Wqa St1 & St2 Rs Banyumas 9k Ia

Certification Details
Report No.
IA RSB
Sheet No. 1 of 1
REASON FOR ISSUE / RE-ISSUE :
(e.g. change of address)
Client : (as to appear on certificate)
BADAN LAYANAN UMUM DAERAH RUMAH SAKIT UMUM BANYUMAS
Registered Address :
Invoice Address :
JALAN RUMAH SAKIT NO. 1 BANYUMAS

CENTER JAVA INDONESIA
Postcode : 53182

Postcode : 53182
Trading Name (also to appear on Certificate) :

Total No. of Appendices :
Location address :
Same as the above address

Postcode
Approved site address :
Same as the above address

Postcode
Recommended scope of Registration (as to appear on appendices) :
PROVISION OF OUT-PATIENT, IN-PATIENT, EMERGENCY UNIT AND HOSPITAL SUPPORTING SERVICE

& FUNCTION ACTIVITIES
UKAS :
N/A
EA Code
RvA :
:
N/A
INMETRO :
N/A
38/85.12
Client Tel. No. :

Client Fax. No. :
Client Contact :
Certificate Prefix
Visit Frequency
.
4 Man-Days / annually
Alt. Contact
Start Month
+62-281 796031
+62-281 796182
Dr. ISTANTO, M.Kes (QMR)
Dr. WIDAYANTO, M.Kes (DIRECTOR)
N/A
Signatures :
Istanto
Client
Dr. ISTANTO, M.Kes
Harry Parathon
Team Leader :
Dr. HARRY PARATHON, SpOG (K)
WQA 7, Issue 2
WQA Nov 2003
Sales Enquiry
Name
Address
JALAN RUMAH SAKIT NO. 1 BANYUMAS 53182, CENTER JAVA INDONESIA
Telephone
+62-281 796031
Certificate number
N/A
Type of quote
ISO 9001:2000
Type of client
Initial Audit Stage 2
Notes (include Scope and Mandays required)

Scope :
PROVISION OF OUT-PATIENT, IN-PATIENT,

EMERGENCY UNIT AND HOSPITAL SUPPORTING
SERVICE & FUNCTION ACTIVITIES
Total employee :
700
Total Mandays :
1 Day Doc. Review & Reporting + 6 Days on-site Visit = 7
BASIS OF QUOTE
7 days
Application Fee
N/A
Day rate charged
PAID BY CONSULTANT
Assessment Fee
PAID BY CONSULTANT
Additional charges
N/A
Total application and

assessment Fee
PAID BY CONSULTANT
Number of assessment days
Continuing assessment days
4 days / year
Continuing assessment rate
IN DISCUSSION
Management Fee
Total Add. Management
Continuing Assess. fees
N/A
IN DISCUSSION
Auditor/Audit team requirements (technology, processes, specifications, and regulations)
Feed-back on progress of Lead
WQA 40, Issue 3
Quotation
Quotation for
Quotation Date
1 OCTOBER 2008
The fees for Quality Systems Assessment and Registration as a WQA Registered Firm will be as detailed below :
Pre Qualification
N/A
Assessment Fee
N/A
Application Fee
N/A
Document Review & Final Assessment
PAID BY CONSULTANT
Total
PAID BY CONSULTANT
The fees are exclusive of VAT (10%), all travel, and subsistence costs.
Fees are invoiced following assessments.
First Certificate
N/A
N/A
Additional Certificate(s)
N/A
N/A
Annual Surveillance fees
4 Man-days / Year
@ IN DISCUSSION
per day
@ IN DISCUSSION
per year
NOTE : -
In certain circumstances, additional charges may be incurred, viz : Termination of a Certificate,

WQA Conditions of Contract are not complied with, or
How to display the WQA Registered Firm Symbol is not complied with.
Any additional charges will be invoiced at the prevailing rate.
This quotation is valid for 3 months from the date of issue.
I confirm acceptance of this quotation and agree to pay all fees in accordance with this quotation even if
registration is not granted by WQA. I have read and agreed to comply with the WQA Conditions of Contract and
How to display the WQA Registered Firm Symbol.
Signed
Istanto
Name (block capitals)
Dr. ISTANTO, M.Kes
Date
1 NOVEMBER 2008
WQA 34, Issue 2

WQA Mar 2003
Application for Registration

Part of ISO 9001:2000 for which Registration is being applied for
ISO 9001:2000
Relevant schemes to be included, if applicable : (e.g. USED CARS, TICKIT, EMS)
Company Details

CENTER JAVA INDONESIA Postcode or Zip code
53182
Position
Dr. ISTANTO, M.KES
QMR
N/A
Fax No.
+62-281 796031
+62-281 796031
Name of Company / Organisation

Head Office Address
Contact
Quality Manager
Telephone No.
Address of locations to be assessed if different from above (use a separate sheet if necessary)
N/A
Contact
Telephone No.
Position
Fax No.
N/A
N/A
N/A
N/A
Proposed Scope of Registration (this will be discussed at the pre-audit visit)
PROVISION OF OUT-PATIENT, IN-PATIENT, EMERGENCY UNIT AND HOSPITAL SUPPORTING SERVICE &
FUNCTION ACTIVITIES
Have you engaged a QA consultant to assist you? (if so give details)
YES, with SURVEYOR INDONESIA

DECLARATION : I/We undertake to comply with the WQA regulations relating to registration and pay all fees and charges connected with
the registration process, irrespective of the eventual granting of registration.
Signed
Istanto
Name (block capitals)
Dr. ISTANTO, M.Kes
Date
1 NOVEMBER 2008
Position
QMR
WQA 41, Issue 2

WQA Mar 2003
Document Review and Record ISO 9001:2000

Company
BADAN LAYANAN UMUM DAERAH RUMAH

Auditor :
SAKIT UMUM BANYUMAS
WQA Ref.
IA RSB
Documentation Submitted and Revision Status :
Issue /
Document number / Revision date / Revision number
1. Is system documented?
Yes, MM / RSUBMS / 1 Sep 2008 / 00
2. Is quality policy defined?
3. Name of management representative?
Dr. ISTANTO, M.Kes
4. Is organization clear and adequate?
4.1 General requirements
MM / RSUBMS / 1 Sep 2008 / 00
4.2 Documentation requirements
MM / RSUBMS / 1 Sep 2008 / 00
5.1 Management commitment
MM / RSUBMS / 1 Sep 2008 / 00
5.2 Customer focus
MM / RSUBMS / 1 Sep 2008 / 00
5.3 Quality policy
MM / RSUBMS / 1 Sep 2008 / 00
5.4 Planning
MM / RSUBMS / 1 Sep 2008 / 00
5.5 Responsibility, authority and communication
MM / RSUBMS / 1 Sep 2008 / 00
5.6 Management review
MM / RSUBMS / 1 Sep 2008 / 00
6.1 Provision of resources
MM / RSUBMS / 1 Sep 2008 / 00
6.2 Human resources
MM / RSUBMS / 1 Sep 2008 / 00
6.3 Infrastructure
MM / RSUBMS / 1 Sep 2008 / 00
6.4 Work environment
MM / RSUBMS / 1 Sep 2008 / 00
7.1 Planning of product realization
MM / RSUBMS / 1 Sep 2008 / 00
7.2 Customer-related processes
MM / RSUBMS / 1 Sep 2008 / 00
7.3 Design and development
N/A or Exclusion
7.4 Purchasing
MM / RSUBMS / 1 Sep 2008 / 00
7.5 Production and service provision
MM / RSUBMS / 1 Sep 2008 / 00
7.6 Control of monitoring and measuring devices
MM / RSUBMS / 1 Sep 2008 / 00
8.1 General
MM / RSUBMS / 1 Sep 2008 / 00
8.2 Monitoring and measurement
MM / RSUBMS / 1 Sep 2008 / 00
8.3 Control of nonconforming product
MM / RSUBMS / 1 Sep 2008 / 00
8.4 Analysis of data
MM / RSUBMS / 1 Sep 2008 / 00
8.5 Improvement
MM / RSUBMS / 1 Sep 2008 / 00
Reviewed by
Proposed Action
:
:
Date :
30 OCTOBER 2008
N/A
WQA-SEA 62. Issue 0

WQA Mar 2005
Client Confidentiality Document

I, (Printed Name) :
Dr. ISTANTO, M.Kes.
of (Company Name) : BADAN LAYANAN UMUM

DAERAH RUMAH SAKIT
UMUM BANYUMAS
Hereby allow Worldwide Quality Assurance Ltd access to the under-mentioned Documents
in order to carry-out an Audit of our Quality System / Procedures :
Company Quality Manuals
Associated Appendices
Work Instructions
Attachments
Company Documents associated with Quality Manuals (Invoices, Advice Notes etc.)
Documents associated with N.C.Rs / C.A.Rs / Customer Complaints Register etc.
Istanto
Signed: (on behalf of the Client)
Dr. ISTANTO, M.Kes
Harry Parathon
Signed: (on behalf of the WQA)
Date:
1 NOVEMBER 2008
Note to Client :All Worldwide Quality Assurance Auditors sign a Confidentiality Document to ensure they are
aware of the paramount importance of Client Confidentiality. Information viewed may contain information
which is Confidential to the Client and as such, details of which must not be disclosed to
any persons not connected either with the Audit or the Client.
It should be noted that this document is a requirement of Section 3.8 of ISO/IEC GUIDE 62:1996(E)
WQA 52, Issue 1

WQA Mar. 06
Assessment Plan
Audit Objectives
To conduct initial audit and verify conformity and effectiveness of ISO 9001:2000 standard
Scope
Person(s) Responsible For Objectives and Scope

Dr. WIDAYANTO, M.Kes (DIRECTOR) & Dr. ISTANTO, M.Kes (QMR)
Reference Documents
Quality Manual, Quality Procedures,
Work Instructions, Records and Related Documents
Audit Team
Dr. HARRY PARATHON, SpOG (K) (HAP)
Drg. NINIK IRA WIBAWATI, MQIH (IW)
DHIDIEK AGUS MULYONO (DAM)
Audit Language
INDONESIAN
Proposed Date and Place of Audit

31 OCTOBER - 1 NOVEMBER 2008 / Auditee Area
Areas To Be Audited (including duration of audit )

BANYUMAS, CENTER JAVA / 2 Man-Days
Management Meeting Schedule

08:00 Opening Meeting and 13:00 Closing Meeting
Other Comments
N/A
Confidentiality Requirements
YES, see WQA 52, Issue 1 (Client Confidentiality Document)
Audit Report Distribution

WQA-UK, WQA-SEA, AUDITEE (COMPANY)
WQA 59. Issue 1
WQA Jan 2000
Assessment Report
Report No.
IA RSB
Sheet No. 1 of 1
Client :
BADAN LAYANAN UMUM DAERAH RUMAH

SAKIT UMUM BANYUMAS
Address :
Client Ref. No.
N/A
Certificate / Licence No.
N/A
No. of Employees
700
Scope :
JALAN RUMAH SAKIT NO. 1 BANYUMAS ,

53182
Post code :
Ref. Doc. Client
PROVISION OF OUT-PATIENT, IN-PATIENT,

EMERGENCY
UNIT
AND
HOSPITAL
SUPPORTING
SERVICE
&
FUNCTION
ACTIVITIES
Verified as correct : Y / N ? YES
(if changes, to be detailed below)
All company documented system
WQA Management Standard :
Man-Days
Mr. Achmad Setyahadi
Mr. Novian Amrah Putra
Visit duration (Mandays) : 4
ISO 9001:2000
Scheme Requirement :
WQA Contacts
Client Manager
Client Administrator (phone)

Type of Assessment
Commencement date :
Initial Audit / Assessment

1 NOVEMBER 2008
NCR ref. Nos raised this visit :
HAP
IW
DAM
= Minor 1
= None at this assessment
= None at this assessment
Outstanding NCR
From Report
+62-281 796031
Team Members :
Drg. NINIK IRA WIBAWATI, MQIH

DHIDIEK AGUS MULYONO
Signed for WQA :
Harry Parathon
Yes / No
Name :
Signed for Client :
Istanto
Corrective Action Letter :
(acknowledging receipt of report)
Required by
Name :
Date
Dr. ISTANTO, M.Kes

1 NOVEMBER 2008
Where it is found on a subsequent visit that Corrective Actions have not been implemented in accordance with the agreed programme, then WQA may take steps
to withdraw Certification.
Where the Client wishes to distribute copies of this Report all pages must be included.
WQA 1, Issue 1
WQA Jan 2000
Audit Summary Report ISO 9001:2000
AUDIT SUMMARY REPORT
BADAN LAYANAN UMUM

DAERAH RUMAH SAKIT UMUM BANYUMAS
BRANCH
N/A
AUDITOR/ASSESSOR
HAP, IW, DAM
Departments/Disciplines
COMPANY
AUDIT No.
IA RSB
Date
31 OCTOBER - 1 NOVEMBER 2008
AUDIT SCOPE : UNLESS A FOLLOW UP AUDIT THE SCOPE WILL ADDRESS ALL THE REQUIREMENTS OF BS EN ISO 9001:2000 AND
QUALITY MANAGEMENT PROCEDURES BS EN ISO 9001:2000.
4.1
GENERAL REQUIREMENTS
4.2
DOCUMENTATION REQUIREMENTS
5.1
MANAGEMENT COMMITMENT
5.2
CUSTOMER FOCUS
5.3
QUALITY POLICY
5.4
PLANNING
5.5
RESPONSIBILITY, AUTHORITY, AND COMMUNICATION
5.6
MANAGEMENT REVIEW
6.1
PROVISION OF RESOURCES
6.2
HUMAN RESOURCES
6.3
INFRASTRUCTURE
6.4
WORK ENVIRONMENT
7.1
PLANNING OF PRODUCT REALIZATION
7.2
CUSTOMER-RELATED PROCESSES
7.3
DESIGN AND DEVELOPMENT
7.4
PURCHASING
7.5
PRODUCTION AND SERVICE PROVISION
7.6
CONTROL OF MONITORING AND MEASURING DEVICES
8.1
GENERAL
8.2
MONITORING AND MEASUREMENT
8.3
CONTROL OF NON-CONFORMING PRODUCT
8.4
ANALYSIS OF DATA
8.5
IMPROVEMENT
(NUMBER)
APPLICABLE
N/A
No.
Auditor(s)
DAM
CAT 1
= ELEMENT ADDRESSED, NO CORRECTIVE ACTION RAISED

= ELEMENT ADDRESSED, NUMBER OF CORRECTIVE ACTIONS RAISED
COMMENTS :
TOTAL
CAT 2
Minor
CAT 3
Major
Observation
22
No.
Auditor(s)
Department(s)
Top Mgt & QMR Activities
HAP/IW
IGD, In Patient, Out Patient,

Mental Rehabilitation, ICU
DAM
Human Resources, Training

Cashier
HAP/IW
Surgery, Haemodialysis and

Perinathology
HAP
Admission
Records
DAM
Purchasing, Equipment
HAP/DAM
DAM
Nutrients
AUDITORS NAME :
Department(s)
and
Medical
Pharmacy & Laboratory

SIGNED :
DATE :
OCTOBER 2008
Harry Parathon 31
1 NOVEMBER 2008
WQA-SEA 2. Issue 0
WQA May 2005
Continuing Assessment Record

Report No.
IA RSB
Sheet No. 1 of 1
Client
Ref. No.
JALAN RUMAH SAKIT NO. 1 BANYUMAS 53182, CENTER JAVA INDONESIA

4 Man-days / annually
Site / Location
Visit cycle
Report Number
SA01
SA02
SA03
SA04
SA05
Triennial
Activity / Department / Operation
Date
04 / 2008
Date
10 / 2009
Date
04 / 2009
Date
10 / 2010
Date
04 / 2010
Date
10 / 2011
0 MD
4 MD
0 MD
4 MD
0 MD
4 MD
Man-days
Top Management Discussions
QMR Activities
Human Resources, Training Cashier
Admission and Medical Records
Pharmacy & Laboratory
IGD, In Patient, Out Patient, Mental

Rehabilitation, ICU
Surgery, Haemodialysis and Perinathology
Purchasing, Equipment
Nutrients
QMR Activities :
Review the previous findings
WQA Logo used
Internal Quality Audit
Management Review Meeting
C / PAR ( Corrective / Preventive Action Request ) including customer complaints
Customer Satisfaction
WQA 5 Issue 2
WQA Apr 2003
Recommendation for Certification

Report No.
IA RSB
Sheet No. 1 of 1
Congratulations, we recommend certification for the scope detailed below :The non-conformities advised, indicate areas where you may improve your Management System.
BADAN LAYANAN UMUM DAERAH RUMAH SAKIT UMUM BANYUMAS (Client Manager) will look forward to
receiving your Corrective Action Programme by 8 NOVEMBER 2008 (date), and will be attached to this report.
Once this recommendation is verified, we will be able to issue your Certificate of Registration.
WQA believes the best approach is one of partnership, and we will be re-visiting
your Company 1
time(s) per year for
4
day(s) per visit.
Recommended scope of registration :

1.
2.
This assessment is based on random samples and therefore nonconformities may exist which have not been identified.
Nonconformity Reports are observed nonconformities against the requirement of the Management Standard, other relevant Standards or your Quality System.
Signatures :
Istanto
Harry
Parathon
Client
Dr. ISTANTO, M.Kes.
Team Leader
Harry Parathon
Corrective Actions Reviewed and Accepted by Team Leader
Novian
Reviewing Manager
Reviewing Manager UK
Novian Amrah Putra
Date
2 NOVEMBER 2008
Date
WQA 10, Issue 2

WQA Mar 2003

Wqa St1 &amp; St2 Rs Banyumas 9k Ia

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Certification Details

REASON FOR ISSUE / RE-ISSUE :

(e.g. change of address)

Client : (as to appear on certificate)

BADAN LAYANAN UMUM DAERAH RUMAH SAKIT UMUM BANYUMAS

JALAN RUMAH SAKIT NO. 1 BANYUMAS

JALAN RUMAH SAKIT NO. 1 BANYUMAS

Trading Name (also to appear on Certificate) :

Same as the above address

Same as the above address

PROVISION OF OUT-PATIENT, IN-PATIENT, EMERGENCY UNIT AND HOSPITAL SUPPORTING SERVICE

Client Tel. No. :

Dr. ISTANTO, M.Kes

Dr. HARRY PARATHON, SpOG (K)

BADAN LAYANAN UMUM DAERAH RUMAH SAKIT UMUM BANYUMAS

JALAN RUMAH SAKIT NO. 1 BANYUMAS 53182, CENTER JAVA INDONESIA

Initial Audit Stage 2

Notes (include Scope and Mandays required)

PROVISION OF OUT-PATIENT, IN-PATIENT,

1 Day Doc. Review & Reporting + 6 Days on-site Visit = 7

Day rate charged

Total application and

Number of assessment days

Continuing assessment days

Continuing assessment rate

Auditor/Audit team requirements (technology, processes, specifications, and regulations)

Feed-back on progress of Lead

WQA 40, Issue 3

BADAN LAYANAN UMUM DAERAH RUMAH SAKIT UMUM BANYUMAS

Document Review & Final Assessment

Annual Surveillance fees

In certain circumstances, additional charges may be incurred, viz : Termination of a Certificate,

Name (block capitals)

Dr. ISTANTO, M.Kes

WQA 34, Issue 2

Application for Registration

BADAN LAYANAN UMUM DAERAH RUMAH SAKIT UMUM BANYUMAS

Name of Company / Organisation

Proposed Scope of Registration (this will be discussed at the pre-audit visit)

Have you engaged a QA consultant to assist you? (if so give details)

YES, with SURVEYOR INDONESIA

Name (block capitals)

Dr. ISTANTO, M.Kes

WQA 41, Issue 2

Document Review and Record ISO 9001:2000

BADAN LAYANAN UMUM DAERAH RUMAH

Documentation Submitted and Revision Status :

Dr. HARRY PARATHON, SpOG (K)

Document number / Revision date / Revision number

Yes, MM / RSUBMS / 1 Sep 2008 / 00

2. Is quality policy defined?

Yes, MM / RSUBMS / 1 Sep 2008 / 00

3. Name of management representative?

Dr. ISTANTO, M.Kes

4. Is organization clear and adequate?

Yes, MM / RSUBMS / 1 Sep 2008 / 00

4.1 General requirements

MM / RSUBMS / 1 Sep 2008 / 00

4.2 Documentation requirements

MM / RSUBMS / 1 Sep 2008 / 00

5.1 Management commitment

MM / RSUBMS / 1 Sep 2008 / 00

5.2 Customer focus

MM / RSUBMS / 1 Sep 2008 / 00

Wqa St1 & St2 Rs Banyumas 9k Ia

Wqa St1 & St2 Rs Banyumas 9k Ia