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PST.54 HSSED FRM 002 Formulir Kuesioner Penilaian Dokumen Kualifikasi Contractor Pre Qualification Assessment Questionnaire
PST.54 HSSED FRM 002 Formulir Kuesioner Penilaian Dokumen Kualifikasi Contractor Pre Qualification Assessment Questionnaire
PST.54 HSSED FRM 002 Formulir Kuesioner Penilaian Dokumen Kualifikasi Contractor Pre Qualification Assessment Questionnaire
54-HSSED-FRM-002
Penerbit : HSSE
Revisi : 0
Formulir Kuesioner Penilaian Berlaku : 9 Agustus 2022
Dokumen Kualifikasi
Judul :
(Contractor Pre-Qualification Halaman : -
Assessment Questionnaire)
Apakah perusahaan Saudara telah mendapatkan Sertifikat Sistem Manajemen Keselamatan dan
Kesehatan Kerja (SMK3) berdasarkan Peraturan Pemerintah Nomor 50 Tahun 2012 atau ISO
45001:2018, dan Sistem Manajemen Lingkungan ISO 14001:2015 dari badan sertifikasi yang
terkareditasi oleh Komite Akreditasi Nasional (KAN) atau yang terdaftar pada IAF (International
Accreditation Forum)?
Does your company already conduct an external audit of the HSE Management System?
2
If so, please attach the external audit report of Health & Safety Management System, and ISO
14001:2015 external audit report.
Apakah perusahaan Saudara telah melakukan audit eksternal Sistem Manajemen K3LL?
Jika Ya, Lampirkan Laporan Audit Eksternal SMK3 dari PJK3 Lembaga Audit & Laporan Audit ISO
14001:2015.
Answer:
Jawaban:tidak
Lampirkan daftar induk dokumen SMK3 dan SML atau dokumen Sistem Manajemen Terintegrasi
minimal K3 dan Lingkungan.
Answer:
Jawaban:iya
Does your company always carry out routine inspections/tests to all equipments as required
5
by regulations and other requirements?
Apakah perusahaan Saudara selalu melakukan pemeriksaan/Riksa Uji secara rutin kondisi semua
peralatan kerja sesuai Peraturan Perundangan dan Persyaratan Lainnya?
Lampirkan daftar peralatan yang dilengkapi dengan nomor Sertifikat pemeriksaan / Riksa Uji;
Lampirkan Bukti Sertifikat pemeriksaan / Riksa Uji sesuai Peraturan Perundangan atau persyaratan
lainnya.
Answer:
Jawaban:iya
6 Does your company have employees with special certifications such as an Operational
License (Surat Izin Operasional – SIO) for certain equipment, and personnel certificates
related to HSE) as required by regulations and other requirements?
Nomor : PST.54-HSSED-FRM-002
Penerbit : HSSE
Revisi : 0
Formulir Kuesioner Penilaian Berlaku : 9 Agustus 2022
Dokumen Kualifikasi
Judul :
(Contractor Pre-Qualification Halaman : -
Assessment Questionnaire)
Please attach a list of personnel along with their technical and/or HSE competencies, the
certificate number and validity period;
Please attach a certificate as required by regulations and other requirements.
Apakah perusahaan Saudara memiliki karyawan dengan sertifikasi khusus seperti surat izin operasi
(SIO) perlatan tertentu dan sertifikat personil terkait K3LL) sesuai Peraturan Perundangan dan
Persyaratan Lainnya?
Lampirkan daftar pekerja beserta kompetensi Teknis dan/atau K3LL disertai nomor Sertifikat dan
masa Berlaku;
Lampirkan sertifikat kompetensi Teknis dan/atau K3LL Personil sesuai Peraturan Perundangan atau
persyaratan lainnya.
Answer:
Jawaban:iya
Does your company already record the summary and follow-up of all incidents for the last 3
7a
(three) years?
Please attach the HSE performance report for the last 3 (three) years;
If there was incidents, attach investigation report and it’s follow-up report.
Apakah perusahaan Saudara telah mencatat rangkuman dan tindak lanjut kecelakaan selama 3
(tiga) tahun terakhir?
7b Has your company ever received a zero accident certificate from govenrment or zero
accident award from other company/employer?
If so, please attach a zero accident certificate from Government and/or zero accident award
from other company/employer.
Nomor : PST.54-HSSED-FRM-002
Penerbit : HSSE
Revisi : 0
Formulir Kuesioner Penilaian Berlaku : 9 Agustus 2022
Dokumen Kualifikasi
Judul :
(Contractor Pre-Qualification Halaman : -
Assessment Questionnaire)
Lampirkan sertifikat zero accident dari Pemerintah dan/atau penghargaan zero accident dari
perusahaan pemberi kerja lain.
Answer:
Jawaban:iya
8 Is your company join in relevant associations (technical related associations or HSE related
associations)?
Apakah perusahaan Saudara tergabung dalam asosiasi yang relevan, baik sesuai dari aspek teknis
maupun K3LL?
9 Does your company have any other special features that are not included in the document
above?
Please attach evidences such as the following details, but not limited to:
Company's participation in BPJS Employment;
Other ISO series certificates;
HSE Awards from other companies;
Government / Association appreciation or an award for HSE implementation.
Nomor : PST.54-HSSED-FRM-002
Penerbit : HSSE
Revisi : 0
Formulir Kuesioner Penilaian Berlaku : 9 Agustus 2022
Dokumen Kualifikasi
Judul :
(Contractor Pre-Qualification Halaman : -
Assessment Questionnaire)
Apakah perusahaan Saudara memiliki ciri-ciri keistimewaan / kekhususan lain yang tidak termasuk
pada dokumen di atas?