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QUESTIONNAIRE TO ASSIST Form Title : FF-TNI-001 PREPARATION FOR AN ISO Revision No. : 04 22000 / HACCP AUDIT Effective Date : 29.03.2018 Page : 1 of 13 1 General information Informasi Umum Company : with legal form (Nama Perusahaan dengan Legalitas perusahaan) Address (Alamat) : Postcode, Town: Country (Negara) : (Kode pos, Kota) Contact Person : (Kontak Penghubung) Function (Fungsi) : Quality Representative; Other: Telephone : Website: www. (Nomor Telp) Telefax : E-Mail : (Nomor fax) Sector (Sektor) : Memberships in Industrial Associations : (anggota asosiasi) 2 No. of employees at the location Jumlah karyawan di Lokasi In terms of full-time Total no. of employees : employees : Total Jumlah karyawan (Jumlah karyawan tetap) of which no. of employees in shift working : (Jumlah karyawan shift) no. of temporary employees : (Jumlah karyawan kontrak) Number of Shifts : (Jumlah shift) FF-TNI-001 Rev. 04 (Questionnaire - Preparation for ISO 22000 or HACCP ) QUESTIONNAIRE TO ASSIST Form Title : FF-TNI-001 PREPARATION FOR AN ISO Revision No. : 04 22000 / HACCP AUDIT Effective Date : 29.03.2018 Page : 2 of 13 3 Factors which can influence the time needed for the audit and the cost Faktor yang dapat mempengaruhi waktu audit dan biaya No in-house development (tidak ada pengembangan intenal) Large variety of regulations (menggunakan berbagai peraturan) Low process risk (Resiko proses rendah) High process risk (Resiko proses tinggi) Mature Management System (Kematangan sistem manajemen) Large location with small no. of employees (lokasi luas dengan jumlah karyawan sedikit) Family-owned company or simple processes (Perusahaan keluarga atau proses sederhana) Small location with large no. of employees (Lokasi kecil dengan jumlah karyawan besar) Is combined certification required? No / Tidak Yes / Ya (Apakah diperlukan kombinasi audit sertifikasi?) Does an integrated management system already exist in the company? No/Tidak Yes / Ya (Apakah integrasi sistem manajemen sudah tersedia di perusahaan anda?) Is an integrated certification audit (IMS Audit) required? (apakah dIperlukan integrasi audit sertifkasi (audit integrasi sistem manajemen?) ISO 9001 ISO 14001 ............... Were you supported by a consultant? (Apakah Anda menggunakan konsultan?), No/Tidak Yes /Ya IF yes, by / Apabila ya, oleh : ………………………………….. Is your company already certified ? (existing certifications?) (Apakah perusahaan anda sebelumnya sudah mendapat sertifikasi?) Certificate Standard Certification Date of Certificate No. / Company certification valid until Directive audit No. etc. Lembaga Sertifikasi Masa Sertifikat Tanggal Audit Berlaku Standar Sertifikasi Sertifikat FF-TNI-001 Rev. 04 (Questionnaire - Preparation for ISO 22000 or HACCP ) QUESTIONNAIRE TO ASSIST Form Title : FF-TNI-001 PREPARATION FOR AN ISO Revision No. : 04 22000 / HACCP AUDIT Effective Date : 29.03.2018 Page : 3 of 13 4 Detailed Information about the Company Detail Informasi Perusahaan Business Line : (E.g. Manufacturing / Distribution/ etc...) (Lini Bisnis) Product Category : .................................................................. (Kategori Produk) Main Raw Materials and purchased Parts used or processed: (Bahan baku utama dan bagian yang dibeli untuk digunakan atau diproses) ..................................................................................................................... ..................................................................................................................... Manufacturing Process(es): (Proses manufaktur) ..................................................................................................................... Does HACCP study, exist? Please enclose., (use brief description or separate sheet, where necessary). (Apakah rencana HACCP sudah tersedia? Mohon lampirkan, ( Deskripsikan secara singkat atau dalam lembar terpisah jika perlu) yes / ya no / tidak Do you maintain and implement HACCP study? (Apakah anda memelihara dan menerapkan rencana HACCP?) yes / ya no / tidak Total number of HACCP study ? ............................. (Jumlah rencana HACCP?) Details of HACCP study : (Rincian jumlah HACCP) Size of the manufacturing facility in square metres: .......................... 2 (Ukuran fasilitas pabrik dalam m ) Is there a process production subcontracted / outsourced ? (Apakah ada proses produksi yang disubkontrakkan?) yes / ya no / tidak If yes, please decribe (Jika Ya, Jelaskan) FF-TNI-001 Rev. 04 (Questionnaire - Preparation for ISO 22000 or HACCP ) QUESTIONNAIRE TO ASSIST Form Title : FF-TNI-001 PREPARATION FOR AN ISO Revision No. : 04 22000 / HACCP AUDIT Effective Date : 29.03.2018 Page : 4 of 13 The operating system : (Sistem operasi) Batch Semi-continuous Continuous Details of the operating system : (Rincian sistem operasi) Which of the documents listed below are already on hand? If available, please attach document below (Manakah dokumen berikut yang sudah tersedia? Jika tersedia, lampirkan dokumen dibawah ini) Document Remarks (√) Dokumen Tanda (√) Food safety Policy (Kebijakan Keamanan Pangan ) Food safety Objectives (Sasaran Keamanan Pangan) ISO 22000 manual (scope implementation) (Manual ISO 22000 (Implementasi ruang lingkup) HACCP Study (HACCP Plan, OPRP’s, PRP) (Rencana HACCP , Program Persyaratan Dasar operasional, Program Persyaratan Dasar) Internal audit & management review result (Audit internal dan kaji ulang manajemen) Mandatory Procedures (control document and record, internal audit, withdrawl, control of non- conformity and corrective action, etc.) Prosedur wajib ( Pengendalian dokumen dan rekaman, audit internal, penarikan produk, penangan penanganan produk yang tidak sesuai, tindakan perbaikan, dll) Product registration (Registrasi produk) We agree that this information may be stored for the purposes of drafting an offer and processing any resulting order or transactions. Place/Date Name Signature *) *) If sending by email, the sender's address will be accepted FF-TNI-001 Rev. 04 (Questionnaire - Preparation for ISO 22000 or HACCP )
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