KI / FORM / ISO / 15

LIST OF SUMMARY FORM

PERSONNEL SECTION (HRD)

NO FORM NO DESCRIPTION

1 KI/FORM/HRD/01 EMPLOYEE REQUISITION FORM

2 KI/FORM/HRD/02 APPLICATION FOR EMPLOYMENT

3 KI/FORM/HRD/03 LEAVE REQUESITION FORM

4 KI/FORM/HRD/04 LIST OF LEAVE RECORD

5 KI/FORM/HRD/05 PERFORMANCE APPRAISAL

6 KI/FORM/HRD/06 SURAT TUGAS

7 KI/FORM/HRD/07 EMERGENCY CONTACT

8 KI/FORM/HRD/08 SALARY ADJUSTMENT FORM

9 KI/FORM/HRD/09 ACCIDENT REPORT FORM

10 KI/FORM/HRD/10 OVERTIME AUTHORIZATION FORM

11 KI/FORM/HRD/11 TRAINING REQUEST

12 KI/FORM/HRD/12 TRAINING PROGRAM

13 KI/FORM/HRD/13 TRAINING ATTEDANCE LIST

14 KI/FORM/HRD/14 TRAINING RESUME

15 KI/FORM/HRD/15 ACCIDENT RECORD

16 KI/FORM/HRD/16 SUMMARY ACCIDENT RECORD

 KI/FORM/HRD/01

Project : ………………….

EMPLOYEE REQUISITION

REQUESTED BY :

Name : …………………………………… Date : ……………………………………

Section/Position : …………………………………… Signature : ……………………………………

REQUIRED :

Job Title : …………………………………… Date : ……………………………………

Number : ……………………………………

Description of duties :
……………………………………………………………………………………………………………..
……………………………………………………………………………………………………………..

……………………………………………………………………………………………………………..

Qualification : ……………………………………………………………………………………………………………..

……………………………………………………………………………………………………………..

Employment Status : 1. Permanen with three months probation period

2. Contract : from …...……..………. to …..……………….

Condition of Employment :

……………………………………………………………………………………………………………..

……………………………………………………………………………………………………………..
……………………………………………………………………………………………………………..

……………………………………………………………………………………………………………..

……………………………………………………………………………………………………………..

……………………………………………………………………………………………………………..

……………………………………………………………………………………………………………..
……………………………………………………………………………………………………………..

c.2000/PTGA/1.3 APPROVAL
 KI/FORM/HRD/02

APPLICATION FOR EMPLOYMENT

PERMOHONAN LAMARAN KERJA

POSITION APPLIED FOR : DATE OF APPLICATION :

LAMARAN UTK JABATAN TANGGAL PERMOHONAN

NAME : PRESENT ADDRESS :

NAMA ALAMAT SEKARANG

PLACE OF BIRTH :
TEMPAT LAHIR

DATE OF BIRTH :
TANGGAL LAHIR

ID CARD NUMBER :
NO. KTP CONTACT ADDRESS :
ALAMAT SAUDARA
RELIGION : YG DAPAT DIHUBUNGI
AGAMA

MARITAL STATUS :
KAWIN/TIDAK KAWIN

NUMBER OF CHILDREN :
JUMLAH ANAK

EDUCATION :
PENDIDIKAN TERAKHIR

WORK EXPERIENCES : APPLICANT SIGNATURE :

PENGALAMAN KERJA TANDATANGAN PELAMAR

FOR ADMINISTRATION USE

SALARY CONDITION
Date of Employment :
Basic Salary/month : Rp
Employment Status :
Medical Allowance/month : Rp
Position :
House Allowance/month : Rp
Location of work :
Meal Allowance/month : Rp

APPROVAL Traffic Allowance/month : Rp

Project Allowance/month : Rp

Management Allowance/month : Rp

Overtime Rate/hour : Rp
 KI/FORM/HRD/03

LEAVE REQUISITION FORM

Name : ………………………….. Signature …………………………. Date : ………………………….

………………………… …………………………
Date Date
From : To :
……………………….. …………………………
Period of leave Time Time

Number of days off : …………..

( excluding public holiday / office holiday )

Annual leave. Death of husband/wife, parents,

parents in law, child of the the
Sick leave. employee.

Maternity leave. Wedding of a child of the employee.

Monthly period leave. Circumcision/baptism of a child

of the employee.
Reason for leave Marriage of the employee.

Birth of a child of the employee. Civic duties.

Note : In case of sick leave, doctor's certificate should submitted together with this form.

Record Balance carried forward Leaves conformed by this appl. Balance after this appl.

Annual Leave

Address to be Address : …………………………………… Telp. No. : ……………………

contacted during
leave. ……………………………………

Management Approval / Disapproval Acknowledge

c.2001 PTGA/1.4
 KI/FORM/HRD/03

LEAVE REQUISITION FORM

Rev : 1 / 15 Jun 09

Name : Irwan Priyatna Signature …………………………. 2-May-18

14-May-18
Date Date
From : To
08:00 17:00
Period of leave Time Time

Number of days off : 1 (one) day

( excluding public holiday / office holiday )

Annual leave ( 12 days per year ). Death of husband/wife, parents,

parents in law, child of the the
Un-paid leave. employee.

Sick leave. Wedding of a child of the employee.

Maternity leave. Circumcision/baptism of a child

of the employee.
Reason for leave Monthly period leave ( for women only ).
Birth of a child of the employee.
Marriage of the employee.

Project Leave/ Offwork √ Long Service Leave

(the 7th year) on 1st August 2017

* Fisiotheraphy @ Bina Husada Cibinong Hospital

Note : In case of sick leave, doctor's certificate should submitted together with this form.

Record Balance carried forward Leaves conformed by this appl. Balance after this appl.

Annual Leave

Address to be Address : Bumi Cakra Blok B.1/7 Telp. No. : 087770409295

contacted during RT.03/08 Pondok Rajeg
leave. Cibinong, Bogor

Management Approval / Disapproval Acknowledge

 KI/FORM/HRD/03

LEAVE REQUISITION FORM

Rev : 1 / 15 Jun 09

Name : Irwan Priyatna Signature ………………………….

12-Apr-18 16-Apr-18
Date Date
From : And
08:00 17:00
Period of leave Time Time

Number of days off : 2 days

( excluding public holiday / office holiday )

Annual leave ( 12 days per year ). Death of husband/wife, parents,

parents in law, child of the the
Un-paid leave. employee.

Sick leave. Wedding of a child of the employee.

Maternity leave. Circumcision/baptism of a child

of the employee.
Reason for leave Monthly period leave ( for women only ).
Birth of a child of the employee.
Marriage of the employee.

Project Leave/ Offwork √ Long Service Leave

(the 7th year) on 1st August 2017

Note : In case of sick leave, doctor's certificate should submitted together with this form.

Record Balance carried forward Leaves conformed by this appl. Balance after this appl.

Annual Leave 10 2 8

Address to be Address : Bumi Cakra Blok B.1/7 Telp. No. : 087770409295

contacted during RT.03/08 Pondok Rajeg
leave. Cibinong, Bogor

Management Approval / Disapproval Acknowledge

 KI/FORM/HRD/04

LEAVE RECORD 2002

Name of Employee :
Date of Employment :

Total
Month 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 A B C D E F G H I J K

Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec

Note : A= Annual leave. G= Death of husband/wife, parents, parents in law, child of the employee. Total used
B= Sick leave. H= Wedding of a child of the employee. Available
C= Maternity leave. I = Circumcision/baptism of a child of the employee. Balance
D= Monthly period leave. J= Private needs of the employee ( not exceeds 10 days per year ).
E= Marriage of the Employee. K= Civic duties.
F= Birth of a child of the employee.
Approved Checked Prepared
 KI/FORM/HRD/04

LEAVE RECORD
Period : 2002 ~
Name of Employee :
Date of Employment :

Total
Month 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 A B C D E F G H I J K

Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec

Note : A= Annual leave. G= Death of husband/wife, parents, parents in law, child of the employee. Total used
B= Sick leave. H= Wedding of a child of the employee. Available
C= Maternity leave. I = Circumcision/baptism of a child of the employee. Balance
D= Monthly period leave. J= Private needs of the employee ( not exceeds 10 days per year ).
E= Marriage of the Employee. K= Civic duties.
F= Birth of a child of the employee.
Approved Checked Prepared
 KI/FORM/HRD/05

PERFORMANCE APPRAISAL
NAME OF EMPLOYEE BIRTHDAY DATE OF EMPLOYMENT PERIOD OF
APPRAISAL

EMPLOYMENT STATUS SECTION POSITION to

NO. FACTOR APPRAISED SCORE REMARKS

Employee I II III IV V (Average)

A OUT PUT OF WORKS. SCORE RATING :

1. Quantity. A = Excellent
2. Quality. B = Above average
3. Punctuality. C = Average
D = Below average
E = Bad
B WORKING METHOD.

1. Knowledge of work.
2. Skill of work.
3. Teamworking.
4. Carefulness.
5. Motivation / effort.
6. Initiative / creativity.

C ATTITUDE AND PERSONALITY

1. Responsibility.
2. Dependability.
3. Obedience / dicipline.
4. Interpersonal relationship.
5. Achievement / learning motivation
6. Attendance / absence.

D MANAGERIAL SKILL

1. Leadership.
2. Planning and organizing.
3. Analyze and problem solving.
4. Innovation and improvement.

FINAL SCORE

APPRAISED BY
NO NAME POSITION INITIAL DATE COMMENTS

Employee -

II

III

IV

V
 KI/FORM/HRD/0
KI/FORM/HRD/05
5
KI/FORM/HRD/05

PERFORMANCE APPRAISAL
Rev : 1
NAME OF EMPLOYEE BIRTHDAY DATE OF EMPLOYMENT PERIOD OF APPRAISAL

EMPLOYMENT STATUS SECTION POSITION to

NO. FACTORS CRITERIA EVALUATION

I II III IV V
Attitude towards job obligations as assigned by the superior as well as in compliance with
1 Disciplinary
Company regulations.

2 Achievement Ability to complete targeted job with good standart qualitywithin time schedule

3 Relationship Ability to create good relationship with all concerned parties to reach company objective

4 Problem Solving Ability to take righ decition and effective actions as situations and conditions

5 Communication Ability to express ideas and initiative clearly to support smooth completion of the job

Stable personality and ability to appear and act properly in every situation, condition
6 Marurity
and social envoroment.

7 Planning Ability to anticipate future condition based on existing condition

8 Negotiation Ability to presuade other party to reach mutual agreement

Moral comitment to reach company objectives, as such as being fully aware of any posible
9 Responsibility
consequencies of the job
Attitude toward the company and awareness to keep and maintain belonging and good
10 Sense of belonging
good reputation of the company

11 Secrecy Ability to keep secret and not disclose the job issues to unconcernede party

12 Leadership Ability to manage and control people and get them to cary out their tasks and responsibility

13 Supervision Ability to prepare and establish appropriate system to monitor the work of the subordinates

14 Man - Management Ability to create effective work system by utilizing all resources available

Knowledge about company,s business activities in order to be able to syncronize his work
15 Enterprenuership
program with company objective

SCORE

RATING LEVELS : A = Exellent B = Very Good C = Average E = Below Average

APPRAISED BY
NO NAME POSITION INITIAL DATE COMMENTS

I Employee

II

III

IV
V
 KI/FORM/HRD/0
KI/FORM/HRD/05
5
KI/FORM/HRD/05

PERFORMANCE APPRAISAL
Rev : 2 / 1 Nov 08
NAME OF EMPLOYEE BIRTH DATE DATE OF EMPLOYMENT PERIOD OF APPRAISAL

EMPLOYMENT STATUS SECTION POSITION to

NO. FACTORS CRITERIA EVALUATION

I II III IV V
Attitude towards job obligations as assigned by the superior as well as in compliance with
1 Disciplinary
Company regulations.

2 Achievement Ability to complete targeted job with good standard quality within time schedule

3 Relationship Ability to create good relationship with all concerned parties to reach company objective

4 Problem Solving Ability to take righ decition and effective actions in every situations and conditions

5 Communication Ability to express ideas and initiative clearly to support smooth completion of the job

Stable personality and ability to appear and act properly in every situation, condition
6 Maturity
and social environment.

7 Planning Ability to anticipate future condition based on existing condition

8 Negotiation Ability to persuade other party to reach mutual agreement

Moral comitment to reach company objectives, such as being fully aware of any posible
9 Responsibility
consequencies of the job

Attitude toward the company and awareness to keep and maintain sense of belonging and
10 Sense of belonging
good reputation of the company

11 Secrecy Ability to keep secret and not disclose the job issues to unconcerned party

12 Leadership Ability to manage and control people and get them to cary out their tasks and responsibility

13 Supervision Ability to prepare and establish appropriate system to monitor the work of the sub-ordinates

14 Man - Management Ability to create effective work system by utilizing all available resources

Knowledge about company,s business activities in order to be able to syncronize his work
15 Enterprenuership
program with company objective

Implementation of all safety procedure, work instruction and general safety standard practice
16 Safety Awareness & Implementation
and guidelines adopted by the company, as stated in the company Policy.

SCORE

RATING LEVELS : A = Excellent B = Very Good C = Average D = Below Average E = Poor

APPRAISED BY
NO NAME POSITION INITIAL DATE COMMENTS

I Employee

II

III
IV

V
D/05
 KI/FORM/HRD/06

SURAT TUGAS
No. 19/ST/V-2001

Diberikan kepada :

Nama
Jabatan

Uraian Tugas

Waktu

Dikeluarkan di : Jakarta
Pada tanggal :

_______________

Personnel

cc : SPTP PT. Kajima Indonesia.

 KI/FORM/HRD/07

EMERGENCY CONTACT
Project : PT. JST INDONESIA JAKARTA PLANT Ph4

PRESIDENT DIRECTOR
SECRETARY

KAJIMA CORP. (TOKYO) KOA HQ (SINAPORE)

TEL. 001.81.3.5324.5876 TEL. 001.65.339.8890
FAX. 001.81.3.5324.5948 FAX. 001.65.339.1985
HEAD OFFICE
TEL. 021.572.4477
FAX. 021.572.4433

OWNER
Name : PT. JST Indonesia SITE OFFICE
Jakarta Plant Name : JST Ph4 Project
Tel. : 021.8998 2040 MM2100
Tel. : 021-8998-2004

POLICE TELEPHONE
Name : Polsek Cibitung TOYO DENSO Name : MM2100
Tel. : 021-890-1150 Name : Site Office MM2100 Tel. : 021-898-1001
Tel. : 021-8998-2530

MM-2100 SEWERAGE
Name : Mr. Darwoto Name : MM2100
Tel. : 021-898-1001 SITE OFFICE Tel. : 021-898-1001
Name : Cikarang Office
Tel. : 021-897-5318
FIRE GAS
Name : Damkar Bekasi Name : CV. Jaya Teknik
Tel. : 021-880-1227 Tel. : 021-897-0593
SIG SITE OFFICE
Name : Delta Silicon
HOSPITAL Tel. : 021-8990-0222 ARMY
Name : Karya Medika Name : Koramil Cbt.
Tel. : 021-890-0191 Tel. : 021-897-0593

OTHERS PROJECT
HEALTH Name : Delta Silicon
Name : Klinik Permata MM Tel. : 021-8970-1067
Tel. : 021-898-0734
 KI/FORM/HRD/08

PROJECT : …………………………..

SALARY ADJUSTMENT FORM

NO. NAME POSITION CURRENT SALARY NEW SALARY REASON

Amount Effective Date

1
2
3
4
5
6
7
8
9
10

SUBMITTED BY MANAGEMENT INITIAL DATE COMMENT

INITIAL DATE

Deputy P.M. President Director

Site Manager Director

Deputy S.M. Project Manager

Processed by Personnel
 KI/FORM/HRD/09

PROJECT : ……………………………..

ACCIDENT REPORT
LAPORAN KECELAKAAN

REPORTED BY
DILAPORKAN OLEH

Name : Date :
Nama : Tanggal :

Section/Position : Time :
Seksi/Jabatan : Waktu :

Signature :
Tanda Tangan :

DETAILS OF ACCIDENT
KETERANGAN KECELAKAAN

Casualty's Name : SKETCH OF LOCATION

Nama Korban : DENAH LOKASI KECELAKAAN

Section/Position :
Seksi/Jabatan :

Date :
Tanggal :

Time :
Waktu :

Location :
Lokasi :

Description :
Uraian Kecelakaan :

First aid taken

Pertolongan pertama yang telah diberikan

ACKNOWLEDGE
P.M S.M ADM.
 KI/FORM/HRD/10

OVERTIME AUTHORIZATION

Name : ………………………………………. Position : …………………………..

NIK : ………………………………………. Section : …………………………..

Day

Date
OVERTIME
Estimated Start

Time Finish

Reason & …………………………………………………………………………………………………

Target for
Overtime …………………………………………………………………………………………………

Day

Date
OVERTIME
Actual Start

Time Finish
Approved By : Acknowledge By : Instructed By :

c.2014.PTGA/1.2

KI/FORM/HRD/10

OVERTIME AUTHORIZATION

Name : ………………………………………. Position : …………………………..

NIK : ………………………………………. Section : …………………………..

Day
OVER TIME
Date
OVERTIME
Estimated Start
TIME
Time Finish

Reason & …………………………………………………………………………………………………

Target for
Overtime …………………………………………………………………………………………………

Day

Date
OVERTIME
Actual Start

Time Finish
Approved By : Acknowledge By : Instructed By :

c.2014.PTGA/1.2
 OVERTIME INSTRUCTION SHEET

Date :
Project / Section :
Day :

No. Name Position Estimated O/T Reason for Overtime

Start Finished
1

Instructed by

Name

Date

OVERTIME INSTRUCTION SHEET

Date :
Project / Section :
Day :

No. Name Position Estimated O/T Reason for Overtime

Start Finished
1

Instructed by

Name
Date
 KI/FORM/HRD/10

Rev. 1

ERTIME INSTRUCTION SHEET

Reason for Overtime

Instructed by

: …………………

: …………………

KI/FORM/HRD/10

Rev. 1

ERTIME INSTRUCTION SHEET

Reason for Overtime

Instructed by

: …………………
: …………………
PT. KAJIMA INDONESIA

OVERTIME INSTRUCTION SHEET

Name : Section / Position :

No. Date Day Estimated O/T Reason for Overtime

Start Finished

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

31
VERTIME INSTRUCTION SHEET

Instructed by
 KI/FORM/HRD/11

TRAINING REQUEST Page 1 of 2

NOMINATOR TO BE COMPLETED & RETURNED TO :

Name : ……………………………….. Manager General affairs / Personel

Job Title : ………………………………..

…………………………………..
Signature

PART 1 : TO BE COMPLETED BY THE NOMINATOR

1. Trainee's Name (as in NR/C) : ……………………………………………………………….

2. I/C No (New) : ……………………………………………………………….

3. Department : ……………………………………………………………….

4. Course Title : ……………………………………………………………….

(Please enclose a photocopy of the course brochure)

5. Date(s) : ………………………………………………………………………………………………………….

6. Organised by : ………………………………………………………………………………………………………….

7. Venue : ………………………………………………………………………………………………………….

8. Course Fee : ………………………………………………………………………………………………………….

9. Additional Expenses : Travel Rp. : ………………… Hotel Rp. : …………. Food Rp. : …………….
10. Please explain the nominee's major responsibilities, and state how attending this course can help
enchance his/her job knowledge and work performance :

………………………………………………………………………………………………………………………………………….

………………………………………………………………………………………………………………………………………….

………………………………………………………………………………………………………………………………………….

………………………………………………………………………………………………………………………………………….

………………………………………………………………………………………………………………………………………….

11. Have you issued the trainee the course outline and work performance improvement objectives to be
achieved as a result of attending this training programme ? Yes No

12. Is it essential that the trainee attend their external course at this point of time ? Yes No

OR should this course be organised by the company within the next one (1) year, can the trainee
wait and attend the course intenally ? Yes No
 KI/FORM/HRD/11

TRAINING REQUEST Page 2 of 2

PART 2 : RECOMMENDATION FROM HEAD OF DEPARTMENT/SECTION

Recommended to Attend Not Recommended

…………………………………. ……………………………..
Signature Date
Name :

PART 3 : FOR PROCESSING BY GENERAL AFFAIRS/PERSONNEL SECTION

Recommended to Attend Not Recommended

Comments : ……………………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………………………………………
Date Replied :…………………………….. By Phone By Mail By Fax

Any further action : ……………………………………………………………………………………………………………………..

…………………………………………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………………………………………

…………………………… …………………………..
Signature Date
Name :

PART 4. MANAGING DIRECTOR'S APPROVAL

Recommended to Attend Not Recommended

…………………………… …………………………..
Signature Date
Name :
 KI/FORM/HRD/11
KI/FORM/HRD/11

KI/FORM/HRD/11

TRAINING REQUEST (Rev.1) Page 1 of 2

NOMINATOR TO BE COMPLETED & RETURNED TO :

Yang mengusulkan Harus dilengkapi & dikembalikan ke :

Name : Mrs. L.F. Yanti Chief Personel

Job Title : Chief Accounting

Jabatan

…………………………………..
Signature

PART 1 : TO BE COMPLETED BY THE NOMINATOR

PART 1 : Harus diisi oleh yang mengusulkan

1. Trainee's Name (as in NR/C) : Mr. Herman Rizani

Nama peserta
2. I/C No (New) :-
No pegawai
3. Department : Personel
Bagian
4. Course Title : Corporation Income Tax in Accounting Report Compare with Fiscal
Topik training Version
(Please enclose a photocopy of the course brochure)
(sertakan fotocopy dari brosur training)
5. Date(s) : 17 Juni 2003
Tanggal
6. Organised by : Workshop Akutansi
Dilaksanakan oleh
7. Venue : Hotel Millenium Sirih, Jakarta
Lokasi
8. Course Fee : Rp. 880.000,-
Biaya training
9. Additional Expenses : Travel Rp. : - Hotel Rp. : - Food Rp. : -
Biaya tambahan Perjalanan Hotel Makan
10. Please explain the nominee's major responsibilities, and state how attending this course can help
enhance his/her job knowledge and work performance :
Tolong jelaskan tanggung jawab dari peserta, dan jelaskan bagaimana dengan mengikuti training ini
dapat meningkatkan pengetahuan dan kerja peserta :
………………………………………………………………………………………………………………………………………….

………………………………………………………………………………………………………………………………………….

………………………………………………………………………………………………………………………………………….

………………………………………………………………………………………………………………………………………….

11. Have you issued the trainee the course outline and work performance improvement objectives to be
achieved as a result of attending this training programme ? Yes No
Sudahkah anda menjelaskan tentang training ini dan tujuan peningkatan kerja yang
harus dicapai sebagai hasil keikutsertaan pada training tersebut ?
12. Is it essential that the trainee attend their external course at this point of time ? Yes No
Apakah penting bagi peserta untuk menghadiri training pada saat ini ?

OR should this course be organised by the company within the next one (1) year, can the trainee
wait and attend the course internally ? Yes No
Atau bisakah training ini dilaksanakan sendiri oleh perusahaan dalam waktu 1 tahun
ini, dapatkah peserta menunggu dan mengikuti training dalam perusahaan ?
 KI/FORM/HRD/11

TRAINING REQUEST (Rev.1) Page 2 of 2

PART 2 : RECOMMENDATION FROM CHIEF SECTION

PART 2 : Rekomendasi dari chief department / section

Recommended to Attend Not Recommended

Direkomendasikan tidak direkomendasikan

…………………………………. ……………………………..
Signature Date
Name :

PART 3 : FOR PROCESSING BY PERSONNEL SECTION

PART 3 : Untuk diproses oleh HRD

Recommended to Attend Not Recommended

Direkomendasikan tidak direkomendasikan
Comments
Komentar : ……………………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………………………………………
Date Replied :…………………………….. By Phone By Mail By Fax
Tanggal dibalas dengan telepon dengan surat dengan fax

Any further action :

Keterangan lebih lanjut :
…………………………………………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………………………………………

…………………………… …………………………..
Signature Date
Name :

PART 4. DIRECTOR'S APPROVAL

PART 4 : Persetujuan Management

Recommended to Attend Not Recommended

Direkomendasikan tidak direkomendasikan

…………………………… …………………………..
Signature Date
Name :
 KI/FORM/HRD/11

TRAINING REQUEST (Rev.1) Page 1 of 2

NOMINATOR TO BE COMPLETED & RETURNED TO :

Yang mengusulkan Harus dilengkapi & dikembalikan ke :

Name : Mrs. L.F. Yanti Chief Personel

Job Title : Chief Accounting

Jabatan

…………………………………..
Signature

PART 1 : TO BE COMPLETED BY THE NOMINATOR

PART 1 : Harus diisi oleh yang mengusulkan

1. Trainee's Name (as in NR/C) : Mr. Asep S.

Nama peserta
2. I/C No (New) :-
No pegawai
3. Department : Accouting
Bagian
4. Course Title : Corporation Income Tax in Accounting Report Compare with Fiscal
Topik training Version
(Please enclose a photocopy of the course brochure)
(sertakan fotocopy dari brosur training)
5. Date(s) : 17 Juni 2003
Tanggal
6. Organised by : Workshop Akutansi
Dilaksanakan oleh
7. Venue : Hotel Millenium Sirih, Jakarta
Lokasi
8. Course Fee : Rp. 880.000,-
Biaya training
9. Additional Expenses : Travel Rp. : - Hotel Rp. : - Food Rp. : -
Biaya tambahan Perjalanan Hotel Makan
10. Please explain the nominee's major responsibilities, and state how attending this course can help
enhance his/her job knowledge and work performance :
Tolong jelaskan tanggung jawab dari peserta, dan jelaskan bagaimana dengan mengikuti training ini
dapat meningkatkan pengetahuan dan kerja peserta :
………………………………………………………………………………………………………………………………………….

………………………………………………………………………………………………………………………………………….

………………………………………………………………………………………………………………………………………….

………………………………………………………………………………………………………………………………………….

11. Have you issued the trainee the course outline and work performance improvement objectives to be
achieved as a result of attending this training programme ? Yes No
Sudahkah anda menjelaskan tentang training ini dan tujuan peningkatan kerja yang
harus dicapai sebagai hasil keikutsertaan pada training tersebut ?
12. Is it essential that the trainee attend their external course at this point of time ? Yes No
Apakah penting bagi peserta untuk menghadiri training pada saat ini ?

OR should this course be organised by the company within the next one (1) year, can the trainee
wait and attend the course internally ? Yes No
Atau bisakah training ini dilaksanakan sendiri oleh perusahaan dalam waktu 1 tahun
ini, dapatkah peserta menunggu dan mengikuti training dalam perusahaan ?
 KI/FORM/HRD/11

TRAINING REQUEST (Rev.1) Page 2 of 2

PART 2 : RECOMMENDATION FROM CHIEF SECTION

PART 2 : Rekomendasi dari chief department / section

Recommended to Attend Not Recommended

Direkomendasikan tidak direkomendasikan

…………………………………. ……………………………..
Signature Date
Name :

PART 3 : FOR PROCESSING BY PERSONNEL SECTION

PART 3 : Untuk diproses oleh HRD

Recommended to Attend Not Recommended

Direkomendasikan tidak direkomendasikan
Comments
Komentar : ……………………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………………………………………
Date Replied :…………………………….. By Phone By Mail By Fax
Tanggal dibalas dengan telepon dengan surat dengan fax

Any further action :

Keterangan lebih lanjut :
…………………………………………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………………………………………

…………………………… …………………………..
Signature Date
Name :

PART 4. DIRECTOR'S APPROVAL

PART 4 : Persetujuan Management

Recommended to Attend Not Recommended

Direkomendasikan tidak direkomendasikan

…………………………… …………………………..
Signature Date
Name :
 KI/FORM/HRD/11

TRAINING REQUEST (Rev.1) Page 1 of 2

NOMINATOR TO BE COMPLETED & RETURNED TO :

Yang mengusulkan Harus dilengkapi & dikembalikan ke :

Name : ……………………………….. Chief Personel

Job Title : ………………………………..

Jabatan

…………………………………..
Signature

PART 1 : TO BE COMPLETED BY THE NOMINATOR

PART 1 : Harus diisi oleh yang mengusulkan

1. Trainee's Name (as in NR/C) : ……………………………………………………………….

Nama peserta
2. I/C No (New) : ……………………………………………………………….
No pegawai
3. Department : ……………………………………………………………….
Bagian
4. Course Title : ……………………………………………………………….
Topik training
(Please enclose a photocopy of the course brochure)
(sertakan fotocopy dari brosur training)
5. Date(s) : ………………………………………………………………………………………………………….
Tanggal
6. Organised by : ………………………………………………………………………………………………………….
Dilaksanakan oleh
7. Venue : ………………………………………………………………………………………………………….
Lokasi
8. Course Fee : ………………………………………………………………………………………………………….
Biaya training
9. Additional Expenses : Travel Rp. : ………………… Hotel Rp. : …………. Food Rp. : …………….
Biaya tambahan Perjalanan Hotel Makan
10. Please explain the nominee's major responsibilities, and state how attending this course can help
enhance his/her job knowledge and work performance :
Tolong jelaskan tanggung jawab dari peserta, dan jelaskan bagaimana dengan mengikuti training ini
dapat meningkatkan pengetahuan dan kerja peserta :
………………………………………………………………………………………………………………………………………….

………………………………………………………………………………………………………………………………………….

………………………………………………………………………………………………………………………………………….

………………………………………………………………………………………………………………………………………….

11. Have you issued the trainee the course outline and work performance improvement objectives to be
achieved as a result of attending this training programme ? Yes No
Sudahkah anda menjelaskan tentang training ini dan tujuan peningkatan kerja yang
harus dicapai sebagai hasil keikutsertaan pada training tersebut ?
12. Is it essential that the trainee attend their external course at this point of time ? Yes No
Apakah penting bagi peserta untuk menghadiri training pada saat ini ?

OR should this course be organised by the company within the next one (1) year, can the trainee
wait and attend the course internally ? Yes No
Atau bisakah training ini dilaksanakan sendiri oleh perusahaan dalam waktu 1 tahun
ini, dapatkah peserta menunggu dan mengikuti training dalam perusahaan ?
 KI/FORM/HRD/11

TRAINING REQUEST (Rev.1) Page 2 of 2

PART 2 : RECOMMENDATION FROM CHIEF SECTION

PART 2 : Rekomendasi dari chief department / section

Recommended to Attend Not Recommended

Direkomendasikan tidak direkomendasikan

…………………………………. ……………………………..
Signature Date
Name :

PART 3 : FOR PROCESSING BY PERSONNEL SECTION

PART 3 : Untuk diproses oleh HRD

Recommended to Attend Not Recommended

Direkomendasikan tidak direkomendasikan
Comments
Komentar : ……………………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………………………………………
Date Replied :…………………………….. By Phone By Mail By Fax
Tanggal dibalas dengan telepon dengan surat dengan fax

Any further action :

Keterangan lebih lanjut :
…………………………………………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………………………………………

…………………………… …………………………..
Signature Date
Name :

PART 4. DIRECTOR'S APPROVAL

PART 4 : Persetujuan Management

Recommended to Attend Not Recommended

Direkomendasikan tidak direkomendasikan

…………………………… …………………………..
Signature Date
Name :
 KI/FORM/HRD/12

TRAINING PROGRAM - 2002 rev.0

PERIOD
TRAINING SUBJECT TRAINEE TYPE
JUN JUL AUG SEP OCT NOV DEC

Internal Quality Audit 1. Mr. Soga PD

2. Mr. Yefrihendy IN
3. Mr. Rahmad
4. Mr. Mahmud
5. Mr. Yuli
6. Mr. Tri P
7. Mrs. Tina
8. Mr. Didi

LEGEND : Q - Quality ST - Skill Training IN - In-house Trainig

S/Q - Safety, Other PD - Personal Development EX - External training

Prepared by : Verified by : Approved by :

……………………………………………………………… …………………………………………… …………………………………………………

Manager General Affair / Personel Management Representative Director
 KI/FORM/HRD/12

TRAINING PROGRAM - 2003 rev.1 Page 1 of 7

PERIOD
TRAINING SUBJECT TRAINEE TYPE
JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC
Project ( Chief Supervisor )
- QP Customer Communication 1 Mr. Rahmat IN
- QP Corrective & Preventive 2 Mr. Budi IN
- QP Project Development 3 Mr. Sumaryono IN
4 Mr. Faisal IN
5 Mr. Suherman IN
6 Mr. Dodi IN 14 January 2003
7 Mr. Basri IN
8 Mr. Toha ( survey) IN
9 Mr. Darim ( survey ) IN
10 Mr. Warkam ( survey ) IN
11 Mr. Manorus ( survey ) IN

Project ( Chief Supervisor )

- QP Material Receiving 1 Mr. Rahmat IN
- QP Material Order 2 Mr. Budi IN
- QP Project & Technical Doc Control 3 Mr. Sumaryono IN
4 Mr. Faisal IN
5 Mr. Suherman IN
6 Mr. Dodi IN 15 January 2003
7 Mr. Basri IN
8 Mr. Toha ( survey) IN
9 Mr. Darim ( survey ) IN
10 Mr. Warkam ( survey ) IN
11 Mr. Manorus ( survey ) IN

LEGEND : Q - Quality ST - Skill Training IN - In-house Trainig

S/Q - Safety, Other PD - Personal Development EX - External training
 KI/FORM/HRD/12

TRAINING PROGRAM - 2003 rev.1 Page 2 of 7

PERIOD
TRAINING SUBJECT TRAINEE TYPE
JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC
Project ( Chief Supervisor )
- QP Non Conformance Control 1 Mr. Rahmat IN
- WI Safety In Project 2 Mr. Budi IN
- WI Site Preparation 3 Mr. Sumaryono IN
4 Mr. Faisal IN
5 Mr. Suherman IN
6 Mr. Dodi IN 21 January 2003
7 Mr. Basri IN
8 Mr. Toha ( survey) IN
9 Mr. Darim ( survey ) IN
10 Mr. Warkam ( survey ) IN
11 Mr. Manorus ( survey ) IN

Project ( Chief Supervisor )

- WI Project Instruction 1 Mr. Rahmat IN
- WI Monthly Progres Report 2 Mr. Budi IN
- WI Vendor Monitoring 3 Mr. Sumaryono IN
4 Mr. Faisal IN
5 Mr. Suherman IN
6 Mr. Dodi IN 22 January 2003
7 Mr. Basri IN
8 Mr. Toha ( survey) IN
9 Mr. Darim ( survey ) IN
10 Mr. Warkam ( survey ) IN
11 Mr. Manorus ( survey ) IN

LEGEND : Q - Quality ST - Skill Training IN - In-house Trainig

S/Q - Safety, Other PD - Personal Development EX - External training
 KI/FORM/HRD/12

TRAINING PROGRAM - 2003 rev.1 Page 3 of 7

PERIOD
TRAINING SUBJECT TRAINEE TYPE
JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC
Project ( Chief Supervisor )
- WI Project Hand over 1 Mr. Rahmat IN
- WI Maintenance 2 Mr. Budi IN
- WI Survey Equipment Control 3 Mr. Sumaryono IN
4 Mr. Faisal IN
5 Mr. Suherman IN
6 Mr. Dodi IN 28 January 2003
7 Mr. Basri IN
8 Mr. Toha ( survey) IN
9 Mr. Darim ( survey ) IN
10 Mr. Warkam ( survey ) IN
11 Mr. Manorus ( survey ) IN

Project ( Supervisor )
- QP Customer Comunication 1 Mr. Sahrul IN
- QP Corrective & Prepentive 2 Mr. Suwandi IN
- QP Material Storage 3 Mr. Rizal Munajad IN
- QP Material Distribution 4 Mr. Uja IN
5 Mr. Dede Masduki IN
6 Mr. Tri Priyadi IN 29 January 2003
7 Mr. Sumedi IN
8 Mr. Haris Sc. IN
9 Mr. Wahab IN
10 Mr. Rosevelt IN
11 Mr. Tugiono IN
12 Mr. Safrial IN

Personel
Strategic HR Management 1 Mr. Herman Rizani EX 30 January 2003

LEGEND : Q - Quality ST - Skill Training IN - In-house Trainig

S/Q - Safety, Other PD - Personal Development EX - External training
 KI/FORM/HRD/12

TRAINING PROGRAM - 2003 rev.1 Page 4 of 7

PERIOD
TRAINING SUBJECT TRAINEE TYPE
JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC
Project ( Supervisor )
- QP Non Conformance Control 1 Mr. Sahrul IN
- QP Project Quality Control 2 Mr. Suwandi IN
- WI Safety In Project 3 Mr. Rizal Munajad IN
4 Mr. Uja IN
5 Mr. Dede Masduki IN
6 Mr. Tri Priyadi IN 4 February 2003
7 Mr. Sumedi IN
8 Mr. Haris Sc. IN
9 Mr. Wahab IN
10 Mr. Rosevelt IN
11 Mr. Tugiono IN
12 Mr. Safrial IN

Project ( Supervisor )
- WI Vendor Monitoring 1 Mr. Sahrul IN
- WI Inspection Record 2 Mr. Suwandi IN
- WI Maintenance 3 Mr. Rizal Munajad IN
- WI Inspection & Testing Procedure 4 Mr. Uja IN
5 Mr. Dede Masduki IN
6 Mr. Tri Priyadi IN 5 February 2003
7 Mr. Sumedi IN
8 Mr. Haris Sc. IN
9 Mr. Wahab IN
10 Mr. Rosevelt IN
11 Mr. Tugiono IN
12 Mr. Safrial IN

LEGEND : Q - Quality ST - Skill Training IN - In-house Trainig

S/Q - Safety, Other PD - Personal Development EX - External training
 KI/FORM/HRD/12

TRAINING PROGRAM - 2003 rev.1 Page 5 of 7

PERIOD
TRAINING SUBJECT TRAINEE TYPE
JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC
Project (Chief Drafter & Drafter)
- QP Costumer Comunication 1 Mr. Eko J. IN
- QP Corrective Preventive 2 Mr. M. Nur IN
- QP Project & Technical Doc Control 3 Mr. Muzaini Asror IN
4 Mr. Tri Suwantoro IN
5 Mr. Djoko Susilo IN
6 Mr. Muryanto IN
7 Mr. Subandi IN 13 February 2003
8 Mr. Mashud IN
9 Mr. Sri Bernard S IN
10 Mr. Heri Widodo IN
11 Mr. Ernawan A IN
12 Mr. M Yusuf IN
13 Mr. Denny R IN

Project (Chief Drafter & Drafter)

- QP Non Conformance Control 1 Mr. Eko J. IN
- WI Maintanence 2 Mr. M. Nur IN
3 Mr. Muzaini Asror IN
4 Mr. Tri Suwantoro IN
5 Mr. Djoko Susilo IN
6 Mr. Muryanto IN
7 Mr. Subandi IN 14 February 2003
8 Mr. Mashud IN
9 Mr. Sri Bernard S IN
10 Mr. Heri Widodo IN
11 Mr. Ernawan A IN
12 Mr. M Yusuf IN
13 Mr. Denny R IN

LEGEND : Q - Quality ST - Skill Training IN - In-house Trainig

S/Q - Safety, Other PD - Personal Development EX - External training
 KI/FORM/HRD/12

TRAINING PROGRAM - 2003 rev.1 Page 6 of 7

PERIOD
TRAINING SUBJECT TRAINEE TYPE
JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC
Project ( All Staff )
Manual Book Surabaya Project Staff IN 17 ~ 19 February 2003

Finance
Vision Enterprises-An Analytic Tools to 1 Mrs. Liani Farijanti EX 20 February 2003
gain visibility into your business 2 Mr. Asep Saefullah
information 3 Mr. Isro
4 Mr. Anang Purwantoro

Management Representative
Lead Auditor 1 Mr. Yefrihendi EX 24 ~ 28 February 2003

Logistic
- QP Customer Communication 1 Mr. Sahrizal IN
- QP Corrective preventive 2 Mr. Warsad IN
- QP Material Receiving 3 Mr. Tumino IN 25 February 2003
- QP Material Distribution 4 Mr. Solihin IN
5 Mr. Alephen IN
6 Mr. Suyud IN

Logistic
- QP Non Conformance Control 1 Mr. Sahrizal IN
- QP Material Order 2 Mr. Warsad IN
- QP Material Storage 3 Mr. Tumino IN 26 February 2003
4 Mr. Solihin IN
5 Mr. Alephen IN
6 Mr. Suyud IN

LEGEND : Q - Quality ST - Skill Training IN - In-house Trainig

S/Q - Safety, Other PD - Personal Development EX - External training
 KI/FORM/HRD/12

TRAINING PROGRAM - 2003 rev.1 Page 7 of 7

PERIOD
TRAINING SUBJECT TRAINEE TYPE
JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC
Logistic
- WI Rejected material Suply 1 Mr. Sahrizal IN
- WI Survey Equipment Control 2 Mr. Warsad IN
- WI Vendor Sourching 3 Mr. Tumino IN 5 March 2003
4 Mr. Solihin IN
5 Mr. Alephen IN
6 Mr. Suyud IN

Administrasi
- QP Customer Comunication 1 Mr. Nana Supriatna IN
- QP Corrective Preventive 2 Mr. Erwan Ermawan IN 6 March 2003
3 Mr. Kustam IN
4 Mr. Didi Supriyadi IN

Administrasi
- QP Vendor Payment Procedure 1 Mr. Nana Supriatna IN
- QP Non Conformance Control 2 Mr. Erwan Ermawan IN 11 March 2003
- WI Safety in Project 3 Mr. Kustam IN
4 Mr. Didi Supriyadi IN

TOTAL COST =

LEGEND : Q - Quality ST - Skill Training IN - In-house Trainig

S/Q - Safety, Other PD - Personal Development EX - External training

Prepared by : Verified by : Approved by :

…………………………………………………… ……………………….. …………………………………………… ………………. …………………………………………………

Manager General Affair / Personel date Management Representative date Director
KI/FORM/HRD/12

Cost
Cost
Cost
Cost
KI/FORM/HRD/12

Cost
KI/FORM/HRD/12

Cost

Rp -

Rp 4,400,000
 Cost

Rp 4,400,000

…………………………
date
 KI/FORM/HRD/12

TRAINING PROGRAM - 2003 rev.1 Page 1 of 2

PERIOD
TRAINING SUBJECT TRAINEE TYPE Cost
JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC
Project ( Chief Supervisor )
- QP Customer Communication
- QP Corrective & Preventive
- QP Project Development
- QP Material Receiving
- QP Material Order
- QP Project & Technical Doc Control
- QP Non Conformance Control
- WI Safety In Project Chief Supervisor IN Rp 2,750,000
- WI Site Preparation
- WI Project Instruction
- WI Monthly Progres Report
- WI Vendor Monitoring
- WI Project Hand over
- WI Maintenance
- WI Survey Equipment Control

Project ( Supervisor )
- QP Customer Comunication
- QP Corrective & Prepentive
- QP Material Storage
- QP Material Distribution
- QP Non Conformance Control
- QP Project Quality Control Supervisor IN Rp 1,800,000
- WI Safety In Project
- WI Vendor Monitoring
- WI Inspection Record
- WI Maintenance
- WI Inspection & Testing Procedure

Project (Chief Drafter & Drafter)

- QP Costumer Comunication
- QP Corrective Preventive
- QP Project & Technical Doc Control Drafter IN Rp 1,300,000
- QP Non Conformance Control
- WI Maintanence

LEGEND : Q - Quality ST - Skill Training IN - In-house Trainig

S/Q - Safety, Other PD - Personal Development EX - External training
 KI/FORM/HRD/12

TRAINING PROGRAM - 2003 rev.1 Page 2 of 2

PERIOD
TRAINING SUBJECT TRAINEE TYPE Cost
JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC
Project ( All Staff )
Manual Book Surabaya Project Staff IN Rp 300,000

Logistic
- QP Customer Communication
- QP Corrective preventive
- QP Material Receiving
- QP Material Distribution
- QP Non Conformance Control Logistic IN Rp 900,000
- QP Material Order
- QP Material Storage
- WI Rejected material Suply
- WI Survey Equipment Control
- WI Vendor Sourching

Administrasi
- QP Customer Comunication
- QP Corrective Preventive
- QP Vendor Payment Procedure Administrasi IN Rp 400,000
- QP Non Conformance Control
- WI Safety in Project

TOTAL COST = Rp 7,450,000

LEGEND : Q - Quality ST - Skill Training IN - In-house Trainig

S/Q - Safety, Other PD - Personal Development EX - External training

Prepared by : Verified by : Approved by :

…………………………………………………… ……………………….. …………………………………………… ………………. ………………………………………………… …………………………

Manager General Affair / Personel date Management Representative date Director date
 KI/FORM/HRD/13

TRAINING ATTENDANCE LIST Page No : ……………….

COURSE PARTICULARS

Name

Department

Designation

Qualification

Date Joined

Past Experiences

NO COURSES ATTENDED DATE REMARKS

 KI/FORM/HRD/14

Seminar / course title
Seminar / course date(s)
Training Organisation
Name of Staff Trained
TRAINING RESUME
: __________________________________ Trainee's Acknowledgement
: __________________________________
: __________________________________
: __________________________________ ______________________________
Name / Signature / Date

Please fill up this form by indicating the appropriate boxes with a cross ( X )
RATINGS
< Agree - Disagre >
1. TRAINEE 5 4 3 2 1
1.1 I know why I need to atend this course
1.2 I know what to expect from this course
1.3 I be;ieve my expecrtations have been met

2. COURSE
2.1 I understand the course objectives at the beginning of the course
2.2 I find the course duration reasonable
2.3 I find the course well organized
2.4 I am satisfied with the course contents / materials
2.5 I find this course relevant to my work
2.6 I have learnt a lot from this course
2.7 I can apply what I have learnt to my work

3. INSTRUCTOR
3.1 My instructor is able to explain the lessons clearly
3.2 My instructor is able to keep the lessons lively and interesting
3.3 My instructor makes me feel free to ask questions

4. GENERAL COMMENTS
4.1 Usefulness of new knowledge & skill acquired
4.2. I would not hesitate to introduce this course to my colleagues

TRAINING EVALUATION (by HOD - Please indicate level of Achievement, e.g. - A, B, etc.)
Improvement in Work performance - _________________
Improvement in Skill & Knowledge - _________________

Other comments :___________________________________________

Recommendation : Re-training / Next advance trainig / No training required

Name of immediate Superior of training staff _________________ Sign ___________ Date ____________

RATING CRITERIA
To HOD shall base on the following criteria to review the effectiveness of the training event attended
Level of Achievement
A - Has achieved the objectives
B - Above Average
C - Average - Trainee needs further practise to gain from lesson learnt
D - Good - Trainee has obtained the knowledge / information for future improvement
E - Below average - Trainee only captured the general information
 KI/FORM/HRD/14
KI/FORM/HRD/14
Rev. 1
TRAINING RESUME
Seminar / course title : __________________________________ Trainee's Acknowledgement
Judul seminar / training Sepengetahuan peserta
Seminar / course date(s) : __________________________________
Tanggal seminar / training
Training Organisation : __________________________________
Pelaksana training
Name of Staff Trained : __________________________________ ______________________________
Nama peserta training Name / Signature / Date

Please fill up this form by indicating the appropriate boxes with a cross ( X )
Silahkan isi form ini dengan menandai kotak memakai tanda silang ( X ) RATINGS
< Agree - Disagre >
<Setuju-Tidak Setuju>
1. TRAINEE / PESERTA 5 4 3 2 1
1.1 I know why I need to atend this course
Saya mengetahui mengapa harus mengikuti training ini
1.2 I know what to expect from this course
Saya mengetahui apa yang diharapkan dari training ini
1.3 I believe my expectations have been met
Saya percaya kemampuan saya sudah memenuhi syarat
2. COURSE / TRAINING
2.1 I understand the course objectives at the beginning of the course
Saya mengerti tujuan training ini dari awal training
2.2 I find the course duration reasonable
Saya meyadari lamanya training masuk akal
2.3 I find the course well organized
Saya menyadari training ini terorganisasi dengan baik
2.4 I am satisfied with the course contents / materials
Saya puas dengan materi dari training ini
2.5 I find this course relevant to my work
Saya mengetahui training ini berhubungan dengan kerjaan saya
2.6 I have learnt a lot from this course
Saya sudah mempelajari banyak dari training ini
2.7 I can apply what I have learnt to my work
Saya dapat menerapkan apa yang saya pelajari ke pekerjaan saya
3. INSTRUCTOR / INSTRUKTUR
3.1 My instructor is able to explain the lessons clearly
Instruktur saya dapat menjelaskan pelajaran dengan baik
3.2 My instructor is able to keep the lessons lively and interesting
Instruktur saya dapat membuat pelajaran lebih hidup dan menarik
3.3 My instructor makes me feel free to ask questions
Instruktur saya membuat saya merasa bebas bertanya
4. GENERAL COMMENTS / KOMENTAR
4.1 Usefulness of new knowledge & skill acquired
Mendapatkan pengetahuan dan kemampuan baru
4.2. I would not hesitate to introduce this course to my colleagues
Saya tidak malu untuk memperkenalkan training ini kepada rekan saya
TRAINING EVALUATION (by HOD - Please indicate level of Achievement, e.g. - A, B, etc.)
Improvement in Work performance - _________________
Peningkatan dalam pekerjaan
Improvement in Skill & Knowledge - _________________
Peningkatan dalam keahlian dan pengetahuan
Other comments :___________________________________________
Komentar lain
Recommendation : Re-training / Next advance training / No training required
Saran : Training kembali / training selanjutnya / tidak memerlukan training
Name of immediate Superior of training staff _________________ Sign ____________Date ____________
Nama atasan dari peserta training training
RATING CRITERIA
To HRD shall base on the following criteria to review the effectiveness of the training event attended
HRD berdasarkan penilaian ini akan meriview keefektifan training yang dihadiri
Level of Achievement
Tingkatan keberhasilan
A - Has achieved the objectives
Telah mencapai objective
B - Above Average
Diatas rata-rata
C - Average - Trainee needs further practise to gain from lesson learnt
Rata-rata - Peserta memerlukan latihan lebih lanjut
D - Good - Trainee has obtained the knowledge / information for future improvement
Bagus - Peserta telah mendapat pengetahuan / informasi untuk peningkatan kedepan
E - Below average - Trainee only captured the general information
Dibawah rata-rata - peserta hanya menangkap garis besarnya saja
 ACCIDENT RECORD
PROJECT : ………………
YEAR : ……………… KI/FORM/HRD/15

ACCIDENT POSITION SURAT Lap. THP I Lap. THP II CLAIM Tanggal Terima
NO. NAME DESCRIPTION Keterangan
DATE DAY TIME LOCATION CRAFT KET. DOC Dibuat Lapor Dibuat Lapor Diajukan Dibayar Acct.

ACKNOWLEDGE
Prepared
Management SM ADM.
 SUMMARY ACCIDENT RECORD KI/FORM/HRD/16
PROJECT IN YEAR …….

ACCIDENT RECORD YEAR ……..

NO. MONTH PROJECT

1 JANUARY
2 FEBRUARI
3 MARCH
4 APRIL
5 MAY
6 JUNE
7 JULY
8 AUGUST
9 SEPTEMBER
10 OCTOBER
11 NOVEMBER
12 DECEMBER
TOTAL

ACKNOWLEDGE Prepared
Management Site Manager ADM
 Employee Competence Evaluation

Name Job Title Requirement

Education

Experiences

Skill

Other
 KI/FORM/HRD/17

ompetence Evaluation

Actual Action by Management

this column to be filled by President

Director
Evaluated by,

______________________
date/name/sign
 KI/FORM/HRD/18

NEW EMPLOYEE TEST RESULT

Name of Applicant

TEST SUMMARY

Item Good Poor Remarks

Experience in relevant field

Knowledge in job to be assigned
Referrence of previous job
Communication in verbal

RESULT

ACCEPT NOT ACCEPT

Acknowledge, Test by,

date/name date/name
 KI/FORM/HRD/07

EMERGENCY CONTACT

PRESIDENT DIRECTOR
SHINJI IRIE

KAJIMA CORP. (TOKYO) KOA HQ (SINGAPORE)

TEL. 001.81.3.5324.5876 TEL. 001.65.339.8890
FAX. 001.81.3.5324.5948 FAX. 001.65.339.1985
DIRECTOR
TAKESHI SAWAMURA

OWNER SITE OFFICE CIKARANG OFFICE

SHINJI IRIE TATSURU FUJIEDA
PT. S T S ( 0811-187386 ) ( 0811-934896 )
( 021-5723456 ) Project Manager Project Manager

MITSUHIRO YOSHIDA ISAMU MIYAKUNI

POLICE ( 0811-156772 ) ( 0811-190170 )
Construction Manager Site Manager
POLSEK TANAH ABANG
( 021-5701585 ) MASAO AMBAI TRI PRIYADI
( 0816-964588 ) ( 0816-4815075 )
Site Manager Superintendant
FIRE
FAISAL IDHAM
DINAS PMK JKT. PUSAT ( 0816-1649230 )
( 021 - 3453929 ) Deputy Site Manager

YEFRIHENDI
HOSPITAL ( 0816-4853680 )
QC Engineer
RS AL MINTOHARDJO
( 021-5733026 & 5703081 )

TELEPHONE

PT TELKOM JKT. PUSAT

( 021-3824519 )
PT. KAJIMA INDONESIA
STAFF TARDINESS PROBLEM
Location Question Comments
Head Office Is there any serious problem with staff tardiness ?. - Yes. Some company activities cannot done caused of
the person in charge not coming yet.
- Disturb the other staff to completed their job, if their
job have relation with the staff who coming late.
- The staff who coming on time previously, may
demotivation, and next time they may coming late as
well.
Project Is there any serious problem with staff tardiness ?.
12 Feb. 2007
Proposed Solution 2007
Feb Mar Apr May
- Staff who coming late to the office should fill in the
Tardiness Notice Form ( attached ).
Definition of coming late is 08:11.
Personnel Section Staff will monitor and check time
card of staff, and will asked the staff who coming late
to fill in Tardiness Notice Form.
- Give 1st Warning Letter to the staff who coming late
more than 2 times a week during 1 month.
No penalty.
- Remind the staff who often coming late during appraisal
2006/2007 to change their habit.
- Staff who coming late to the office should fill in the
Tardiness Notice Form, and Management will consider
to give penalty. Penalty amount will decided by
Management later.
 TARDINESS NOTICE FORM

Name : …………………………..
Signature : …………………….. Date : ………………………….
Position/ : …………………………..
Section

Tardiness Date : ……………………………. Time arrived at the office : ………………..

Reason for tardiness

Management Comments : Penalty / No Penalty * Acknowledge

Note : * please circle. Form HRD lap.

 NOTICE FOR WORKING ON SUNDAY / HOLIDAY

Notify by : ……………………………………… Date : …………………………………………..

Position/Section : ……………………………… Signature : …………………………………………..

Name of Staff who will work on Sunday / holiday : ……………………………………………………………

Date of Sunday / holiday : …………………………………………………………..

Estimated working time : from ……………….....….. to ……… ……………..…

Reason for working on Sunday / holiday : …………………………………………………….….…..

…..…………………………………………………………

Acknowledge

Form HRD lap.

 RECOMMENDATION TO BE APPOINTED AS PERMANENT STAFF
On April 2016

1. Full Name :

2. Current Job Title :

3. Current Project Name / Section :

4. Last Appraisal Date : (to be fill in by HR)

5. Significant Contribution / : Please select the appropriate description below:

Achievement in PT. Kajima
Indonesia

Work process re-engineering on Secure budget on his/her own section/

his/her own section/department department

Develop policy & regulation regarding Implement new process & procedure
own section/department to streamline work processes at work

Minimize company/project lost Dismantle criminals cases and crimes

caused inefficient work processes occured in company/own work places

Facilitate change & improvement in Always come up with solution and

his/her own work places reliable way out

Provide assistances to his/her Maintain good relationship with third

manager/superior party related project

Raise applicable recommendation Disfuse unsatisfiy flaming occured

based in his/her best practice in the company/project site

Wining negotiation with the vendor or Administration order in all documentation

a third party and filling system

Others (please describe in detail)

6. Main reason for recommendation:

Jakarta

Recommended by :

Name :

Job Title :
 ATTENDANCE CONFIRMATION
(Head Office)

DAY : ……………………………………………….

DATE : ………………………………………………

Time
No. Name Position Reason
In Out

Confirmed by, Prepared by,

Name: Name:
Date: Date:

469053629.xlsx
 KI/FORM/HRD/03

LEAVE REQUISITION FORM

Rev : 1 / 15 Jun 09

Name : Irwan Priyatna Signature …………………………. 23 December 2019

24, 26, 27 December 2019 30 & 31 December 2019

Date Date
From : To
08:00 17:00
Period of leave Time Time

Number of days off : 5 days

( excluding public holiday / office holiday )

Annual leave ( 12 days per year ). Death of husband/wife, parents,

parents in law, child of the employee.
Un-paid leave.
Wedding of a child of the employee.
Sick leave.
Circumcision/baptism of a child
Maternity leave. of the employee.

Reason for leave Monthly period leave (for women only) Birth of a child of the employee.

Marriage of the employee.

√ Long Service Leave
Project Leave/ Offwork 8th years

Note : In case of sick leave, doctor's certificate should submitted together with this form.

Record Balance carried forward Leaves conformed by this appl. Balance after this appl.

Annual Leave 5 5 0

Address to be Address : Bumi Cakra Blok B.1/7 Telp. No. : 087770409295

contacted during RT.03/08 Pondok Rajeg
leave. Cibinong, Bogor

Management Approval / Disapproval Acknowledge