E2/IAC/SBM/49

Rev. 1 / Oct ‘17

INTERNAL AUDIT CHECKLIST

Auditor / rank : Wisnu K / Lead auditor Audit date : 04-01-2018

Auditee / rank : Iskandar D / Master Audit place : Jakarta, Marunda water
No. Questionnaires Status ISM ISO ISO OHSAS
Y/N/NA Code 9001 14001 18001
2014 2015 2015 2007
1 Company Policies 2.2 4.3 4.3 4.1
1. Companies policies are reviewed periodically Y 1.2 5.2 5.2 4.2
2. Latest company polices are communicated and posted on Y 1.4
observable areas as applicable 2.1
2 Environmental Aspects 6.1.2
1. Environmental aspects and impacts assessment are Y
communicated
2. Significant environmental aspects and impacts Y
3. Understanding on how to do environmental aspects and Y
impacts assessment
3 Hazard Identification, Risk Assessment, Actions to address 6.1 6.1 4.3.1
Risk and Opportunities
1. Risks and opportunities are assessed and communicated Y
2. HIRADC for HSE activities are communicated Y
3. Understanding on how to do risks and opportunities Y
assessment and HIRADC for HSE activities
4 Compliance Obligations 1.2.3 8.2.2 6.1.3 4.3.2
1. Applicable legal and other requirements are identified, Y 8.2.3 9.1.2 4.5.2
assessed for compliance status and documented
2. Legal and other requirements compliance status is Y
reviewed and communicated
5 Objectives and Targets for Health and Safety Y 1.2.2 4.3.3
1. Objectives and Targets are communicated 1.2.3
6 Objectives and Planning for Quality and Environmental 6.2 6.2
1. Objectives and Targets are communicated Y 6.3
7 Customer Requirements 8.2
1. Customer communication (handling customer’s enquires, Y
instructions, contract, etc.)
2. Customer’s specific requirement on ship management Y
3. Management of change on customer’s requirement N/A
8 Management Programs Implementation 1.4.3 4.4 4.4 4.3.3
1. Integrated safety program and other HSE campaign Y 3.2 5.1 5.1
2. Management and vessel manager visit Y 11.3 5.3 5.3
9 Management System Documentation 1.4 7.5 7.5 4.4.4
1. Latest company manual Y 3.2 4.4.5
2. Obsolete document of company manual Y 11
10 Resources, Roles, Responsibility, Accountability, Authority 3.3 5.3 5.3 4.4.1
1. Top management commitment to provide adequate Y 7.1.1 7.1
resources need to implement company manual meet 7.1.2
customer’s satisfaction and applicable legal compliance
2. Significant change on company organization and manual, N/A
including long period vacant critical position (if any)
11 Infrastructures as required to meet customer’s satisfaction 7.1.3
1. Buildings and associated utilities Y
2. Equipment, including hardware and software Y
3. Transportation resources Y
4. Information and communication technology Y
12 Environment for Office and Shipboard Services Operation 7.1.4
1. Social; e.g. non-discriminatory, calm, non-confrontational Y
2. Psychological; e.g. stress-reducing, burnout prevention, Y
emotionally protective
3. Physical; e.g. temperature, heat, humidity, light, airflow, Y
hygiene, noise
13 DPA, CSO, QHSE MR 3.3 4.4.1
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Rev. 1 / Oct ‘17

1. Identification of DPA, CSO and/or QHSE MR Y 4

2. Master review and SSP review feedback from office Y
3. Actions to reduce incident statistic Y
14 Master’s Responsibility and Authority 5.1
1. Master’s standing order and night order Y 5.2
2. Master’s overriding authority implementation Y
3. Ability to lead emergency response team onboard Y
4. Shipboard drill evaluation, including ship shore drill Y
5. Master’s review on company manual, SOPEP/SMPEP, Y
BWMP, SEEMP, etc. as applicable to ship specific type
15 Personnel 6.1 4.4.1
1. Onboard Master’s certificates and medical fitness Y 6.2
2. Other onboard crew’s certificates and medical fitness Y 6.3
3. Crew recruitment process N/A 6.6
4. Minimum safe manning meets flag requirement Y 6.7
5. Handover of onboard Master, C/O, C/E and other crews Y
6. Vessel operation is following master instruction Y
7. Latest company manual update is discussed onboard Y
8. Recruitment process for crews and office staffs N/A
9. Recruitment process for crews through manning agent N/A
10. Crews and office staffs implement company manual as Y
per their duties, responsibilities and authorities
16 Competence, Training, Awareness 6.3 7.2 7.2 4.4.2
1. Office staff competence matrix N/A 6.4 7.3 7.3
2. Crew’s vessel competence matrix Y 6.5
3. Office staff appraisal N/A
4. Onboard crew appraisal Y
5. Office staff training programs implementation N/A
6. Crew training programs implementation N/A
7. Training programs are as per office staff and crew’s rank N/A
8. Specific training requirement from customer N/A
17 Communication, Participation, Consultation 7.4 7.4 4.4.3
1. Office meeting N/A
2. Meeting with external interested parties, e.g. costumer, N/A
insurance, flag state, supplier, service provider, etc.
3. Onboard meeting to discuss office circular, safety alert, Y
lesson learnt, drill evaluation, finding report, near miss,
tool box talk, and other HSE issues
18 Control of Documents (valid, retention and obsolete docs.) 11 7.5.3 7.5.3 4.4.5
1. Applicable regulations, rules, codes, publications, etc. Y
2. Certificates, inspection reports, or technical documents Y
3. HSE posters, muster list and emergency contact list Y
4. DPA and/or CSO appointment letter Y
19 Operational Control 1.2.3 8.1 8.1 4.4.6
1. OPM, SBM, VOM and SOP implementation (as per ship Y 1.4.2 8.5.1
specific type operation, e.g. towing, anchor handling, etc.) 7 8.5.5
2. HIRADC, environmental assessment, PTW, TBT & MoC N
3. Personal protective equipment Y
4. Cargo, ballast and bunker (plan and operation) Y
5. Simultaneous operations (SIMOPS) Y
6. Vessel navigation (E1/NAC/SBM/83) Y
7. 500 meter zone Y
8. Dangerous goods or hazardous wastes handling N
9. Service provider (subcontractor) works onboard Y
10. Crew’s rest hour Y
11. Hygiene and housekeeping Y
12. Life cycle perspective on purchasing goods as practicable Y
13. Customer requirement change on project execution period N/A
14. Handling customer complaint N/A
20 Control of Externally Provided Processes, Products and 12.2 8.4 4.5.7
Services
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1. Supplier (vendor) and service provider (subcontractor) N/A

selection and evaluation audit
2. High risk supplier and service provider N/A
3. High risk and/or long time outstanding ship requisition Y
4. Purchased goods and services verification Y
21 Property belonging to Customers or External Providers 8.5.3
1. Control of ship’s drawing and other technical documents Y
(equipment manual book, pervious inspection reports
before ship take over into company management, etc.)
2. Service provider’s tools and equipment inspection prior to Y
use onboard ship or at office for specific project
22 Preservation of Service 8.5.4
1. Customer’s contract (ship management, time charter, etc.) N/A
2. SBM 11 implementation (project control) Y
23 Identification and Traceability 8.5.2
1. Control of document tracking system Y
2. Control of record tracking system Y
24 Maintenance of the Ship and Equipment 10.1 7.1.5 4.4.6
1. VMM or NS5 PMS implementation N 10.2
2. Critical equipment Y 10.3
3. Monitoring and measuring equipment Y 10.4
4. MARPOL equipment Y
5. ISPS equipment Y
6. Defect equipment Y
7. Class inspection program Y
25 Emergency Preparedness and Response 1.4.5 8.2 4.4.7
1. Office emergency response drill Y 8.1
2. Shipboard emergency response drill N 8.2
3. Ship shore drill, involving external interested parties and Y 8.3
media handling as practicable
26 Monitoring, Measurement, Analysis, Evaluation 7.1.5 9.1 4.5
1. HSE objective, target and program evaluation Y 7.1.6
2. Other corporate target evaluation Y 9.1
3. Customer satisfaction evaluation Y
4. Training program evaluation Y
5. Vessel team KPI evaluation Y
6. NS5 PMS implementation evaluation Y
27 Improvement 9.1 8.7 10 4.5.3.1
1. Update on risk and opportunities assessment Y 9.2 10
2. Finding report and corrective action Y 10.2
3. Near miss report and corrective action Y
4. Incident investigation report and corrective action Y
28 Control of Records 3.1 7.5.3 7.5.3 4.5.4
1. Company manual controlled forms Y 10 8.5.6
2. Ship certificates Y 13
3. Office certificates N/A
29 Internal Audit 12.1 9.2 9.2 4.5.5
1. Internal audit schedule and actual implementation Y 12.3
2. Internal audit record Y 12.4
12.5
12.6
30 Management Review 12.2
9.3 9.3 4.6
1. MMR implementation and records N/A 12.6
9.3.1
2. Minutes tracking system N/A 12.7
9.3.2
3. Minutes are communicated N/A 9.3.3
Remarks:
When the status is ‘N’ (No), it should be recorded on NC report form (form no. 58-E2-NCF-SBM) and rectified.
HIRADC : Hazard identification, risk assessment and determining control
PTW : Permit to work
TBT : Tool box talk
MoC : Management of change