Form No.

M01-02-02
Selection and/or Evaluation Supplier check list (R-1) Rev. 2

Supplier name : Score :

1 = Poor; 2 = Unsatisfied; 3 = Average
Product name : 4 = Satisfied; 5 = Excellent
Auditor name :
Audit schedule :

Item Checking Items Score Result

Selection Material 1 a How do you select your raw material Supplier (or Maker) we have SOP/PUR/01 about Purchasing
b Any criteria for selection of your supplier ? Quality, delivery time and price
c Do you have selection record ? Yes we have
if new material we inspect to suplier and no
2 Do you conduct inspection material or audit before you order ? inspect if repeat order material
3 a Do you have approved supplier list ? Yes, we have
b Who approved to select the supplier ? Purchasing Dept.
c Do you audit the supplier's quality status regularly? Yes
according request from warehouse and
4 a How do you order the material ? production Dept.
b What is the purchasing route ? Production-warehouse-purchasing-suplier
5 What kind of documents is issued to the supplier ? Inquiry and Purchase Order
Receiving Material 1 a Do you inspect the materials received? Yes
b How do you inspect the delivered material? Visual and dimention check
caliper, dial gauge, micro meter, thikness
c Do you use some tools to check the material? If yes, what kind of tools do you use? meter
d What standard is used to check the material? ANSI & Internal standar
2 Any document received from Manufacture (Mill certificate/ Drawing) Yes
3 If any abnormality of delivered material, how do you do? Returned to supplier
Quality Control 1 Do you have ISO 9001 system? Yes
2 a How is your organization Chart ? See attachment QC
b Who is responsible for quality assurance or control of your product (services)? QC Dept.
3 a What written procedure do you have ? SOP/QC/01 : Product verification
SOP/QC/01 : Product verification and
SOP/QC/02 : Non Conformity, Corrective and
b What procedure do you have to ensure compliance with inspection and test Preventive action
material ?
4 a Do you conduct measuring or inspection on the completion of products Yes
b Do you conduct sampling inspection ? Yes
c Are passing grades clearly determined ? Yes
d Do you have the record of the final inspection (before delivery). Yes
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 e Do you provide an indication of the final inspection report for the packages ? Yes Form No. M01-02-02
Rev. 2
Yes we have SOP/QC/02 : Non Conformity,
5 a Do you have a system for dealing with nonconforming products ? Corrective and Preventive action
b How to distinguish or separate nonconforming products from conforming ones? with labeling dan separete storage area

Selection and/or Evaluation Supplier check list (R-1) -Cont'd

Item Checking Items Score Result
Quality Control 6 a Is any system established to respond to request or claim from client ? Yes, we have customer complain handling
b Who will be responsible for dealing with claims or complaints ? Marketing, QC and Production Dept.
7 a Is your quality control internally audited ? Yes
b Who conduct the audit ? Qualified internal auditor
8 Do you conduct periodical training to your employee ? Yes
Yes we have SOP-WHS-01 Handling,
Inventory Control 1 a Do you have procedure to control your stock inventory ? storage, protection and shipping
and Storage b Do you have stock list ? Yes
c Do you have a record for outgoing material ? Yes
2 Are the method for preventing deterioration of products clearly indicated ? Yes
3 a What kind of facility do you have for handling material in your storage/whs? Overhead crane, hand lift/hand pallet
b Do you conduct inspection periodically for the handling facility? yes
4 a Who control your storage or inventory? Werahouse Dept.
b Do you implement 5S activities in your storage area? Yes
c How many persons work in storage area? 6 persons
5 a Do you inspect your inventory at regular interval ? Yes
b Who inspect your inventory ? Warehouse and Finance Dept.
Yes we have SOP-WHS-01 Handling,
Transportation 1 Do you have procedure for protecting product during transportation ? storage, protection and shipping
(Delivery Term) 2 Do you conduct packaging inspection ? NA
3 Who is responsible for giving the delivery permit ? Marketing and Finance Dept
4 a What documents issued to client ? Manual Book
b Do you have a system for issuing the delivery permit ? Yes
5 a How do you arrange delivery material ? Direct delivery ? Direct dilevery and by logistic service company
b If there is an emergency delivery ? How is proceed ? -
6 a Do you have truck to deliver the material ? NA
b Do you provide PPE to your employee (for driver /Ass.driver) ? Yes
c Do you check the truck condition before deliver the material ? NA

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Environment 1 Do you have enviromental Policy ? Yes, we have Form No. M01-02-02
2 a Do you have ISO 14000 system ? Yes, we have Rev. 2
Inspection, monitoring and audit for 14001
b What activities are your involve in which could give rise to an environmental system
problem ?
c What are you procedure for Environment ? See attactment
3 Do you have aspect impact of your product or Transportation or others? Yes

4 a What it is ? aspect impact made by each department head

b Any document issued related to environment UPL/UKL

Selection and/or Evaluation Supplier check list (R-1) - Cont'd

Item Checking Items Score Result
Safety, and Health 1 a Do you have safety policy ? Yes
b Who is responsible for Safety, Health and Environment ? Ahli K3 Umum
2 a What are you procedure for carrying out risk assessment ? Hirardc
b How are risk assessment monitored ? with regulary hse meeting
3 a Do you have formal procedure for reporting and investigating of accidents ? Yes we have
investigation conduct by P2K3 Committee
b Who will carry out the investigation and to whom he/she should repot? and report to chief P2K3 and Director
4 Do you provide information about SHE issues to your employee or worker ? Yes
5 Do you have safety advisor ? Yes
6 Do you conduct SHE training to your employee or worker ? Yes
7 a Do you have an accident history ? Yes
b What kind of accident ? blisters and pinched
c Do you have accident report and/or statistic ? Yes
8 How do you monitor SHE performance of your employees or worker ? Yes
Customers 1 Do you have Customer list ? Yes
2 Do you have category of your customer list ? (eg.Chemical Plant ) Yes
3 What is the most material that purchase by your customer ? Fire truck

Total Score : 0
(note : If total score is less than 80, the supplier is not approved)

Comment/Conclusion :
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 Form No. M01-02-02
Rev. 2

Date :

Reported by, Approved by

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 Form No. M01-02-02
Rev. 2

mpany

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