VENDOR ASSESSMENT QUESTIONNAIRE

PT. BAKRIE PIPE INDUSTRIES

1.0 ASSESSMENT OBJECTIVE

To ensure VENDOR fulfill COMPANY’s requirement prior supplying products and/or services to
COMPANY. Once VENDOR passed COMPANY assessment, VENDOR should be listed in COMPANY
Approved Vendor List and may supply products and/or services to COMPANY.

2.0 SCOPE

VENDOR Quality Management System, Products and/or Services Realization including Production and/or
Service Capacity, Verification of Purchased Products, and Control of Monitoring and Measuring
Equipment.

3.0 REFERENCE
1. API Spec. Q1, latest edition, Specification for QualityPrograms for the Petroleum, Petrochemical
and Natural Gas Industry.
2. ISO 9001, latest edition, Quality Management Systems – Requirements.
3. SNI ISO 9001, latest edition, Quality Management Systems – Requirements
4. ISO 19011, latest edition, Guidelines For Auditing Management Systems.
5. QAM-1, latest revision, COMPANY Quality Assurance Manual.

4.0 ABBVERIATION

VENDOR A company who provide products and/or services to COMPANY

COMPANY PT. Bakrie Pipe Industries (PT.BPI)

5.0 ASSESSMENT CRITERIA

Refers to COMPANY Requirements as stated in COMPANY Quality Assurance Manual, COMPANY

Procedures, Technical Specification, Manufacturing Procedure Specification, Inspection & Test Plan,
VENDOR related documents and other related documents.

6.0 RESPONSIBILITY
COMPANY Quality Assurance Engineer or personnel who assigned by Quality Assurance Engineer shall
conduct this assessment.

Form No.: QP-7.4 Page 1 of 7

 VENDOR ASSESSMENT QUESTIONNAIRE
PT. BAKRIE PIPE INDUSTRIES

7.0 ASSESSMENT METHODS

The methoduses are:

a. Reviewing documents.
b. Interview
c. Field visit for verification.
d. Combination above methods.

8.0 ASSESSMENT DURATION

If interview and/or field visit for verification will be conducted, the duration minimum 1 (one) day and
might be extended at the assessor’s consideration.

9.0 ASSESSMENT QUESTIONNAIRE

A. General
1. Vendor Name: PT INTIPRATAMA MULYASANTIKA
2. Vendor Address: JL MAYJEN SUTOYO NO.42/47 KOMPLEKS SPBU Gn.MALANG BALIKPAPAN
3. Vendor Representative / Contact Person:
a. Name: PT INTIPRATAMA MULYASANTIKA
b. Address: JL KAPTEN TENDEAN NO.07 , WISMA TENDEAN LT.03 , JAKARTA SELATAN
c. Phone Number: 021 7996147 Handphone: AGUNG TAMTOMO 08119882527
d. Fax : 021 7996149 Email: [email protected]

B. Quality and/or OH&S Management System

1. What are your Company main products and/or services? Please explain and provide your
Company Profile.
Intipratama Mulyasantika, is a company under Intipratama Group. We focused on Freight
Forwarding, Trucking, Supply, Warehouse and also Jetty for Supply Base.
Company Profile Intipratamagroup 2021.pdf

2. Does your Company have API, ISO or other Certification for your Quality and OH&S
Management System? If YES, please provide a copy of the certificate and your Quality
Assurance Manual and/or OH&S Management System.
Yes, we have.
SERTIFIKAT IPM ISO 9001;2015.pdf

Form No.: QP-7.4 Page 2 of 7

 VENDOR ASSESSMENT QUESTIONNAIRE
PT. BAKRIE PIPE INDUSTRIES

3. If your Company does not have API, ISO or other Certification for your Quality and/or OH&S
Management System, how do you manage your Quality and/or OH&S Management System?
Please explain and give proof of evidence.
4. Please provide your Company Organization Structure.
IPM Structure .pdf
5. How many employees does your Company have? 58

Please Provide Detail employee for:

a. Production/Operation : 5
b. Quality Assurance/Quality Control : -
c. Engineering : 4
d. Safety Health and Environment : 2

6. Do you conduct hazard identification, risk assessment and determining controls? Please
explain and provide sample of documents.
yes we do and we follow safety rules
HIRADC Operation.pdf
7. Do you update your legal and other requirements related to OH&S Management System
and implement to your OH&S Management System?

Yes, we do and implement to our OH&S Management System

8. Do you have your Audit Program or Audit Schedule for this year? Please provide a copy of
your Audit Program or Audit Schedule for both Quality and/or OH&S Management System.

PROGRAM KERJA HSE 2021.pdf

9. Do you conduct Annual Quality and/or OH&S Review or Management Review Report?
Please explain and give copy of the related documents, if necessary.
RENCANA DAN PEMANTAUAN PELAKSANAAN SASARAN DAN PROGRAM HSE 2021.pdf

C. Products and/or Service Realization

1. What is your Company production and/or service capacity can provide?

Freight Forwarding, Customs Clearance , Cargo Handling, Transporter for Light and Heavy
Material, Warehouse and Private Jetty.

2. How do you plan your resources prior products and/or services realization?

We make a Market Share for this service and and make it happen with several connecting
aspects in one service in Transportation

Form No.: QP-7.4 Page 3 of 7

 VENDOR ASSESSMENT QUESTIONNAIRE
PT. BAKRIE PIPE INDUSTRIES

3. What kind of documents or drawings your Company uses for products and/or services
realization?

We used brochure, leaflet, and also Portfolio for many job that we done before. We have
website and Instagram for share any moment that we spend in that jobs done

4. How do you control your productions and/or service provision? Please explain and give copy
of the related documents, if necessary.

some jobs require proof of completion, one of which is receipt/transmitting advance

documents. Intipratama calls him STTB (Receipt of Goods)

STTB Contoh.jpg

5. Do you have procedure toverify or validateyour product and/or services prior production?
Please provide a copy of the procedure?

Yes, we have procedure to validate. PM-IPM-MKT-01 Rev03 Penanganan Order 2019.pdf

6. How do you review your Customer requirements into products and/or services realization?

Some Customer give us checklist to be fulfilled as a condition for the implementation of

work. Like, Vacinate Certified, Rapid Test, PPE, Tyre Management, and safety tools for truck.

7. Please provide a sample of Products and/or Service realization in you Company, starting
from review of Customer requirements, planning and products and/or service realization
and development of Manufacturing Data Book?

For samples, we have customers who require checking before departure. It is mandatory
and is attached to the submitted document. Irhamdin KT 8816 LU.pdf

8. How do you maintain your products and/or services traceability? Please explain and give
copy of the related documents, if necessary.

Form No.: QP-7.4 Page 4 of 7

 VENDOR ASSESSMENT QUESTIONNAIRE
PT. BAKRIE PIPE INDUSTRIES

every year we send a questionnaire to our customers to measure the level of satisfaction.

9. How do you maintain the quality of your products before delivery to the Customer?Please
explain and give copy of the related documents, if necessary.
Some customers will asked for communication updates regarding the condition and position
of the goods we carry. All of this is stated in our satisfaction survey F-IPM-MKT-06 REV.00
SURVEY KEPUASAN PLGN IPM.pdf

10. Please provide List of Customers you have supplied.

- DNX Indonesia - Badak LNG
- AEL Indonesia - Kaltim Parna Industri
- ELNUSA - ARUTMIN
- PERTAMINA - KAI INDONESIA
- PAL Indonesia Persero - INKA Madiun
- Kaltim Prima Coal

D. SHE Operational Control

1. How do you determine the operations and activities that are associated with the identified
hazard?
Each job has its own method, and in that job all man power has standard implementation
skills. In some cases, the item will be submitted to the MSDS for a more detailed explanation
MSDS-EU_AS S6.PDF
2. How do you identify the potential for emergency situations and respond to such emergency
situations?
In dealing with this situation, the job executor is obliged to ensure that he/she is aware and
protected from danger by always ensuring that the vehicle and goods carried are in
excellent condition.
3. How do you measure and monitor OH&S performance?
Prior to carrying out work, workers and HSE must ensure and identify potential , condition
of the vehicle is in the best condition by conducting a manual checklist of vehicles and
equipment.
4. How do you investigate incident, nonconformity, corrective action and preventive action?
There needs to be a corrective action and plan as well as an incident report, so that
unfavorable conditions are monitored and can be avoided
E. Verification of Purchased Product
1. Do you outsource your processes and/or services to external Company?
for some conditions, yes we do and we have limited work tools.

Form No.: QP-7.4 Page 5 of 7

 VENDOR ASSESSMENT QUESTIONNAIRE
PT. BAKRIE PIPE INDUSTRIES

2. How do you control your Supplier to meet your Company requirements?Please explain and
give copy of the related documents, if necessary.
Before choosing a supplier, we conduct a vendor assessment to determine our capabilities,
capacities and convey our needs and the standard specifications that we have set. 21.
VENDOR TRUCKING PT. SEMOGA JAYA TRANSPORT.pdf
3. How do you validate and/or verify products and/or services that process by external
Company?Please explain and give copy of the related documents, if necessary.
So far, only vendors that pass verification are used. If you have to use it, the vendor must
complete the previous findings or re-verification will be carried out.
4. If outsourced products and/or services fail to meet your Company requirements, what will
your Company do?
For some reason we will not use it and provide improvement feedback

F. Control of Monitoring and Measuring Equipment

1. Do your measuring and inspection activities are conducted in house or outsourced?
For jobs that do not require special certification we do it ourselves.
2. If your measuring and inspection activities are outsourced, please provide the company
profile of the company.
Some client need third party certified, and we used Sucofindo to do it 2919-compro
sucofindo.pdf
3. Please describe measuring and inspection activities which are conducted in house and/or
outsourced.
These activities include pre-work activities listed in the checklist and vendors must meet the
specified classification.
4. Do you have your IMTE (Inspection and measuring testing equipment) owned by your
Company? Please provide IMTE list.
We don't have it
5. Do you calibrate your IMTE in house or outsourced? Please explain.
We don’t have and used it
6. Please provide copy of your Calibration Procedures and Certificate of IMTE Calibration.
We don’t used or have it.
7. If IMTE are out of tolerance, what will your Company do?
We need to recalibrating
8. Please provide to us your Personnel Qualification Record for QA/QC Personnel.
QA/QC we don’t have it,
9. Please provide copy of your Inspection and Measuring Procedures.
21. VENDOR TRUCKING PT. SEMOGA JAYA TRANSPORT.pdf

Form No.: QP-7.4 Page 6 of 7

 VENDOR ASSESSMENT QUESTIONNAIRE
PT. BAKRIE PIPE INDUSTRIES

10.0 ASSESSMENT RESULT

The result will be informed to VENDOR 1 (one) week after the assessment questionnaires are complete,
interview and/or field visit has been done. The result will be confidential only for VENDOR and
COMPANY concerns and shall not be copied and informed to other party without written permission
from COMPANY.

11.0 RE-ASSESSMENT
Re-assessment will be conducted to VENDOR, if they fail in first assessment. VENDOR will be given 2
(two) months to do improvement based on ASSESSMENT RESULT. If VENDOR fails again, they will be
given 1 (month) to do improvement and Final Re-assessment will be conducted. If VENDOR fails again,
they will not be listed in Approved Supplier List and could not supply products and/or services to
COMPANY.

12.0 STATEMENT
Here with we inform you that the data supplied at Section 9.0 are correct and valid. Any invalid data will
have impact in disqualification of the assessment process.

Submitted By, Verified By,

VENDOR REPRESENTATIVE COMPANY ASSESSOR

NAME:__________________ NAME :_________________

POSITION : POSITION :

Form No.: QP-7.4 Page 7 of 7