GSV Self-Assessment Form

GSV 自我评估表
Please complete this Self-Assessment Form and return to Intertek GSV coordinator before the audit date.
请填写以下自我评估表，并在审核日期前发送至 GSV 协调员。
Facility Name : PT. KORINA SEMARANG GSV Registration Number :
企业名称： GSV 注册号：
Facility Information
　 企业信息
What type of commodity is produced by the facilities?
1 贵企业生产的产品类型是什么？ Garments
What year was the company established?
2 公司在哪一年成立？ 1996
What is the approximate percentage of export into the U.S.?
3 出口美国的比例是多少？ 100 %
How many containers are shipped to US per month or year from
this facility?
4 该企业每月或每年运往美国的集装箱是多少？ ± 15
Numbers/types of building?
5 建筑物数量/类型？ 1
Approximate property size?
6 企业大约的面积？ 6.100,876 m2
Who are the company's major customers?
7 贵公司的主要客户？ Kohls, JCP & ADIDAS
1 Shift 0f 8 hours
What are the hours of operations?
8 工作时间？ 07.00 – 16.000
How many entrances for external in your facility?
9 贵企业有多少个通往外部的出口？ 2
How many employees work in the facility? (Full/Part Time/
Seasonal)
10 企业有多少员工？(全职/兼职/季节性) 1167 employees
Expeditors Indonesia – Jakarta
Graha Indochem, 5th Floor
What are the names of the company's brokers/freight forwarders? Jl. Pantai Kapuk Boulevard,
11 公司的货运代理的名称？ Kav.SSB/E Jakarta 14470 -Indonesia
What are names of the company's transportation providers and PT. BUANA KARYA SANTOSA
their current address? Ruko Taman Niaga BSB Blok D No.1
12 公司的运输商及其现驻址？ Semarang, Indonesia
General Yes/No/N/A
　 综合信息 是/否/无

Do you have a policy that requires all security procedures to be documented?

13 是否要求所有安全程序有书面制度？ 　Yes
Do you have a designated security department/chief?
14 是否有专职的保安部/主管？ 　Yes
Personnel Training Yes/No/N/A
人员培训 是/否/无
Is there a process in place to screen prospective employees and to periodically check current
employees?
15 是否对应聘人员进行筛查，并对现在员工进行定期检查？ 　Yes
When allowed by law, are background checks conducted on all employees?
16 在法律允许的范围内，是否对所有员工进行背景审查？ 　Yes
Is the issuance of employee identification centralized and controlled by a specific department?
17 员工证的发放是否专门的部门负责？ 　Yes

Form No.: GSV-F14 Issue Date: 16 May 2011

Issue No. : 04 Page 1 of 4
 Does new employee orientation include security and threat awareness training?
18 新员工的入职培训是否包括安全和危险意识培训？ 　Yes
Have you identified restricted areas and determined who is authorized to be present?
19 企业内是否设有禁区，是否有进入权限的规定？ 　Yes
Is all training for new employees documented (including information such as subject, date,
attendees)?
20 是否对所有的新员工培训进行记录(包括主题、日期、参加人员等)？ Yes
Do you have a written code of conduct for employees?
21 是否有书面的员工行为守则？ 　 Yes
Is there an established procedure to conduct unannounced security checks periodically for all
areas of concern?
22 是否有相关制度，对所有重点区域是否定期进行突击安全检查？ 　 Yes
Physical Security Yes/No/N/A
实体安全 是/否/无

Does the facility have an intrusion detection or alarm system?

23 企业是否有非法进入监测和报警系统？ 　Yes
Is an employee identification system used for positive identification and access control?
24 是否实施了员工身份认证系统和出入控制？ 　Yes
Do adequate locking devices protect all access points (doors, windows, gates)?
25 所有出入口(门、窗、大门等)都装有完备的锁闭装置吗？ 　Yes
Do you have a documented procedure regarding facility Key Control (assign, date out-in,
tracking)?
26 企业是否有书面的钥匙管理制度(发放、收发日期、追踪)？ 　Yes
Is your building perimeter secured by an adequate wall or fence?
27 建筑物周围是否有完善的围墙或护栏？ 　Yes
Is there any outside flood lighting of entrances, exits, cargo handling and storage areas?
28 入口、出口、货物装卸和储存区是否有外部泛光照明？ 　Yes
Are inbound shipments containerized?
29 输入的物品是否用集装箱装载？ 　Yes
If yes, are the shipments seals verified and documented?
30 如果是，是否对货物的封条进行查验并记录？ 　Yes
Do you store empty or loaded containers on site?
31 是否将空的或已装货的集装箱存放在企业内？ 　Yes
If yes, are the container doors sealed or locked?
32 如果是，集装箱的门是否贴封条或上锁？ 　Yes
Do you have a designated security guard force?
33 企业是否有专门的保安力量？ 　Yes
Are closed circuit television cameras (CCTV) used to monitor the activity inside/outside the
facility?
34 是否采用闭路电视摄像机（CCTV）监控企业内/外部的情况？ 　Yes
Are closed circuit television cameras (CCTV) used to monitor the shipping dock and container
loading areas?
35 是否采用闭路电视摄像机（CCTV）监控运输区和集装箱装货区？ 　Yes
Do you have the recording data stored?
36 是否储存记录资料？ 　Yes
Is there a visitors log maintained?
37 是否有访客记录？ 　Yes
Are visitors, delivery drivers, and transportation drivers required to show a picture ID before
permitted access to the facility?
38 访客、送货司机和运输司机是否需要出示身份证明才能进入企业？ 　Yes
Is a container security seal verified for accuracy against shipping documents prior to departing
39 the facility? 　Yes

Form No.: GSV-F14 Issue Date: 16 May 2011

Issue No. : 04 Page 2 of 4
 集装箱离开企业前是否要根据运输文件对安全封条的准确性进行验证？
Is vistitor parking away from entrances and docks?
40 访客停车区是否与入口和货运区分开？ 　Yes
Are vehicles prohibited/prevented from parking near cargo conveyances?
41 是否禁止/防止车辆停在货物运输工具附近？ 　Yes
Are there procedures in place for detecting and reporting shortages or overages in incoming
shipments?
42 是否有相应程序，检查或汇报入厂货物的短缺或超量？ 　Yes
Information Access Controls Yes/No/N/A
信息资料控制 是/否/无

Do you have procedures concerning access to automated systems and documents?

43 是否有进入自动系统和查看文件的权限控制？ 　Yes
Do you have established password controls for your automated systems?
44 自动系统是否有密码控制？ 　Yes
Shipment Information Controls Yes/No/N/A
运输信息控制 是/否/无
Is there a designated company representative responsible for providing accurate information
to the broker?
45 公司是否有专人负责向代理商提供准确的信息？ 　Yes
Storage & Transportation/Distribution Yes/No/N/A
储存和运输/分销 是/否/无
Are stored container doors secured with a high security locking device or seal?
46 企业中存放的集装箱是否装有高安全性锁闭装置或封条？ 　 Yes
Who provides and affixes the seals to conveyances?
47 由谁负责提供和加贴封条？ 　Yes
Is dangerous cargo (including hazardous materials) stored separately and properly identified?
48 危险货品(包括有害材料)是否单独存放或标注识别信息？ 　Yes
Is loading of containers supervised by a security guard or designated supervisor?
49 集装箱的装运是否由保安或专门的主管监管？ 　Yes
Are there procedures for tracking shipments? (From where to where?)
50 是否有追踪货物的程序？(从哪里到哪里？) 　Yes
Are containers utilized for shipments?
51 运输是否采用集装箱？ 　Yes
Do you only use ISO17712 high security compliant seals for ocean shipments?
52 海运货物是否只采用符合 ISO17712 高安全性要求的封条？ 　Yes
Do you have a documented policy on how to affix,replace, record, and track seals placed on
containers?
53 是否有集装箱封条加贴、更换、记录和追踪的书面规章制度？ 　Yes
Do you have procedures in place to properly check the integrity of containers (7-point
inspection)?
54 是否有检查集装箱完好性(7 点检验)的程序？ 　Yes
Is there a written contract with the transporter that moves containers from the facility to the
port?
55 与将集装箱从企业运输至港口的运输商之间是否签有书面合同？ 　Yes
Is there a procedure for in-country carriers to report in-transit security violations to the facility
management?
56 是否有相关程序，规定国内运输商如何向企业管理层汇报运输过程中违反安全规定的情况？ 　Yes
Contractor Controls Yes/No/N/A
承包商管理 是/否/无
Do you have written security standards and procedures for contractors?
57 是否有针对承包商的书面标准和程序？ 　Yes
Where applicable, do you require C-TPAT enrollment of contractors?
58 在适用的情况下，贵公司是否要求承包商加入 C-TPAT？ 　Yes
Export Logistics (Carrier/Third Party Logistics) Yes/No/N/A
出口物流 (承运商/第三方物流) 是/否/无

Form No.: GSV-F14 Issue Date: 16 May 2011

Issue No. : 04 Page 3 of 4
 Does the facility perform background checks on the consolidators, freight forwarders, 3PL's,
or carriers used by the facility?
59 企业是否会对拼装商、货代、3PL's 或承运商的背景进行审查？ 　Yes
‘

Completed by: HASAN NUDIN

填写人：
Department/ Title: COMPLIANCE / STAFF
部门/职务：
Date: 10-05-2017
日期：

Form No.: GSV-F14 Issue Date: 16 May 2011

Issue No. : 04 Page 4 of 4