: FMLF-TNI-

Form Title
Audit Schedule Revision No.
007b
: 00
Effective Date
Surveillance Page
:101.04.2016
: of 5

Master Data of Organisation

Name of Organisation PDAM GIRI MENANG

Name of corporate group N/A

(in case of group certification)

Street Jl. Pendidikan No. 39, Mataram, Nusa Tenggara Barat - Indonesia

Postcode / Town / Country Nusa Tenggara Barat / Indonesia

Contact Mrs. BAIQ SUHARTINI,SE
E-Mail tini151515@gmail.com
Phone/Fax 0370-632510 0370 - 637536
Language Indonesia

The Provision of Processing and Distribution of Clean and Drinking

Water Supply Services
Scope Description

more description regarding scope in annex

Industry / Scope (EA, TA, ...) 27
Technical Area (EnMS only) N/A
Boundaries (EnMS only) N/A
Audit profile ?
Standards under contract / ISO 9001:2015
Audit type Surveillance Audit 2 (SA-2)

System documentation: Revision / PDAMGM-MSMM/01, Rev.01 Issued Date : 31 July 2017

Issue
Surveillance mode Yearly surveillance
Audit team leader / responsible Poernomo Amiprodjo (PA) 15 16 037
Audit team            

           

           

Technical expert - Trainee            

           

Multisite-organisation All sites are listed in:

Audit Reference Data Sheet seperate Listing
Audit program/ATEA
Multisite-certification (Sample)

Shift operation 1 shift operation

Document1 Page 1 of 5 Rev. 00/01.04.2016
 : FMLF-TNI-
Form Title
Audit Schedule Revision No.
007b
: 00
Effective Date
Surveillance Page
:201.04.2016
: of 5

Audit Details

Sites Jl. Pendidikan No. 39, Mataram, Nusa Tenggara Barat - Indonesia

Audit date 20-21.12.2018

Audit duration 2.00 person days on site

Focus /
Date/ Time1) Site/ shift/ Processes
Auditor
Contact 2)
Standard Requirement /
Business unit (Initials)
Chapter/Clause
1.
20.12.2018 Day One

2. All concerned
10:00 Opening meeting PA All Introduction and Briefing
departments
3. Context of the
organization
Leadership
(Commitment,
Policy,
Responsibility
and authority)
Planning (Risk
& Opportunity,
Objectives,
Planning of
Change)
Support
(Resource, QMS: 4.1-4.4, 5.1-5.3, 6.1-
Top management
Competence, 6.3, 7.1-7.5, 9.1-9.3, 10.1-
and Quality
Awareness, TM 10.3
10:30 Management PA
Communication) QMR Use of marks,
Representative
Monitoring, Follow up the previous NC (If
(QMR) measurement, any)
analysis and
evaluation
Management
system; Policy,
Responsibility &
Authority,
Communication
Internal audit,
Nonconformities
, and Corrective
action
Management
review

Document1 Page 2 of 5 Rev. 00/01.04.2016

 : FMLF-TNI-
Form Title
Audit Schedule Revision No.
007b
: 00
Effective Date
Surveillance Page
:301.04.2016
: of 5

Context of
organization
Risks and
Opportunities
Resources
Operational
planning and
control
Production and
services
provision QMS: 4.1-4.2, 6.1-6.3, 7.1,
13:00 Pelayanan PA Dept Head
Release of 8.1, 8.5, 9.1.1, 9.1.3, 10.3
products and
services
Control of NC
outputs
Monitoring,
measurement,
analysis and
evaluation
Continual
improvement
5. Context of
organization
Risks and
Opportunities
Resources
QMS: 4.1-4.2, 6.1-6.3, 7.1,
14:30 Peralatan Monitoring, PA Dept Head
8.1, 8.5, 9.1.1, 9.1.3, 10.3
measurement,
analysis and
evaluation
Continual
improvement
6. Context of
organization
Risks and
Opportunities
Resources
Operational
planning and
control
Production and
services
provision Production QMS: 4.1-4.2, 6.1-6.3, 7.1,
15:30 Production PA
Release of Mgr. 8.1, 8.5, 9.1.1, 9.1.3, 10.3
products and
services
Control of NC
outputs
Monitoring,
measurement,
analysis and
evaluation
Continual
improvement
7.
17:00 Meeting Room Auditor review PA

8.
18:00 End of day one

9.
21.12.2018 Day Two

Document1 Page 3 of 5 Rev. 00/01.04.2016

 : FMLF-TNI-
Form Title
Audit Schedule Revision No.
007b
: 00
Effective Date
Surveillance Page
:401.04.2016
: of 5

Context of
organization
Risks and
Opportunities
Resources
Operational
planning and
control
Production and
services
provision QMS: 4.1-4.2, 6.1-6.3, 7.1,
08:00 Distribusi PA Dept Head
Release of 8.1, 8.5, 9.1.1, 9.1.3, 10.3
products and
services
Control of NC
outputs
Monitoring,
measurement,
analysis and
evaluation
Continual
improvement
11.
Resources
-SDM Competence
09.30 PA Dept Head QMS: 7.1-7.4
-IT Awareness
Communication

12.
12:00 Break

13.
13:00 Meeting Room Auditor review PA Review of audit result

14.
14:00 Meeting Room Closing review PA All Presentation of audit result

15.
15:00 End of audit day

1) 2)
from to modifications are possible To be defined by client

Distribution
Organization, audit team, audit documentation,      
Editor
Date: 27.11.2018
Person in charge: Poernomo Amiprodjo

Document1 Page 4 of 5 Rev. 00/01.04.2016

 : FMLF-TNI-
Form Title
Audit Schedule Revision No.
007b
: 00
Effective Date
Surveillance Page
:501.04.2016
: of 5

Explanations:
 The objective (goal) of the audit is to establish compliance of the management system of the
aforementioned organization with the requirements of the aforementioned standard in order to
achieve or maintain certification through an independent and accredited certification body.
Identification of possibilities to improve the management system can also be a component of the
audit and is considered simply to be an enhancement; it does not constitute consultancy or advice
with regard to the management system.

 The audit report is drawn up in German or English and should describe if and how far the
requirements of the aforementioned standards are fulfilled.

 If some requirements of the aforementioned standard are assessed as "not fulfilled" in the audit, it
is possible to demonstrate subsequent fulfilment in the form of a review of documents submitted
later and/or in the form of a re-audit at the company premises, depending on the type of
nonconformity.

 Any objections to the planned form of the audit should be discussed and solved between the
company and the audit team leader before the audit. Any objections to members of the audit team
must be communicated to the certification body.

 All members of the audit team have declared to the certification body in writing that they will keep
confidential all information which becomes known to them during the course of the audit and that
no inappropriate conflict of interest exists (see Annex).

Annexes (for certification body only):

 List of participants
 Declarations of impartiality/confidentiality

Document1 Page 5 of 5 Rev. 00/01.04.2016