elemen III Peninjauan Ulang Perancangan dan KontrakSub. Elemen Pengendalian PerancanganNo Pertanyaan Check Keterangan

NC C

Page 8 of 48

Page 9: Check List Internal Audit 18-19 July 2013

CHECKLIST AUDIT INTERNAL (HSE)SIEMENS (BATAM FABRICATION YARD)

25. Apakah terdapat prosedur terdokumentasi

yang mempertimbangkan identifikasi bahaya

dan penilaian risiko dalam melakukan kegiatan

perancangan atau perancangan ulang ?

Bukti obyektif :

Prosedur tertulis

Is there a documented procedure that

considers the hazard identification and risk

assessment in the design activities or

redesign?

Objective evidence:

• Written procedures

26. Apakah prosedur dan instruksi kerja untuk

penggunaan produk, sarana produksi dan

proses telah disusun selama tahap

perancangan ?

Bukti obyektif :

Prosedur dan Instruksi Kerja untuk

pengoperasian sarana produksi

Are procedures and work instructions for the

use of the products, production facilities and

processes have been developed during the

design phase?

Objective evidence:

• Procedures and Work Instructions for the

operation of the means of production

Sub. Elemen Peninjauan Ulang Kontrak

Page 9 of 48

Page 10: Check List Internal Audit 18-19 July 2013

CHECKLIST AUDIT INTERNAL (HSE)SIEMENS (BATAM FABRICATION YARD)

27. Apakah terdapat kegiatan memasok barang

dan jasa ? apabila ada apakah terdapat

prosedur tertulis yang mempertimbangkan

identifikasi bahaya dan penilaian risiko pada

saat memasok barang dan jasa dalam suatu

kontrak ?

Bukti obyektif :

Prosedur tertulis

Hasil identifikasi bahaya dan penilaian

risiko

Catatan tinjauan ulang

Kontrak

Are there activities of supplying goods and

services? if there is there a written procedure

that considers the hazard identification and

risk assessment at the time of supply of goods

and services in a contract?

Objective evidence:

• Written procedures

• The results of hazard identification and risk

assessment

• Note new review

• Contracts

28. Apakah kontrak-kontrak ditinjau ulang

sebelum pelaksanaan pekerjaan ? Dimana

kontrak-kontrak yang telah disimpan tersebut

di pelihara dan didokumentasikan?

Bukti obyektif :

Catatan tinjauan ulang kontrak

Are contracts reviewed prior to execution of

work? Where contracts have been deposited in

the maintained and documented?

Objective evidence:

• Note review of contracts

Elemen IV Pengendalian DokumenSub. Elemen Persetujuan dan Pengeluaran DokumenNo Pertanyaan Check Keterangan

NC C

Page 10 of 48

Page 11: Check List Internal Audit 18-19 July 2013

CHECKLIST AUDIT INTERNAL (HSE)SIEMENS (BATAM FABRICATION YARD)

29. Apakah dokumen K3 / OHSAS 18001: 2007 /

ISO 14001: 2004 yang di susun telah memiliki

identitas status, wewenang, tanggal

pengeluaran dan tanggal modifikasi?

Bukti obyektif :

Prosedur tertulis yang mengatur format

prosedur

Setiap prosedur memiliki status,

wewenang, tanggal pengeluaran & tanggal

modifikasi

Is the document K3 / OHSAS 18001: 2007 / ISO

14001: 2004 has had identity stacking status,

authority, date of issuance and modification

date?

Objective evidence:

• Written procedures governing the format

procedure

• Each procedure has a status, authority, date

of issuance and the date of modification

No Pertanyaan Check KeteranganNC C

30. Bagaimana pendistribusian dokumen K3 /

OHSAS 18001: 2007 / ISO 14001: 2004 kepada

tenaga kerja ? Apakah edisi terbaru?

Bukti obyektif :

Daftar distribusi

Verifikas ke bagian-bagian

Metode revisi dokumen

Metode untuk distribusi dokumen

Prosedur tertulis

How the distribution of documents K3 / OHSAS

18001: 2007 / ISO 14001: 2004 to the

workforce? Is the latest edition?

Objective evidence:

• The distribution list

• Verifikas to the parts

• Method of document revision

• The method for document distribution

• Written procedures

Page 11 of 48

Page 12: Check List Internal Audit 18-19 July 2013

CHECKLIST AUDIT INTERNAL (HSE)SIEMENS (BATAM FABRICATION YARD)

31. Bagaimana menangani dokumen-dokumen

usang yang sudah tidak terpakai lagi ?

Bukti obyektif :

Prosedur tertulis

Contoh dokumen using

How to deal with obsolete documents that are

not used anymore?

Objective evidence:

• Written procedures

• Examples of documents using

32. Bagaimana pendistribusian dokumen K3 /

OHSAS 18001: 2007 / ISO 14001: 2004 kepada

tenaga kerja ? Apakah edisi terbaru ?

Bukti obyektif :

Daftar distribusi

Verifikas ke bagian-bagian

Metode revisi dokumen

Metode untuk distribusi dokumen

Prosedur tertulis

How the distribution of documents K3 / OHSAS

18001: 2007 / ISO 14001: 2004 to the

workforce? Is the latest edition?

Objective evidence:

• The distribution list

• Verifikas to the parts

• Method of document revision

• The method for document distribution

• Written procedures

33. Bagaimana menangani dokumen-dokumen

usang yang sudah tidak terpakai lagi ?

Bukti obyektif :

Prosedur tertulis

Contoh dokumen using

How to deal with obsolete documents that are

not used anymore?

Objective evidence:

• Written procedures

• Examples of outdated documents

Sub. Elemen Perubahan dan Modifikasi DokumenNo Pertanya Check Keterangan

NC C

Page 12 of 48

Page 13: Check List Internal Audit 18-19 July 2013

CHECKLIST AUDIT INTERNAL (HSE)SIEMENS (BATAM FABRICATION YARD)

34. Bagaimana cara membuat dan menyetujui

perubahan terhadap dokumen K3 / OHSAS

18001: 2007 / ISO 14001: 2004 ?

Bukti obyektif :

Prosedur tertulis

Form perubahan dokumen K3 / OHSAS

18001: 2007 / ISO 14001: 2004 yang berisi

alasan perubahan

Daftar dokumen (Master List) mencantumkan

status revisi, nomor dokumen, lokasi, dll

Contoh dokumen K3 / OHSAS 18001: 2007 /

ISO 14001: 2004 yang memiliki identitas

status,

Contoh dokumen K3 / OHSAS 18001: 2007 /

ISO 14001: 2004 yang telah diubah

Tanda bagi dokumen K3 / OHSAS 18001:

2007 / ISO 14001: 2004 yang telah diubah

How to make and approve changes to the

document K3 / OHSAS 18001: 2007 / ISO 14001:

2004?

Objective evidence:

• Written procedures

• Form document changes K3 / OHSAS 18001:

2007 / ISO 14001: 2004 which contains the

reasons for the change

• List of documents (Master List) lists the status

of the revision, the document number, location,

etc.

• Examples of documents K3 / OHSAS 18001:

2007 / ISO 14001: 2004 has the status of

identity,

• Examples of documents K3 / OHSAS 18001:

2007 / ISO 14001: 2004 which has been

amended

• Signs for documents K3 / OHSAS 18001: 2007 /

ISO 14001: 2004 which has been amended

Elemen VI Keamanan Bekerja Berdasarkan Sistem Manajemen K3Sub. Elemen Sistem KerjaNo Pertanyaan Check Keterangan

NC C

Page 13 of 48

Page 14: Check List Internal Audit 18-19 July 2013

CHECKLIST AUDIT INTERNAL (HSE)SIEMENS (BATAM FABRICATION YARD)

35. Apakah telah ada kegiatan identifikasi bahaya

dan penilaian risiko ? apabila telah dilakukan

apakah kegiatan tersebut melalui upaya

pengendalian ? apakah ada kegiatan tinjauan

ulang terhadap hasil pengendalian yang telah

dilakukan ?

Bukti obyektif :

Prosedur tertulis mengenai identifikasi

bahaya dan penilaian risiko

Form identifikasi bahaya dan penilaian risiko

Petugas yang ditunjuk

Hasil identifikasi bahaya dan penilaian risiko

Hasil tinjauan ulang terhadap langkah

pengendalian yang telah dilakukan

Has there been any activity hazard identification

and risk assessment? if it had been done if these

activities through control efforts? whether there

is a review of the results of the activities that

have been carried out of control?

Objective evidence:

• Written procedures regarding hazard

identification and risk assessment

• Form hazard identification and risk assessment

• Officers appointed

• The results of hazard identification and risk

assessment

The results of a review of the control measures

that have been done

36. Bagaimana perusahaan mengatur kegiatan-

kegiatan yang berisiko tinggi ? apakah ada

sistem ijin kerja ?

Bukti obyektif :

Prosedur tertulis mengenai ijin kerja

Form ijin kerja

Pengisian form ijin kerja

Penerapan di lapangan

How do companies organize activities at high

risk? is there a system of work permits?

Objective evidence:

• Written procedures regarding work permits

• Form a work permit

• Completion of the work permit form

• Implementation in the field

Page 14 of 48

Page 15: Check List Internal Audit 18-19 July 2013

CHECKLIST AUDIT INTERNAL (HSE)SIEMENS (BATAM FABRICATION YARD)

37. Apakah telah disusun prosedur atau instruksi

kerja terhadap kegiatan-kegiatan yang dinilai

tinggi risikonya ?

Bukti obyektif :

Hasil identifikasi bahaya dan penilaian risiko

Prosedur atau instruksi kerja

Is has been compiled procedures or work

instructions to activities considered high risk?

Objective evidence:

• The results of hazard identification and risk

assessment

• procedures or work instructions

38. Apakah dalam menyusun atau melakukan

modifikasi terhadap prosedur kerja atau instruksi

kerja mengacu kepada suatu standar atau

peraturan ?

Bukti obyektif :

Dalam format prosedur dicantumkan disalah

satu bagiannya point referensi

Whether in developing or making modifications

to work procedures or work instructions refer to

a standard or regulation?

Objective evidence:

• In the format specified procedures at one or

more reference points

39. Apakah prosedur dan instruksi kerja dibuat oleh

petugas yang berkompeten yaitu tenaga kerja

yang dipersyaratkan untuk melakukan tugas ?

Bukti obyektif :

Tanda tangan personil di kolom pembuat

prosedur di halaman muka prosedur

Are procedures and work instructions made by

the competent authority ie labor required to

perform the task?

Objective evidence:

• Signature of personnel in the column on the

front page of the manufacturer's procedure

procedure

Page 15 of 48

Page 16: Check List Internal Audit 18-19 July 2013

CHECKLIST AUDIT INTERNAL (HSE)SIEMENS (BATAM FABRICATION YARD)

40.Apakah APD (Alat Pelindung Diri) telah disediakan untuk setiap tenaga kerja sesuai dengan jenis pekerjaannya ? dan apakah APD tersebut telah memenuhi standar atau peraturan yang ada ?Bukti obyektif :

Prosedur tertulis

Form permintaan APD

Spesifikasi APD

Hasil pengujian APD (bila ada)

Is PPE (Personal Protective Equipment) has been

provided for each labor in accordance with the

type of work? and whether the PPE meets the

standards or regulations exist?

Objective evidence:

• Written procedures

• Form APD request

• Specifications APD

• APD test results (if any)

Sub. Elemen PengawasanNo Pertanyaan Check Keterangan

NC C41. Bagaimana perusahaan melakukan pengawasan

terhadap tenaga kerjanya ? apakah telah ada

mekanisme tersendiri ?

Bukti obyektif :

Peraturan tata tertib K3 / OHSAS 18001: 2007

/ ISO 14001: 2004,

Form teguran

How the company to supervise the work force?

whether there has been a separate mechanism?

Objective evidence:

• Regulation of the order of K3 / OHSAS 18001:

2007 / ISO 14001: 2004,

• Form a reprimand

Page 16 of 48

Page 17: Check List Internal Audit 18-19 July 2013

CHECKLIST AUDIT INTERNAL (HSE)SIEMENS (BATAM FABRICATION YARD)

42. Apakah setiap karyawan telah di awasi sesuai

dengan kemampuan tugas dan

tingkat risiko tugas ?

Bukti obyektif :

Check List Pengenalan

Prosedur Pengenalan (OJT)

Does every employee has been supervised in

accordance with the tasks and capabilities

risk level assignment?

Objective evidence:

• Check List Introduction

• Introduction Procedure (OJT)

43. Apakah pengawas ikut serta dalam identifikasi

bahaya dan membuat upaya pengendalian ?

Bukti obyektif :

Form identifikasi bahaya dan pengendalian

risiko terdapat tanda tangan pengawas

Are supervisors participate in hazard

identification and control make the effort?

Objective evidence:

• Form hazard identification and risk control are

the supervisor's signature

44. Apabila terdapat kecelakaan dan penyakit akibat

kerja, apakah pengawas ikut serta dalam proses

penyelidikan dan pelaporan ?

Bukti obyektif :

Prosedur penyelidikan dan pelaporan

kecelakaan didalamnya melibatkan

pengawas,

Form penyelidikan dan pelaporan kecelakaan

terdapat tanda tangan pengawas.

If there are accidents and occupational diseases,

whether supervisors participated in the

investigation and reporting process?

Objective evidence:

• The procedure of investigation and reporting of

accidents involving supervisors therein,

• Form the investigation and reporting of

accidents are the supervisor's signature

Page 17 of 48

Page 18: Check List Internal Audit 18-19 July 2013

CHECKLIST AUDIT INTERNAL (HSE)SIEMENS (BATAM FABRICATION YARD)

45. Apabila pengawas ikut serta dalam penyelidikan

dan pelaporan kecelakaan dan penyakit akibat

kerja, apakah laporannya diserahkan kepada

manajemen beserta saran-saran perbaikannya ?

Bukti obyektif :

Lihat apakah terdapat saran-saran pada

laporan penyelidikan kecelakaan dan

penyakit akibat kerja kepada pihak

manajemen.

If the supervisor participated in the investigation

and reporting of accidents and occupational

diseases, whether the report submitted to the

management and improvement suggestions?

Objective evidence:

• See if there are any suggestions on accident

investigation and reporting of occupational

diseases to the management.

46. Apakah pengawas ikut serta dalam kegiatan

konsultasi antara pekerja dengan pengurus/P2K3

?

Bukti obyektif :

Daftar hadir kegiatan konsultasi terdapat

nama pengawas dan tanda tangannya.

Are supervisors participated in consultations

between workers with pengurus/P2K3?

Objective evidence:

• List of consulting activities are present

supervisor name and signature.

Sub. Elemen Seleksi dan Penempatan PersonilNo Pertanyaan Check Keterangan

NC C

Page 18 of 48

Page 19: Check List Internal Audit 18-19 July 2013

CHECKLIST AUDIT INTERNAL (HSE)SIEMENS (BATAM FABRICATION YARD)

47. Apakah pada saat menyeleksi dan menempatkan

personil memasukan persyaratan kesehatan dan

tugas tertentu ?

Bukti obyektif :

Apakah ada prosedur seleksi dan

penempatan personil ?

Apabila ada apakah sudah memasukan unsur

K3 / OHSAS 18001: 2007 / ISO 14001: 2004

dan kemampuan ?

Is when selecting and placing personnel and

health requirements include a specific task?

Objective evidence:

• Is there a procedure of selection and

placement of personnel?

• If there is already incorporate elements of K3 /

OHSAS 18001: 2007 / ISO 14001: 2004 and

capabilities?

48. Apakah pada saat menugaskan suatu pekerjaan

berdasarkan kepada tingkat kemampuan dan

keterampilan yang dimiliki oleh masing-masing

tenaga kerja ?

Bukti obyektif :

Job Description

Curriculum Vitae

Is when assigning work based on the level of

ability and skills possessed by each labor?

Objective evidence:

• Job Description

• Curriculum Vitae

Sub. Elemen Lingkungan KerjaNo Pertanyaan Check Keterangan

NC C49. Apakah perusahaan telah menilai lingkungan

kerja untuk mengetahui daerah yang

memerlukan pembatasan ijin masuk ?

Bukti obyektif :

Prosedur yang mengatur

Tabel Daerah dengan Pembatasan Ijin Masuk

Implementasi di lapangan (kunci, rambu-

rambu)

Does the company have assessed the work

environment to determine areas that require

restrictions on entry?

Objective evidence:

• Procedures governing

• Table entry Permit Areas with Restrictions

• Implementation in the field (keys, signs)

Page 19 of 48

Page 20: Check List Internal Audit 18-19 July 2013

CHECKLIST AUDIT INTERNAL (HSE)SIEMENS (BATAM FABRICATION YARD)

50. Apabila telah dilakukan penilaian terhadap

lingkungan kerja, apakah telah dilakukan

langkah pengendalian ?

Bukti obyektif :

Prosedur yang mengatur

Tabel Daerah dengan Pembatasan Ijin Masuk

Implementasi di lapangan (kunci, rambu-

rambu)

If the environmental assessment has been

carried out the work, whether the control

measures have been done?

Objective evidence:

• Procedures governing

• Table entry Permit Areas with Restrictions

• Implementation in the field (keys, signs)

51. Apakah sudah tersedia fasilitas-fasilitas yang

memadai di lingkungan kerja ?

Bukti obyektif :

Apakah terdapat prosedur yang mengatur

Implementasi di lapangan (lihat

penerapannya apakah terdapat sarana-

sarana yang diharuskan oleh standar atau

peraturan perundangan)

Is it available adequate facilities in the

workplace?

Objective evidence:

• Are there procedures that govern

• Implementation in the field (see application

whether there are facilities or standards required

by legislation)

Page 20 of 48

Page 21: Check List Internal Audit 18-19 July 2013

CHECKLIST AUDIT INTERNAL (HSE)SIEMENS (BATAM FABRICATION YARD)

52. Apakah sudah terdapat rambu-rambu

keselamatan termasuk rambu keadaan darurat

di tempat kerja ?

Bukti obyektif :

Apakah terdapat prosedur yang mengatur

Implementasi di lapangan

Is there are already signs of safety including

emergency signs in the workplace?

Objective evidence:

• Are there procedures that govern

• Implementation in the field

Sub. Elemen PelayananNo Pertanyaan Check Keterangan

NC C53. Apabila perusahaan diberi pelayanan melalui

kontrak apakah terdapat prosedur untuk mengatur kegiatan tersebut memenuhi persyaratan K3 / OHSAS 18001: 2007 / ISO 14001: 2004 ?Bukti obyektif : Kontrak pekerjaan Prosedur tertulis Evaluasi kontraktorWhen companies provide services through a contract if there is a procedure for regulating the activity meets the requirements of K3 / OHSAS 18001: 2007 / ISO 14001: 2004? Objective evidence: • Contract work • Written procedures • Evaluate contractor

Sub. Elemen Kesiapan untuk Menangani Keadaan DaruratNo Pertanyaan Check Keterangan

NC C54. Apakah terdapat prosedur keadaan darurat yang

telah mengidentifikasikan seluruh keadaan

darurat yang mungkin terjadi ?

Bukti obyektif :

Prosedur tertulis

Are there emergency procedures that have been

identified throughout the emergencies that

might happen?

Objective evidence:

• Written procedures

Page 21 of 48

Page 22: Check List Internal Audit 18-19 July 2013

CHECKLIST AUDIT INTERNAL (HSE)SIEMENS (BATAM FABRICATION YARD)

55. Apabila prosedur tersebut telah ada, apakah

telah di uji coba oleh personil atau petugas yang

berkompeten ?

Bukti obyektif :

Jadual latihan

Hasil latihan keadaan darurat

Evaluasi hasil pelatihan

If a procedure has been there, whether it has

been tested by competent personnel or officers?

Objective evidence:

• Schedule exercise

• Results of emergency drills

• Evaluation of training results

56. Apakah prosedur keadaan darurat tersebut juga

telah disosialisasikan/dilatihkan kepada

karyawan sesuai dengan tingkat risikonya ?

Bukti obyektif :

Jadual sosialisasi/latihan

Hasil latihan

Are the emergency procedures have also been

socialized / trained to employees in accordance

with the level of risk?

Objective evidence:

• Schedule socialization / training

• The results of the exercise

57. Apabila telah ditunjuk tim penanganan keadaan

darurat, apakah mereka telah dilatih secara

khusus ?

Bukti obyektif :

TNA (Training Need Analysis)

Catatan pelatihan

CV petugas keadaan darurat

If the designated emergency response team,

whether they have been specially trained?

Objective evidence:

• TNA (Training Need Analysis)

• Records of training

• CV emergency personnel

Page 22 of 48

Page 23: Check List Internal Audit 18-19 July 2013

CHECKLIST AUDIT INTERNAL (HSE)SIEMENS (BATAM FABRICATION YARD)

58. Apakah telah terdapat instruksi keadaan darurat

yang diinformasikan kepada seluruh tenaga kerja

secara jelas ditempat-tempat yang telah dinilai ?

Bukti obyektif :

Peta evakuasi

Alur keadaan darurat

Daftar nama personil keadaan darurat

Whether there is an emergency instructions are

communicated to the entire workforce is evident

in places that have been assessed?

Objective evidence:

• Evacuation Map

• Flow emergencies

• The list of emergency personnel

59. Apakah di tempat kerja telah di pasang alat-alat

keadaan darurat sesuai dengan standar

penempatan dan kesesuaiannya ? apabila telah

ada, apakah alat-alat tersebut telah diperiksa,

diuji dan dipelihara secara berkala ?

Bukti obyektif :

Daftar peralatan keadaan darurat

Prosedur tertulis

Jadual pemeriksaan dan pengujian peralatan

keadaan darurat

Hasil pemeriksaan dan pengujian peralatan

keadaan darurat

Whether in the workplace has installed

equipment in accordance with standard

emergency placement and compliance? if it

exists, whether these tools have been inspected,

tested and maintained on a regular basis?

Objective evidence:

• List of emergency equipment

• Written procedures

• The scheduled inspection and testing of

emergency equipment

• The results of the examination and testing of

emergency equipment

Sub. Elemen Pertolongan Pertama Pada Kecelakaan

No Pertanyaan Check KeteranganNC C

Page 23 of 48

Page 24: Check List Internal Audit 18-19 July 2013

CHECKLIST AUDIT INTERNAL (HSE)SIEMENS (BATAM FABRICATION YARD)

60. Apakah telah tersedia peralatan PPPK dan

sistemnya yang dapat menjamin peralatan

tersebut selalu memenuhi standar dan pedoman

yang berlaku ?

Bukti obyektif :

Prosedur PPPK

Implementasi di lapangan (kotak PPPK-nya)

Hasil pemeriksaan kotak PPPK

Is has provided first-aid equipment and systems

to ensure the equipment always meets the

applicable standards and guidelines?

Objective evidence:

• first-aid procedures

• Implementation in the field (first aid box)

• Examination results first-aid kit

61. Apakah petugas PPPK yang ditunjuk telah

diberikan pelatihan secara khusus ?

Bukti obyektif :

TNA (Training Need Analysis)

Catatan pelatihan PPPK

Daftar petugas PPPK

Is the designated first aid officer has been given

special training?

Objective evidence:

• TNA (Training Need Analysis)

• Note first aid training

• List of first aid officers

Elemen VII Standar Pemantauan

Sub. Elemen Pemeriksaan Bahaya

No Pertanyaan Check KeteranganNC C

62. Apakah telah terdapat inspeksi tempat kerja dan

cara kerja yang dilaksanakan secara teratur ?

Bukti obyektif :

Prosedur Inspeksi

Jadwal Inspeksi

Whether there is inspection work and the way

work is carried out on a regular basis?

Objective evidence:

• Inspection Procedures

• Inspection Schedule

Page 24 of 48

Page 25: Check List Internal Audit 18-19 July 2013

CHECKLIST AUDIT INTERNAL (HSE)SIEMENS (BATAM FABRICATION YARD)

63. Siapa yang melaksanakan inspeksi di tempat

kerja? (apakah wakil pengurus dan wakil tenaga

kerja yang telah memperoleh pelatihan

mengenai identifikasi bahaya dan penilaian

risiko)

Bukti obyektif :

Verifikasi petugas inspeksi di lembar hasil

inspeksi

Catatan pelatihan identifikasi bahaya dan

penilaian risiko

Who would carry out inspections in the

workplace? (whether representatives of

management and labor representatives who

have obtained training on hazard identification

and risk assessment)

Objective evidence:

• Verification of inspectors in the inspection

result sheet

• Training records hazard identification and risk

assessment

64.Apabila telah dibuat laporan inspeksinya apakah telah berisi saran-saran masukan bagian yang diinspeksi ?

Bukti obyektif : Lembar hasil inspeksi

If the inspection report has been made whether already contain suggestions inspected input section?

Objective evidence:

• The results of the inspection65. Apakah dalam melakukan inspeksi

menggunakan check list yang telah disusun

sebelumnya ? kemudian apakah telah dibuatkan

laporannya yang diajukan ke pihak manajemen ?

Bukti obyektif :

Contoh Check List

Contoh laporan inspeksi

Whether the conduct inspections using a

checklist that had been developed before? then

whether it has made its report submitted to the

management?

Objective evidence:

• Sample Check List

• Sample inspection report

Page 25 of 48

Page 26: Check List Internal Audit 18-19 July 2013

CHECKLIST AUDIT INTERNAL (HSE)SIEMENS (BATAM FABRICATION YARD)

66. Apakah tindakan korektif terhadap hasil inspeksi

telah dipantau untuk diselesaikan ?

Bukti obyektif :

Contoh Lembar Temuan Inspeksi

Is corrective action on the inspection results

have been monitored to be resolved?

Objective evidence:

• Examples of Inspection Findings Sheet

Sub. Elemen Pemantauan Lingkungan KerjaNo Pertanyaan Check Keterangan

NC C

Page 26 of 48

Page 27: Check List Internal Audit 18-19 July 2013

CHECKLIST AUDIT INTERNAL (HSE)SIEMENS (BATAM FABRICATION YARD)

67. Apakah pada lingkungan kerja telah dilakukan

pemantauan yang meliputi faktos fisik,kimia,

biologi, radiasi dan psikologis ? kemudian apakah

catatannya telah disimpan dan dipelihara di

tempat yang telah ditentukan ?

Faktor fisik (kebisingan, kelembaban,

getaran, cahaya, dll)

Faktor kimia (debu, kandungan bahan kimia

di udara)

Faktor biologi (kandungan penyakit di

lingkungan kerja, virus, bakteri,dll)

Faktor radiasi (radiasi ion dan radiasi non ion)

Faktor psikologis (stress di tempat kerja,dll)

Bukti obyektif :

Prosedur tertulis

Jadual pemantauan

Hasil pemantauan

Is the work environment has been carried out which includes faktos monitoring of physical, chemical, biological, radiation and psychological? then whether the record has been kept and maintained in a designated place? • Physical factors (noise, humidity, vibration, light, etc.) • Chemical factors (dust, the chemicals in the air) • biological factors (content of workplace diseases, viruses, bacteria, etc.) • Factors radiation (ionizing radiation and non-radiation ion) • Psychological factors (stress at work, etc.) Objective evidence: • Written procedures • Schedule monitoring • The results of monitoring

Page 27 of 48

Page 28: Check List Internal Audit 18-19 July 2013

CHECKLIST AUDIT INTERNAL (HSE)SIEMENS (BATAM FABRICATION YARD)

Sub. Elemen Peralatan Inspeksi, Pengukuran dan PengujianNo Pertanyaan Check Keterangan

NC C68. Apakah terdapat suatu sistem untuk melakukan

identifikasi, kalibrasi, pemeliharaan dan

penyimpanan untuk alat pemeriksaan, ukur dan

uji K3 / OHSAS 18001: 2007 / ISO 14001: 2004 ?

siapa yang melakukan kalibrasi ? (apakah

petugas yang berkompeten ?)

Bukti obyektif :

Prosedur terdokumentasi

Jadual pemeliharaan dan kalibrasi

Hasil pemeliharaan dan kalibrasi

Is there a system for the identification,

calibration, maintenance and storage of

inspection tools, measuring and test K3 / OHSAS

18001: 2007 / ISO 14001: 2004? who is doing the

calibration? (whether a compliance officer?)

Objective evidence:

• Documented procedures

• Schedule maintenance and calibration

• Maintenance and calibration results

Sub. Elemen Pemantauan KesehatanNo Pertanyaan Check Keterangan

NC C69. Apakah telah dilakukan identifikasi dimana

pemantauan kesehatan terhadap tenaga kerja

yang bekerja di daerah yang berbahaya perlu

dilakukan ?

Bukti obyektif :

Prosedur terdokumentasi

Form identifikasi pemantauan kesehatan

Is has to identify where monitoring of the health

workers who work in hazardous areas needs to

be done?

Objective evidence:

• Documented procedures

• Form identifying health monitoring

Page 28 of 48

Page 29: Check List Internal Audit 18-19 July 2013

CHECKLIST AUDIT INTERNAL (HSE)SIEMENS (BATAM FABRICATION YARD)

70. Apakah pemeriksaan kesehatan dilakukan oleh

dokter pemeriksa yang ditunjuk sesuai peraturan

?

Bukti obyektif :

Sertifikat dokter pemeriksa

Surat penunjukan sebagai dokter pemeriksa

Is medical examination performed by a physician

examiner appointed according to the rules?

Objective evidence:

• Certificate of examining physician

• Letter of appointment as a physician examiner

71. Apakah perusahaan telah menyediakan

pelayanan kesehatan kerja yang sesuai dengan

peraturan perundangan ?

Bukti obyektif :

Klinik

Tenaga paramedis

Dokter perusahaan

Does the company have been providing

occupational health services in accordance with

the rules and regulations?

Objective evidence:

• Clinic

• Power paramedics

• Physician companies

72. Apabila pemantauan kesehatan telah dilakukan,

apakah catatannya telah dibuat sesuai dengan

peraturan perundangan ?

Bukti obyektif :

Contoh catatan pemantauan kesehatan

If the health monitoring has been done, whether

the record has been made in accordance with

laws and regulations?

Objective evidence:

• Examples of health monitoring records

Elemen VIII Pelaporan dan Perbaikan Kekurangan

Sub. Elemen Pelaporan Keadaan Darurat

No Pertanyaan Check KeteranganNC C

Page 29 of 48

Page 30: Check List Internal Audit 18-19 July 2013

CHECKLIST AUDIT INTERNAL (HSE)SIEMENS (BATAM FABRICATION YARD)

73. Apakah telah di susun suatu prosedur untuk

melaporkan sumber bahaya yang terjadi di

sekitar lingkungan kerja ? dan apakah prosedur

tersebut diketahui oleh semua karyawan/tenaga

kerja ?

Bukti obyektif :

Prosedur terdokumentasi

Wawancara dengan karyawan

Has been in the stacking procedure for reporting

hazards that occur around the work

environment? and whether the procedure was

known by all employees / workers?

Objective evidence:

• Documented procedures

• Interviews with employees

Sub. Elemen Pelaporan Insiden

Page 30 of 48

Page 31: Check List Internal Audit 18-19 July 2013

CHECKLIST AUDIT INTERNAL (HSE)SIEMENS (BATAM FABRICATION YARD)

No Pertanyaan Check KeteranganNC C

Page 31 of 48

Page 32: Check List Internal Audit 18-19 July 2013

CHECKLIST AUDIT INTERNAL (HSE)SIEMENS (BATAM FABRICATION YARD)

74. Apakah terdapat prosedur terdokumentasi

mengenai pelaporan kecelakaan, penyakit akibat

kerja dan insiden ? dan apakah kecelakaan dan

penyakit akibat kerja yang terjadi dilaporkan

sesuai dengan peraturan perundangan yang

berlaku ?

Bukti obyektif :

Prosedur terdokumentasi

Form pelaporan kecelakaan, insiden dan

penyakit akibat kerja,

Bukti pelaporan ke pihak terkait

Is there a documented procedure regarding

reporting of accidents, occupational diseases and

accidents? and whether accidents and

occupational diseases that occur are reported in

accordance with applicable laws and regulations?

Objective evidence:

• Documented procedures

• Form reporting of accidents, incidents and

occupational diseases,

• Evidence of reporting to stakeholders

Page 32 of 48

Page 33: Check List Internal Audit 18-19 July 2013

CHECKLIST AUDIT INTERNAL (HSE)SIEMENS (BATAM FABRICATION YARD)

Sub. Elemen Penyelidikan Kecelakaan KerjaNo Pertanyaan Check Keterangan

NC C75. Apakah terdapat prosedur terdokumentasi

mengenai penyelidikan kecelakaan dan penyakit

akibat kerja ? siapa yang melakukan

penyelidikan (apakah personil/petugas atau ahli

K3 / OHSAS 18001: 2007 / ISO 14001: 2004 yang

telah mendapatkan pelatihan penyelidikan

kecelakaan?)

Bukti obyektif :

Prosedur terdokumentasi

Catatan pelatihan/TNA (Training Need

Analysis)

Form penyelidikan kecelakaan dan penyakit

akibat kerja

Is there a documented procedure regarding the

investigation of accidents and occupational

diseases? who is doing the investigation

(whether personnel / officers or experts K3 /

OHSAS 18001: 2007 / ISO 14001: 2004, which

has received training accident investigation?)

Objective evidence:

• Documented procedures

• Training records / TNA (Training Need Analysis)

• Form the investigation of accidents and

occupational diseases

No Pertanyaan Check KeteranganNC C

Page 33 of 48

Page 34: Check List Internal Audit 18-19 July 2013

CHECKLIST AUDIT INTERNAL (HSE)SIEMENS (BATAM FABRICATION YARD)

76. Apakah laporan penyelidikan berisi saran-saran

perbaikan untuk ditindaklanjuti ? dan apakah

tindakan perbaikan tersebut telah diberikan

kepada personil yang bersangkutan untuk

ditindaklanjuti ?

Bukti obyektif :

Form penyelidikan

Bukti form penyelidikan yang sudah diisi

Is the investigation report containing suggestions

for improvement to be followed? and whether

the corrective action has been provided to the

concerned personnel for follow-up?

Objective evidence:

• Form an inquiry

• Evidence of the completed investigation form

77. Selain itu apakah tindakan perbaikan telah

didiskusikan dengan karyawan di tempat yang

mengalami kecelakaan ? dan apakah tindakan

perbaikan tersebut dipantau efektifitasnya ?

Bukti obyektif :

Form penyelidikan yang sudah diisi

Moreover if corrective action has been discussed

with the employee in a crash? and whether

corrective actions are monitored its

effectiveness?

Objective evidence:

• Form the investigation was completed,

Sub. Elemen Penanganan MasalahNo Pertanyaan Check Keterangan

NC C

Page 34 of 48

Page 35: Check List Internal Audit 18-19 July 2013

CHECKLIST AUDIT INTERNAL (HSE)SIEMENS (BATAM FABRICATION YARD)

78. Apakah telah ada suatu prosedur untuk

menangani masalah K3 / OHSAS 18001: 2007 /

ISO 14001: 2004 yang timbul di lingkungan kerja

dan sesuai dengan peraturan perundangan ? dan

apakah prosedur tersebut telah diketahui oleh

semua karyawan yang ada ?

Bukti obyektif :

Prosedur terdokumentasi

Is there a procedure to deal with K3 / OHSAS

18001: 2007 / ISO 14001: 2004, which arise in

the work environment and in accordance with

the laws and regulations? and whether the

procedure has been known by all existing

employees?

Objective evidence:

• Documented procedures

C

Elemen IX Pengelolaan Material Dan Perpindahannya

Sub. Elemen Penanganan Secara Manual dan Mekanis

No Pertanyaan Check KeteranganNC C

79. Apakah telah dilakukan identifikasi bahaya dan

penilaian risiko pada saat melakukan

penanganan secara manual dan mekanis ? dan

apakah petugas yang menangani telah

mendapatkan pelatihan (berkompeten) ?

Bukti obyektif :

Form identifikasi bahaya dan penilaian risiko

Prosedur tertulis

Has any hazard identification and risk

assessment at the time of manual handling and

mechanical? and whether the officers who have

been trained to handle (competent)?

Objective evidence:

• Form hazard identification and risk assessment

• Written procedures

Page 35 of 48

Page 36: Check List Internal Audit 18-19 July 2013

CHECKLIST AUDIT INTERNAL (HSE)SIEMENS (BATAM FABRICATION YARD)

80. Apabila penilaian risiko dan identifikasi bahaya

telah diterapkan pada saat melakukan

penanganan secara manual dan mekanis,

apakah telah dilakukan tinjauan ulang untuk

menilai sejauhmana efektifitasnya ?

Bukti obyektif :

Hasil tinjauan ulang terhadap penerapan

manajemen risiko di kegiatan penanganan

secara manual dan mekanis

If the risk assessment and hazard identification

has been applied at the time of manual handling

and mechanical, whether the review has been

conducted to assess the extent of its

effectiveness?

Objective evidence:

• The results of a review of the activities of risk

management in manual handling and mechanical

81. Apakah telah disusun suatu prosedur

penanganan bahan yang meliputi metode

pencegahan terhadap tumpahan, kerusakan dan

kebocoran ?

Bukti obyektif :

Prosedur terdokumentasi

Is a procedure has been developed which

includes the material handling methods of

prevention against spills, damage and leaks?

Objective evidence:

• Documented procedures

Sub. Elemen Sistem Pengangkutan, Penyimpanan dan PembuanganNo Pertanyaan Check Keterangan

NC C

Page 36 of 48

Page 37: Check List Internal Audit 18-19 July 2013

CHECKLIST AUDIT INTERNAL (HSE)SIEMENS (BATAM FABRICATION YARD)

82. Apakah terdapat prosedur yang dapat menjamin

bahan disimpan dan dipindahkan secara aman ?

selain itu apakah bahan tersebut dikendalikan

untuk memastikan tidak ada bahan yang

kadaluarsa atau rusak masih digunakan ?

Bukti obyektif :

Prosedur terdokumentasi

Metode pengendalian bahan yang dapat

rusak atau kadaluarsa

Is there a procedure that can ensure the material

is stored and transferred securely? other than

that if the material is controlled to ensure no

expired or damaged materials are still used?

Objective evidence:

• Documented procedures

• Methods of controlling materials that can be

damaged or expired

83. Apakah terdapat prosedur yang menjamin bahan

dibuang secara aman sesuai dengan peraturan

perundangan ?

Bukti obyektif :

Prosedur terdokumentasi

Lembar hasil pembuangan bahan

Are there procedures that ensure the material

disposed of safely in accordance with the laws

and regulations?

Objective evidence:

• Documented procedures

• The results of the disposal of materials

Sub. Elemen Bahan-bahan BerbahayaNo Pertanyaan Check Keterangan

NC C

Page 37 of 48

Page 38: Check List Internal Audit 18-19 July 2013

CHECKLIST AUDIT INTERNAL (HSE)SIEMENS (BATAM FABRICATION YARD)

84. Apakah terdapat prosedur terdokumentasi

mengenai penyimpanan, penanganan dan

pemindahan bahan-bahan yang berbahaya

sesuai dengan persyaratan peraturan

perundangan, standar atau pedoman yang

berlaku ?

Bukti obyektif :

Prosedur terdokumentasi

Are there documented procedures regarding

storage, handling and removal of hazardous

materials in accordance with statutory and

regulatory requirements, standards or guidelines

applicable?

Objective evidence:

• Documented procedures

85. Apakah bahan-bahan berbahaya yang ada telah

memiliki MSDS (Material Safety Data

Sheet/Lembar Data Keselamatan Bahan) yang

sesuai dengan standar ? selain itu apakah ada

sistem pelabelan pada bahan-bahan yang

berbahaya ?

Bukti obyektif :

Contoh MSDS

Is harmful ingredients that exist already have

MSDS (Material Safety Data Sheet / Material

Safety Data Sheet) in accordance with the

standards? other than that if there is a system of

labeling on hazardous materials?

Objective evidence:

• Examples of MSDS

No Pertanyaan Check KeteranganNC C

Page 38 of 48

Page 39: Check List Internal Audit 18-19 July 2013

CHECKLIST AUDIT INTERNAL (HSE)SIEMENS (BATAM FABRICATION YARD)

86. Apakah telah dipasang Rambu-Rambu

peringatan bahaya untuk bahan berbahaya yang

ada di tempat kerja ?

Bukti obyektif :

Contoh rambu-rambu peringatan bahaya

Standar rambu-rambu peringatan bahaya

untuk bahan-bahan berbahaya

Has been fitted hazard warning signs for

hazardous substances in the workplace?

Objective evidence:

• Examples of hazard warning signs

• Standard signs warning of danger for

dangerous substances

87. Apakah petugas/personil yang menangani

bahan-bahan berbahaya telah mendapatkan

pelatihan yang sesuai ?

Bukti obyektif :

TNA (training need analysis)

Catatan pelatihan

CV petugas penanganan bahan berbahaya

Are officers / personnel who handle hazardous

materials have to be appropriately trained?

Objective evidence:

• TNA (training need analysis)

• Records of training

• CV personnel handling hazardous materials

Elemen X Pengumpulan Dan Penggunaan Data

Sub.Elemen Catatan Keselamatan dan Kesehatan Kerja

No Pertanyaan Check KeteranganNC C

88. Apakah telah terdapat prosedur terdokumentasi

mengenai identifikasi, pengumpulan,

pengarsipan dan pemeliharaan Catatan K3 /

OHSAS 18001: 2007 / ISO 14001: 2004 ?

Bukti obyektif :

Prosedur terdokumentasi

Kecepatan dalam memperoleh suatu catatan

Whether there is a documented procedure

regarding the identification, collection, filing and

maintenance of records K3 / OHSAS 18001: 2007

/ ISO 14001: 2004?

Objective evidence:

• Documented procedures

• Speed in obtaining a record

Page 39 of 48

Page 40: Check List Internal Audit 18-19 July 2013

CHECKLIST AUDIT INTERNAL (HSE)SIEMENS (BATAM FABRICATION YARD)

89. Bagaimana undang-undang, peraturan, standar

dan pedoman teknis yang relevan dipelihara dan

mudah di dapat pada tempat yang sesuai ?

Bukti obyektif :

Prosedur terdokumentasi

Daftar peraturan perundangan

Peraturan perundangan

How the laws, regulations, standards and

relevant technical guidelines and can easily be

maintained at the appropriate place?

Objective evidence:

• Documented procedures

• List of legislation

• Rule of law

No Pertanyaan Check KeteranganNC C

90. Bagaimana cara menentukan kerahasiaan

catatan ?

Bukti obyektif :

Prosedur terdokumentasi

Contoh penerapan

How do I determine the confidentiality of

records?

Objective evidence:

• Documented procedures

• Examples of application

91. Apakah catatan tinjauan ulang, pemeriksaan, kecelakaan kerja dan catatan kesehatan dipelihara ? apabila ia bagaimana cara memeliharanya ?Bukti obyektif : Contoh penerapanIs the review notes, checks, workplace accidents and medical records maintained? if he is how to maintain it? Objective evidence: • Examples of application

Sub. Elemen Data Keselamatan dan Kesehatan Kerja No Pertanyaan Check Keterangan

NC C

Page 40 of 48

Page 41: Check List Internal Audit 18-19 July 2013

CHECKLIST AUDIT INTERNAL (HSE)SIEMENS (BATAM FABRICATION YARD)

92. Apakah data K3 / OHSAS 18001: 2007 / ISO

14001: 2004 yang terbaru telah dikumpulkan

dan dianalisa ?

Bukti obyektif :

Prosedur terdokumentasi

Hasil analisa

Is the data K3 / OHSAS 18001: 2007 / ISO 14001:

2004, the latest has been collected and

analyzed?

Objective evidence:

• Documented procedures

• Results of analysis

93. Apakah telah dibuat laporan rutin kinerja K3 /

OHSAS 18001: 2007 / ISO 14001: 2004? apabila

sudah dibuat, apakah telah disebarluaskan di

tempat kerja ?

Bukti obyektif :

Contoh laporan rutin kinerja K3 / OHSAS

18001: 2007 / ISO 14001: 2004

Does performance have made regular reports K3

/ OHSAS 18001: 2007 / ISO 14001: 2004? when it

is made, whether it has been disseminated in the

workplace?

Objective evidence:

• Examples of routine performance reports K3 /

OHSAS 18001: 2007 / ISO 14001: 2004

Elemen XI Audit Sistem Manajemen K3 / OHSAS 18001: 2007 / ISO 14001: 2004 ?

Sub. Elemen Audit Internal HSE

No Pertanyaan Check KeteranganNC C

Page 41 of 48

Page 42: Check List Internal Audit 18-19 July 2013

CHECKLIST AUDIT INTERNAL (HSE)SIEMENS (BATAM FABRICATION YARD)

94. Apakah telah dilakukan kegiatan Audit Internal

yang terjadual ? siapa yang melakukan Audit

Internal (apakah petugas yang terlatih dan

berpengalaman (kompeten)) ?

Bukti obyektif :

Jadual kegiatan Audit Internal

Prosedur Audit Internal

TNA (Training Need Analysis)

Catatan Latihan

Is Internal Audit has carried out activities are

scheduled? who does Internal Audit (whether

officers are trained and experienced

(competent))?

Objective evidence:

• Schedule activities of Internal Audit

• Internal Audit Procedures

• TNA (Training Need Analysis)

• Exercise Diary

95. Apakah kekurangan yang ditemukan pada saat

Audit Internal telah diprioritaskan dan dipantau

agar segera diperbaiki ?

Bukti obyektif :

Laporan Ketidaksesuaian

Laporan Monitoring Ketidaksesuaian

Whether the deficiencies found during the

Internal Audit prioritized and monitored in order

to be fixed soon?

Objective evidence:

• Non-conformance Reports

• Incompatibility Monitoring Report

Elemen XII Pengembangan Ketrampilan Dan Kemampuan

Sub. Elemen Strategi Pelatihan

No Pertanyaan Check KeteranganNC C

Page 42 of 48

Page 43: Check List Internal Audit 18-19 July 2013

CHECKLIST AUDIT INTERNAL (HSE)SIEMENS (BATAM FABRICATION YARD)

96. Apakah telah dilakukan analisis kebutuhan

pelatihan (TNA) yang meliputi pelatihan

mengenai K3 / OHSAS 18001: 2007 / ISO 14001:

2004 ? (keselamatan dan kesehatan kerja) ?

Bukti obyektif :

Contoh TNA

Prosedur pelatihan

is training needs analysis has been conducted

(TNA) which includes training on K3 / OHSAS

18001: 2007 / ISO 14001: 2004? (Health and

Safety)?

Objective evidence:

• Example TNA

• Procedures training

97. Apakah telah disusun rencana pelatihan K3 /

OHSAS 18001: 2007 / ISO 14001: 2004 ? untuk

semua tingkatan dalam perusahaan ? apakah

pelatihan yang dilakukan mempertimbangkan

perbedaan tingkat kemampuan dan keahlian ?

Bukti obyektif :

Rencana pelatihan

Is the training plan has been prepared K3 /

OHSAS 18001: 2007 / ISO 14001: 2004? for all

levels within the company? whether the training

is carried out considering the different levels of

ability and skill?

Objective evidence:

• Training Plan

No Pertanyaan Check KeteranganNC C

Page 43 of 48

Page 44: Check List Internal Audit 18-19 July 2013

CHECKLIST AUDIT INTERNAL (HSE)SIEMENS (BATAM FABRICATION YARD)

98. Siapa yang memberikan pelatihan ? (apakah

dilakukan oleh orang atau badan yang

mempunyai kemampuan dan pengalaman

yang memadai serta diakreditasi menurut

peraturan perundangan yang berlaku ?)

Bukti obyektif :

Catatan pelatihan

Hasil evaluasi pelatihan

Who gave the training? (whether performed by

a person or entity who has the ability and

experience adequate and accredited according

to the laws and regulations that apply?)

Objective evidence:

• Records of training

• Results of the evaluation of training

99. Apakah tersedia fasilitas yang memadai untuk

mengadakan pelatihan yang efektif ?

Bukti obyektif :

Observasi dilapangan (ruang kelas beserta

sarananya)

Are there adequate facilities to conduct

effective training?

Objective evidence:

• Observations in the field (and their

classrooms ingredients)

100. Bagaimana dan dimana catatan pelatihan

didokumentasikan ?

Bukti obyektif :

Implementasi

Prosedur terdokumentasi

How and where training records are

documented?

Objective evidence:

• Implementation

• Documented procedures

101. Apakah setiap selesai pelatihan, dilakukan

evaluasi untuk menjamin peningkatan secara

berkala ?

Bukti obyektif :

Form evaluasi pelatihan

Prosedur terdokumentasi

Is every completed training, conducted an

evaluation to ensure increased periodically?

Objective evidence:

• Form a training evaluation

• Documented procedures

Page 44 of 48

Page 45: Check List Internal Audit 18-19 July 2013

CHECKLIST AUDIT INTERNAL (HSE)SIEMENS (BATAM FABRICATION YARD)

102. Apakah telah dilakukan tinjauan terhadap

program pelatihan K3 / OHSAS 18001: 2007 /

ISO 14001: 2004 ? ?

Bukti obyektif :

Hasil tinjauan ulang pelatihan K3 / OHSAS

18001: 2007 / ISO 14001: 2004 ?

Is has done a review of the training program

K3 / OHSAS 18001: 2007 / ISO 14001: 2004? ?

Objective evidence:

• The results of a review of training K3 /

OHSAS 18001: 2007 / ISO 14001: 2004?

Sub. Elemen Pelatihan Bagi Manajemen dan SupervisorNo Pertanyaan Check Keterangan

NC C103. Apakah manajemen perusahaan telah

mendapatkan pelatihan mengenai kewajiban

hukum dan prinsip-prinsip K3 / OHSAS 18001:

2007 / ISO 14001: 2004 ? ?

Bukti obyektif :

TNA/materi pelatihan

Catatan pelatihan manajemen perusahaan

Does the company management have

received training regarding legal obligations

and principles K3 / OHSAS 18001: 2007 / ISO

14001: 2004? ?

Objective evidence:

• TNA / training materials

• Training records management company

104. Apakah Manajemen dan supervisor telah

mendapatkan pelatihan K3 / OHSAS 18001:

2007 / ISO 14001: 2004 ? yang sesuai dengan

peran dan tanggung jawabnya ?

Bukti obyektif :

TNA/Materi pelatihan

Catatan pelatihan manajemen perusahaan

Are management and supervisors have been

trained K3 / OHSAS 18001: 2007 / ISO 14001:

2004? in accordance with the roles and

responsibilities?

Objective evidence:

• TNA / training materials

• Training records management company

Sub. Elemen Pelatihan bagi Tenaga KerjaNo Pertanyaan Check Keterangan

NC C

Page 45 of 48

Page 46: Check List Internal Audit 18-19 July 2013

CHECKLIST AUDIT INTERNAL (HSE)SIEMENS (BATAM FABRICATION YARD)

105. Apakah pelatihan telah diberikan bagi

karyawan yang baru atau dipindahkan dari

satu bagian ke bagian yang lain ?

Bukti obyektif :

TNA/program pelatihan

Catatan pelatihan

Are the training has been given to a new

employee or transferred from one section to

another?

Objective evidence:

• TNA / training program

• Records of training

106. Apabila terdapat perubahan sarana produksi,

apakah karyawan yang bertugas di bagian

tersebut mendapatkan pelatihan yang sesuai ?

Bukti obyektif :

Catatan pelatihan

If there is a change in the means of

production, whether the employee is on duty

in that section to be appropriately trained?

Objective evidence:

• Records of training

107. Apakah telah direncanakan pelatihan

penyegaran bagi jenis-jenis pelatihan

tertentu ?

Bukti obyektif :

Catatan pelatih

Is refresher training planned for the types of

training

specific?

Objective evidence:

• Note trainers

Sub. Elemen Pelatihan untuk Pengenalan bagi Pengunjung dan KontraktorNo Pertanyaan Check Keterangan

Page 46 of 48

Page 47: Check List Internal Audit 18-19 July 2013

CHECKLIST AUDIT INTERNAL (HSE)SIEMENS (BATAM FABRICATION YARD)

NC C108. Apakah semua karyawan telah menerima

program pengenalan ? apabila sudah ? apakah

K3 / OHSAS 18001: 2007 / ISO 14001: 2004 ?

sudah dimasukan sebagai salah satu materi

pengenalan ?

Bukti obyektif :

Check List pengenalan

Catatan pelatihan

Do all employees have received recognition

programs? if it already? whether K3 / OHSAS

18001: 2007 / ISO 14001: 2004? has been

included as one of the material recognition?

Objective evidence:

• Check List recognition

• Records of training

109. Apakah brieifing telah dilakukan (taklimat)

terhadap tamu atau mitra kerja yang masuk

ke lingkungan perusahaan ?

Bukti obyektif :

Prosedur terdokumentasi

Catatan pengenalan

Do brieifing have done (briefings) to guests or

business partners who enter into a corporate

environment?

Objective evidence:

• Documented procedures

• Note the introduction

Sub. Elemen Pelatihan Keahlian KhususNo Pertanyaan Check Keterangan

NC C

Page 47 of 48

Page 48: Check List Internal Audit 18-19 July 2013

CHECKLIST AUDIT INTERNAL (HSE)SIEMENS (BATAM FABRICATION YARD)

110. Apakah telah ada sistem untuk menjamin

lisensi atau kualifikasi sesuai dengan

peraturan perundangan untuk melaksanakan

tugas khusus, melaksanakan pekerjaan atau

mengoperasikan peralatan ? contoh : sertifikat

operator boiler, operator crane, forklift, dll.

Bukti obyektif :

Prosedur terdokumentasi

Daftar karyawan yang membutuhkan

lisensi

Daftar sertifikat

Is there a system to ensure the licensing or

qualification in accordance with the rules and

regulations to carry out specific tasks, perform

work or operate equipment? example: boiler

operator certificates, crane operators, forklift,

etc..

Objective evidence:

• Documented procedures

• List of employees who require a license

• List of certificates

Page 48 of 48