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NOTE Please complete the Action Plan of (all) CAR(s), save it (them) to the same file name *.

doc and
send the file to dwi.wahyu@sgs.com and mitria.sukma@sgs.com within 5 calendar
days starting from the date of closing meeting.

Corrective Action Request


CAR 1 of 5
Major Minor

Organization: PT Satkomindo Mediyasa


Site(s) audited: Jl. RS Fatmawati No. 1 RT 002/008 Date(s) of audit(s): 24-25 January 2018
Cilandak Barat-Jakarta Selatan
12430, Indonesia
Auditor(s): Dwi Wahyu Wijayatmoko, Achmad Arief Nugroho
Standard(s): ISO 9001:2015 and OHSAS 18001:2007
Organization Mr.Dede Suryadi
Representative:
Area / Depart- MR
ment / Process:
Document Ref.: Prosedur Pengendalian Dokumen, Standard Ref.: ISO 9001:2015
Doc.No.CORP/SOP/2016, Clause: 7.5.1
Issue/Rev. Status: Edition:.2.0, dated: 02/01/18 CAR Close out date:

Details of Non-Conformity:
The documented information procedure has been established as seen on Prosedure Pengendalian
Dokumen, Doc.No.CORP/SOP/2016, however the documented information does not include :
- Documented information required by ISO 9001:2015.
- Documented information determined by the organization as being necessary for the effectiveness of
the quality management system where the extent of documented information for a quality
management system can differ from one organization to another due to:
- Size of organization and its type of activities, processes, products and services;
- The complexity of processes and their interactions;
- The competence of persons.

Organization Mr.Dede Suryadi Auditor: Dwi Wahyu Wijayatmoko


Representative:

Cause Analysis and Corrective Action taken to prevent recurrence:


Cause Analysis:
There is not all the documented information have been compiled and registered by organisation

Corrective Action:
The organisation shall registered and compiled completed documented information affected to organisation
activity as required by ISO9001 : 2015

Organization Date: 29.01.2018


Representative: Dede.S.

Acceptance of Corrective Action / Comments (use additional sheets if necessary):

Documented information determined by the organization as being necessary for the effectiveness of the
quality management system where the extent of documented information for a quality management system
will be issued as required. Effectively soon as confirmed by organization and disseminated to all
organization.

Job / Cert. n°: ID/JKT 3221 Visit Type: Surveillance+Upgrade Visit n°: 05+06
Document: 3221-C2-V5+V6-CAR Issue n°: 5 Page n°: 1 of 7
NOTE Please complete the Action Plan of (all) CAR(s), save it (them) to the same file name *.doc and
send the file to dwi.wahyu@sgs.com and mitria.sukma@sgs.com within 5 calendar
days starting from the date of closing meeting.

Auditor: Date:

Response required (in months) Major Minor


Corrective Action must be addressed within time frame stated. Verification of Define Close Out Define Close Out
action will occur at next visit. Additional follow up may be required as indicated.

Corrective Action Request


CAR 2 of 5
Major Minor

Organization: PT Satkomindo Mediyasa


Site(s) audited: Jl. RS Fatmawati No. 1 RT 002/008 Date(s) of audit(s): 24-25 January 2018
Cilandak Barat-Jakarta Selatan
12430, Indonesia
Auditor(s): Dwi Wahyu Wijayatmoko, Achmad Arief Nugroho
Standard(s): ISO 9001:2015 and OHSAS 18001:2007
Organization Mr.Dede Suryadi
Representative:
Area / Depart- MR
ment / Process:
Document Ref.: QOHS Manual Standard Ref.: ISO 9001:2015
(Doc.No.CORP/SOP/2018) Clause: 8.5.6
Issue/Rev. Status: Edition:.2.0, dated: 02/01/18 CAR Close out date: Next visit

Details of Non-Conformity:
There are some changing of the organization such as: office building and organization structure where since
effective by 27/12/17 the operational office has been moved to new location, however inadequate evidence
that management of change has been provided and reviewed to ensure continuing conformity with
requirements where documented information describing the results of the review of changes,
The person(s) authorizing the change, and any necessary actions arising from the review should be
retained.

Organization Mr.Dede Suryadi Auditor: Dwi Wahyu Wijayatmoko


Representative:

Cause Analysis and Corrective Action taken to prevent recurrence:


Cause Analysis:
Find that the organisation not ensure have procedure or rule how to maintain if there are changing authority
or task or moving place.

Corrective Action:
The organisation should established a documented procedure to cope if there are activity in the organisation
which need to change personnel or activity or location. the documented information should issued
immediately.

Organization Dede S. Date: 29.01.2018

Job / Cert. n°: ID/JKT 3221 Visit Type: Surveillance+Upgrade Visit n°: 05+06
Document: 3221-C2-V5+V6-CAR Issue n°: 5 Page n°: 2 of 7
NOTE Please complete the Action Plan of (all) CAR(s), save it (them) to the same file name *.doc and
send the file to dwi.wahyu@sgs.com and mitria.sukma@sgs.com within 5 calendar
days starting from the date of closing meeting.

Representative:

Acceptance of Corrective Action / Comments (use additional sheets if necessary):


Some changing of the organization such as: office building and organization structure where since effective
by 27/12/17 the operational office has been moved to new location, and evidence that management of
change has been provided and reviewed to ensure continuing conformity with requirements with
documented information describing the results of the review of changes.

Auditor: Dede S Date: 29.01.2018

Response required (in months) Major Minor


Corrective Action must be addressed within time frame stated. Verification of Define Close Out Define Close Out
action will occur at next visit. Additional follow up may be required as indicated.

Corrective Action Request


CAR 3 of 5
Major Minor

Organization: PT Satkomindo Mediyasa


Site(s) audited: Jl. RS Fatmawati No. 1 RT 002/008 Date(s) of audit(s): 24-25 January 2018
Cilandak Barat-Jakarta Selatan
12430, Indonesia
Auditor(s): Dwi Wahyu Wijayatmoko, Achmad Arief Nugroho
Standard(s): ISO 9001:2015 and OHSAS 18001:2007
Organization Mr.Dede Suryadi
Representative:
Area / Depart- P2K3
ment / Process:
Document Ref.: Doc. CORP/SOP/2018, Standard Ref.: OHSAS 18001:2007
Clause : 4.3.2 & 4.5.2
Issue/Rev. Status: Date 02/01/2018 CAR Close out date: Next visit

Details of Non-Conformity:
1. The identifying and reviewing applicable legal requirements is not effectively maintained to ensure that
its always updated and evaluated properly, as bellows :
1. Some applicable legal requirements are not yet identified and evaluated, for instances :
Health regulation
- UU no.36/2009 re’ Kesehatan
- PMK no 70/2016 re’ Standard dan persyaratan kesehatan lingkungan replace Kemenkes
N0.1405/2002
- PMK no.32/2017 re’ Standard baku mutu kesehatan lingkungan dan persyaratan kesehatan air
untuk keperluan higine sanitasi
Fire protection system
- Permen PU.no26/2008 re’ system proteksi kebakaran pada gedung dan lingkungan
- Pergub DKI no.143/2016 Re’ manajemen Keselamatan kebakaran gedung
New regulation
- Permenaker No.03/1999 amanded to Permenaker 32/2015 re’ Syarat2 K3 lift
- Permenaker 02/1989 amanded toPermenaker 31/2015 re’ pengawasan instalasi penyalur petir
- Permanaker 04/1985 amanded to Permanaker no.38/2016re’ K3 pesawat tenaga dan

Job / Cert. n°: ID/JKT 3221 Visit Type: Surveillance+Upgrade Visit n°: 05+06
Document: 3221-C2-V5+V6-CAR Issue n°: 5 Page n°: 3 of 7
NOTE Please complete the Action Plan of (all) CAR(s), save it (them) to the same file name *.doc and
send the file to dwi.wahyu@sgs.com and mitria.sukma@sgs.com within 5 calendar
days starting from the date of closing meeting.

produksi.
- Permanaker no.09/2016 re’ K3 dalam pekerjaan pada ketinggian.

2. Insufficient evidence that lighting arrester permit available for new building (BRI Netcom-
Fatmawati) as required by Permanaker no.31/2015.

Organization Mr.Dede Suryadi Auditor: AAN


Representative:

Cause Analysis and Corrective Action taken to prevent recurrence:


Cause Analysis:
The organisation not ensure have maintained and fulfil K3 Regulation and requirements as stated. Also
there is not evidence that regulation and requirements already comply.

Corrective Action:
All the regulation and requirements that affected and link to organisation activity will be documented and
evaluated regularly as intended period. Also the organisation should fulfilled regarding regulation needs due
to provided by building management such as: Lift, Thunder arrester, Moving equipment and etc.

Organization Dede S. Date: 29.01.2018


Representative:

Acceptance of Corrective Action / Comments (use additional sheets if necessary):


The organisation issued a list of regulation and requirements and evaluated effectivity periodically.

Auditor: Date:

Response required (in months) Major Minor


Corrective Action must be addressed within time frame stated. Verification of Define Close Out Define Close Out
action will occur at next visit. Additional follow up may be required as indicated.

Corrective Action Request


CAR 4 of 5
Major Minor

Organization: PT Satkomindo Mediyasa


Site(s) audited: Jl. RS Fatmawati No. 1 RT 002/008 Date(s) of audit(s): 24-25 January 2018
Cilandak Barat-Jakarta Selatan
12430, Indonesia
Auditor(s): Dwi Wahyu Wijayatmoko, Achmad Arief Nugroho
Standard(s): ISO 9001:2015 and OHSAS 18001:2007
Organization Mr.Dede Suryadi
Representative:
Area / Depart- P2K3 & Human capital (SDM)
ment / Process:
Document Ref.: SHEP Manual Standard Ref.: OHSAS 18001:2007

Job / Cert. n°: ID/JKT 3221 Visit Type: Surveillance+Upgrade Visit n°: 05+06
Document: 3221-C2-V5+V6-CAR Issue n°: 5 Page n°: 4 of 7
NOTE Please complete the Action Plan of (all) CAR(s), save it (them) to the same file name *.doc and
send the file to dwi.wahyu@sgs.com and mitria.sukma@sgs.com within 5 calendar
days starting from the date of closing meeting.

SK.No.068-DIR/GA/XI/2017 Clause 4.4.2


SK.no.010-DIR/UMM/SDM/II/2012
Issue/Rev. Status: CAR Close out date: Next visit

Details of Non-Conformity:

1. See in doc. Job description for GA staff whose appointed as electrical technician that roles,
responsible and competencies related to electrical not yet define. Furthermore, training needs
associated with its OHS risk to fullfill compliance are not clearly determine in matrix competencies,
e.g: LOTO, Electrical competencies or electrical certificate.

2. Seen in doc. Susunan ERT team as SK.No.068-DIR/GA/XI/2017 – covering : ketua, wakil,


secretary, tim tanggap darurat (captain floor 1-4), tim tanggap darurat, kebakaran dan bencana
alam, tim tanggap darurat kecelakaan & P3K . However, standard competencies for those position
not yet determine as functional structural.

Organization Mr.Dede Suryadi Auditor: AAN


Representative:

Cause Analysis and Corrective Action taken to prevent recurrence:


Cause Analysis:
Find that Job description for GA staff whose appointed as electrical technician that roles, responsible and
competencies related to electrical not yet define.

Corrective Action:
The organization established documented procedure that stated about job competencies, roles, responsible
that affected with daily activity and evaluated regularly.

Organization Date:
Representative:

Acceptance of Corrective Action / Comments (use additional sheets if necessary):


Documented procedure stated about job descrition, job competencies, roles, responsibility of organisation
activity established at functional structural and evaluated periodically.

Auditor: Date:

Response required (in months) Major Minor


Corrective Action must be addressed within time frame stated. Verification of Define Close Out Define Close Out
action will occur at next visit. Additional follow up may be required as indicated.

Corrective Action Request


CAR 5 of 5
Major Minor

Job / Cert. n°: ID/JKT 3221 Visit Type: Surveillance+Upgrade Visit n°: 05+06
Document: 3221-C2-V5+V6-CAR Issue n°: 5 Page n°: 5 of 7
NOTE Please complete the Action Plan of (all) CAR(s), save it (them) to the same file name *.doc and
send the file to dwi.wahyu@sgs.com and mitria.sukma@sgs.com within 5 calendar
days starting from the date of closing meeting.

Organization: PT Satkomindo Mediyasa


Site(s) audited: Jl. RS Fatmawati No. 1 RT 002/008 Date(s) of audit(s): 24-25 January 2018
Cilandak Barat-Jakarta Selatan
12430, Indonesia
Auditor(s): Dwi Wahyu Wijayatmoko, Achmad Arief Nugroho
Standard(s): ISO 9001:2015 and OHSAS 18001:2007
Organization Mr.Dede Suryadi
Representative:
Area / Depart- MR
ment / Process:
Document Ref.: CORP/SOP/2018 Standard Ref.: ISO 9001:2015 &
OHSAS 18001:2007
Clause 9.2.1 (9K),
4.5.5 (18K)
Issue/Rev. Status: Rev.2.0 CAR Close out date: Next visit

Details of Non-Conformity:
1. Internal audit was carried out on 13/10/2017 – 19/10/2017, however insufficient evidence that clause
4.1, 4.2, & 6.1.1 for ISO 9001:2015 and 4.4.6, 4.4.7 and 4.5.1 for OHSAS 18001:2007 has been
covered in internal audit.

2. Furthermore, insufficient evidence that causes of analysis not yet defined from the internal audit result
as seen in Form (F-K3-019) ketidak sesuaian (internal audit).

Organization Mr.Dede Suryadi Auditor: Dwi Wahyu Wijayatmoko


Representative:

Cause Analysis and Corrective Action taken to prevent recurrence:


Cause Analysis:
The organisation not ensure already audited based on clause requirements as audited based on activity as
well. Also not clearly defined that finding result reflected as stated on Non Conformity Report.

Corrective Action:
The organisation will be held audit based on clause and activity as required, and stated on documented
procedure that include comptele process as on P-D-C-A. The procedure will be evaluated and updated
regularly.

Organization Dede S. Date: 29.01.2018


Representative:

Acceptance of Corrective Action / Comments (use additional sheets if necessary):


Organisation established Audit Process Documented Procedure that stated schedule, check sheet, location
issued, form and disseminate to designed process, the procedure will be evaluated periodically.

Auditor: Date:

Response required (in months) Major Minor


Corrective Action must be addressed within time frame stated. Verification of Define Close Out Define Close Out
action will occur at next visit. Additional follow up may be required as indicated.

Job / Cert. n°: ID/JKT 3221 Visit Type: Surveillance+Upgrade Visit n°: 05+06
Document: 3221-C2-V5+V6-CAR Issue n°: 5 Page n°: 6 of 7
NOTE Please complete the Action Plan of (all) CAR(s), save it (them) to the same file name *.doc and
send the file to dwi.wahyu@sgs.com and mitria.sukma@sgs.com within 5 calendar
days starting from the date of closing meeting.

Job / Cert. n°: ID/JKT 3221 Visit Type: Surveillance+Upgrade Visit n°: 05+06
Document: 3221-C2-V5+V6-CAR Issue n°: 5 Page n°: 7 of 7

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