Minor Non-Conformance Report NCR B 01

To be completed by the Auditor and client for all major non-conformances (NCR A) raised
and for any minor non-conformances (NCR B) raised at a Stage 2, Transition or Recertification audit.

Date of audit 27 Agustus 2019 Auditor M. Ainun Najib

Company name Puskesmas Cilacap Tengah I Standard(s) ISO 9001:2015
Company address Jl. Kalimantan No. 08, Cilacap 53224, Jawa Clause(s) 6.1
Tengah, Indonesia
Company representative Mrs. Sri Rahayu Major/Minor Minor

Non-conformance (by Auditor) (to be completed at audit)

Management has failed to meet the requirements of clause 6.1 in that it was found risk identification has not been
established at the Community service unit (UKM) and individual health unit (UKP).

Auditor’s signature Date

27 Agustus 2019

Corrective action (by Client) (to be completed at audit)

Root cause(s):

Proposed corrective action(s):

Company representative’s name Company representative’s signature Date action will be completed
Mrs. Sri Rahayu x x

Verification of acceptance of proposed corrective action(s) (by Auditor) (to be completed at audit)

Auditor’s signature Date

X x

Copyright  2019 MSC Global 1 Revision 2.1: 18/06/2019

Certification Committee Member’s response
I have reviewed the Non-Conformance Report and I accept the Report and approve Certification of the company’s System to
the relevant Standard(s). (delete as applicable)
I have reviewed the Non-Conformance Report and I do not accept the Report and require a re-audit of that part of the
System which applies to the non-conformance for the following reason(s): (delete as applicable)
a.
b.
c.
Certification Committee Member’s signature Date
x x

Copyright  2019 MSC Global 2 Revision 2.1: 18/06/2019

 Minor Non-Conformance Report NCR B 02

To be completed by the Auditor and client for all major non-conformances (NCR A) raised
and for any minor non-conformances (NCR B) raised at a Stage 2, Transition or Recertification audit.

Date of audit 27 Agustus 2019 Auditor M. Ainun Najib

Company name Puskesmas Cilacap Tengah I Standard(s) ISO 9001:2015
Company address Jl. Kalimantan No. 08, Cilacap 53224, Jawa Clause(s) 7.1.4
Tengah, Indonesia
Company representative Mrs. Sri Rahayu Major/Minor Minor

Non-conformance (by Auditor) (to be completed at audit)

Management has failed to meet the requirements of clause 7.1.4 in that it was found officers in the pharmaceutical unit
dispensing drugs do not use PPE.

Auditor’s signature Date

27 Agustus 2019

Corrective action (by Client) (to be completed at audit)

Root cause(s):

Proposed corrective action(s):

Company representative’s name Company representative’s signature Date action will be completed
Mrs. Sri Rahayu x x

Verification of acceptance of proposed corrective action(s) (by Auditor) (to be completed at audit)

Auditor’s signature Date

X x

Copyright  2019 MSC Global 3 Revision 2.1: 18/06/2019

Certification Committee Member’s response
I have reviewed the Non-Conformance Report and I accept the Report and approve Certification of the company’s System to
the relevant Standard(s). (delete as applicable)
I have reviewed the Non-Conformance Report and I do not accept the Report and require a re-audit of that part of the
System which applies to the non-conformance for the following reason(s): (delete as applicable)
a.
b.
c.
Certification Committee Member’s signature Date
x x

Copyright  2019 MSC Global 4 Revision 2.1: 18/06/2019

 Minor Non-Conformance Report NCR B 03

To be completed by the Auditor and client for all major non-conformances (NCR A) raised
and for any minor non-conformances (NCR B) raised at a Stage 2, Transition or Recertification audit.

Date of audit 27 Agustus 2019 Auditor M. Ainun Najib

Company name Puskesmas Cilacap Tengah I Standard(s) ISO 9001:2015
Company address Jl. Kalimantan No. 08, Cilacap 53224, Jawa Clause(s) 7.1.5
Tengah, Indonesia
Company representative Mrs. Sri Rahayu Major/Minor Minor

Non-conformance (by Auditor) (to be completed at audit)

Management has failed to meet the requirements of clause 7.1.5 in that it was found medical devices such as dopler,
stethoscope, etc. have not been calibrated.

Auditor’s signature Date

27 Agustus 2019

Corrective action (by Client) (to be completed at audit)

Root cause(s):

Proposed corrective action(s):

Company representative’s name Company representative’s signature Date action will be completed
Mrs. Sri Rahayu x x

Verification of acceptance of proposed corrective action(s) (by Auditor) (to be completed at audit)

Auditor’s signature Date

X x

Copyright  2019 MSC Global 5 Revision 2.1: 18/06/2019

Certification Committee Member’s response
I have reviewed the Non-Conformance Report and I accept the Report and approve Certification of the company’s System to
the relevant Standard(s). (delete as applicable)
I have reviewed the Non-Conformance Report and I do not accept the Report and require a re-audit of that part of the
System which applies to the non-conformance for the following reason(s): (delete as applicable)
a.
b.
c.
Certification Committee Member’s signature Date
x x

Copyright  2019 MSC Global 6 Revision 2.1: 18/06/2019

 Minor Non-Conformance Report NCR B 04

To be completed by the Auditor and client for all major non-conformances (NCR A) raised
and for any minor non-conformances (NCR B) raised at a Stage 2, Transition or Recertification audit.

Date of audit 27 Agustus 2019 Auditor M. Ainun Najib

Company name Puskesmas Cilacap Tengah I Standard(s) ISO 9001:2015
Company address Jl. Kalimantan No. 08, Cilacap 53224, Jawa Clause(s) 7.4
Tengah, Indonesia
Company representative Mrs. Sri Rahayu Major/Minor Minor

Non-conformance (by Auditor) (to be completed at audit)

Management has failed to meet the requirements of clause 7.4 in that it was found there is no evidence of providing
information on the use of drugs to patients.

Auditor’s signature Date

27 Agustus 2019

Corrective action (by Client) (to be completed at audit)

Root cause(s):

Proposed corrective action(s):

Company representative’s name Company representative’s signature Date action will be completed
Mrs. Sri Rahayu x x

Verification of acceptance of proposed corrective action(s) (by Auditor) (to be completed at audit)

Auditor’s signature Date

X x

Copyright  2019 MSC Global 7 Revision 2.1: 18/06/2019

Certification Committee Member’s response
I have reviewed the Non-Conformance Report and I accept the Report and approve Certification of the company’s System to
the relevant Standard(s). (delete as applicable)
I have reviewed the Non-Conformance Report and I do not accept the Report and require a re-audit of that part of the
System which applies to the non-conformance for the following reason(s): (delete as applicable)
a.
b.
c.
Certification Committee Member’s signature Date
x x

Copyright  2019 MSC Global 8 Revision 2.1: 18/06/2019

 Minor Non-Conformance Report NCR B 05

To be completed by the Auditor and client for all major non-conformances (NCR A) raised
and for any minor non-conformances (NCR B) raised at a Stage 2, Transition or Recertification audit.

Date of audit 27 Agustus 2019 Auditor M. Ainun Najib

Company name Puskesmas Cilacap Tengah I Standard(s) ISO 9001:2015
Company address Jl. Kalimantan No. 08, Cilacap 53224, Jawa Clause(s) 8.2
Tengah, Indonesia
Company representative Mrs. Sri Rahayu Major/Minor Minor

Non-conformance (by Auditor) (to be completed at audit)

Management has failed to meet the requirements of clause 8.2 in that it was found the standard reference criteria form in
the laboratory does not match the reagent used.

Auditor’s signature Date

27 Agustus 2019

Corrective action (by Client) (to be completed at audit)

Root cause(s):

Proposed corrective action(s):

Company representative’s name Company representative’s signature Date action will be completed
Mrs. Sri Rahayu x x

Verification of acceptance of proposed corrective action(s) (by Auditor) (to be completed at audit)

Auditor’s signature Date

X x

Copyright  2019 MSC Global 9 Revision 2.1: 18/06/2019

Certification Committee Member’s response
I have reviewed the Non-Conformance Report and I accept the Report and approve Certification of the company’s System to
the relevant Standard(s). (delete as applicable)
I have reviewed the Non-Conformance Report and I do not accept the Report and require a re-audit of that part of the
System which applies to the non-conformance for the following reason(s): (delete as applicable)
a.
b.
c.
Certification Committee Member’s signature Date
x x

Copyright  2019 MSC Global 10 Revision 2.1: 18/06/2019