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.

7.0 ASSESSMENT METHODS

The methoduses are:

Form No.: QP-7.4 Page 1 of 7

 VENDOR ASSESSMENT QUESTIONNAIRE
PT. BAKRIE PIPE INDUSTRIES

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:
2. Vendor Address:
3. Vendor Representative / Contact Person:
a. Name:
b. Address:
c. Phone Number: Handphone:
d. Fax : Email:

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.

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.

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.

5. How many employees does your Company have? 20

Please Provide Detail employee for:

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 VENDOR ASSESSMENT QUESTIONNAIRE
PT. BAKRIE PIPE INDUSTRIES

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

6. Do you conduct hazard identification, risk assessment and determining controls? Please
explain and provide sample of documents.

7. Do you update your legal and other requirements related to OH&S Management System and
implement to your 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.

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.

No

C. Products and/or Service Realization

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

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

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

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 VENDOR ASSESSMENT QUESTIONNAIRE
PT. BAKRIE PIPE INDUSTRIES

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

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

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

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?

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

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.

10. Please provide List of Customers you have supplied.

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 VENDOR ASSESSMENT QUESTIONNAIRE
PT. BAKRIE PIPE INDUSTRIES

D. SHE Operational Control

1. How do you determine the operations and activities that are associated with the identified
hazard?

2. How do you identify the potential for emergency situations and respond to such emergency
situations?

3. How do you measure and monitor OH&S performance?

4. How do you investigate incident, nonconformity, corrective action and preventive action?

E. Verification of Purchased Product

1. Do you outsource your processes and/or services to external Company?

2. How do you control your Supplier to meet your Company requirements?Please explain and
give copy of the related documents, if necessary.

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.

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 VENDOR ASSESSMENT QUESTIONNAIRE
PT. BAKRIE PIPE INDUSTRIES

4. If outsourced products and/or services fail to meet your Company requirements, what will
your Company do?

F. Control of Monitoring and Measuring Equipment

1. Do your measuring and inspection activities are conducted in house or outsourced?

2. If your measuring and inspection activities are outsourced, please provide the company
profile of the company.

3. Please describe measuring and inspection activities which are conducted in house and/or
outsourced.

4. Do you have your IMTE (Inspection and measuring testing equipment) owned by your
Company? Please provide IMTE list.

5. Do you calibrate your IMTE in house or outsourced? Please explain.

6. Please provide copy of your Calibration Procedures and Certificate of IMTE Calibration.

7. If IMTE are out of tolerance, what will your Company do?

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 VENDOR ASSESSMENT QUESTIONNAIRE
PT. BAKRIE PIPE INDUSTRIES

8. Please provide to us your Personnel Qualification Record for QA/QC Personnel.

9. Please provide copy of your Inspection and Measuring Procedures.

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:____Andree____________ NAME :_________________

POSITION : Director POSITION :

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