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
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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
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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?
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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
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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?
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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
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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
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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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
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)
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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
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
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
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
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
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
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
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
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
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
CHECKLIST AUDIT INTERNAL (HSE)SIEMENS (BATAM FABRICATION YARD)
No Pertanyaan Check KeteranganNC C
Page 31 of 48
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
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
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
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
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
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
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
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
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
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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
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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
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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
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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
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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
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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
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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
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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
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