ACTIVITY REPORT

Report Number Standard(s) / Scheme(s) Applicable to this Report

2010/37571/OA1 ISO 9001:2008

Date of Activity

28-29 June 2010

Indicate the Certification Brand that this Audit Activity Report Relates to (Tick Appropriate Box)

ROS

URS

GRi

Client Name

SMP NEGERI 5 PENAJAM PASER UTARA

City/Town and Country of Head Office/Main Location

Jl. Raya Girimukti KM.16 RT 21 No. 87 Penajam Paser Utara Kalimantan Timur 76144 INDONESIA

Confidentiality and Impartiality Statement

This report remains confidential between the above referenced client and the ROS group of companies (ROS, URS, GRI) and as such, should not be circulated to other parties without the express permission, in writing, of the aforementioned parties; with the exception of the ROS group of companies' Regulators. The contents of this report have been made by the impartial Lead Auditor and the Audit Team, where relevant, and are based on random samples selected during the Audit Process. As such, the report does not infer that the comments and/or concerns contained within this report are exhaustive in nature.

Organizations Representative Signature Form R-10.Aiss0408(Cover)

Mr. Sumardiyana, S.Pd

Lead Auditors Signature

Yanuar Wijanarko

Page

Total Number of Pages in this Report is

10

ROS 2007

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Report Number

2010/37571/OA1

Management Summary of Activity Stage 2 and onwards Below is a status summary of the "key" performance indicators of the system against the standard(s) / scheme(s) to which your organization has applied for/is certified to:

Performance Indicators
Notes i) If this is the first visit to the above referenced client by you, the auditor, you must not complete the column marked with an asterix*. ii) If you, the auditor, mark a degradation or danger, you must justify this by raising a finding(s) within this Activity Report.

*Indicate Status From Last Visit 1 = Improvement 2 = No Change 3 = Degradation N/A N/A N/A N/A N/A N/A N/A

Current Status 1 = Very Good 2 = Satisfactory 3 = Danger 2 2 2 2 2 2 2

Overall Commitment to the System Effectiveness of System Controls Effectiveness of Close-out to Issues, e.g. Audits, Internally Raised Issues Customer Complaints Control Setting of Targets / Objectives / Improvements Effectiveness of Achieving Targets/Objectives / Improvements Overall Compliance to the Standard(s)/Scheme(s)

Current Scope of System (as defined by the Job Instruction)

Management of Junior High School

State any Changes Required to be made by the Office/Head Office (for internal use only)

Please, issue certificate for this organization, with the organizations address: Jl. Raya Girimukti KM.16 RT 21 No. 87 Penajam Paser Utara Kalimantan Timur 76144 INDONESIA

Form R-10.Biss0408(Man. Summary)

Page

ROS 2007

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Report Number

2010/37571/OA1

Audit Team Summary

The company is being recommended for registration status of ISO 9001:2008 upon closure of audit findings (Discrepancy) within 10 days from the date of audit. The PNC and OFI are listed in the R-10F page (page 5); whilst the Discrepancies (Minor Findings) are as follows: 1. Setting target of quality objective in each department (Unit Kerja) was not clear, to ensure that related objective could be monitored and measured on periodically basis. (clause 5.4) 2. There was no clear method to ensure that standard competency/basic competency for each subject lesson (mata pelajaran), according to defined RPP/syllabus had been completely delivered during learning teaching process (KBM) semester-II year 2009/2010 in Curriculum. (clause 8.2.3) 3. There was no clear method to ensure the traceability of books inventory (data base) in Library, i.e. location, identification, lost/broken books, etc. (clause 6.3)

Form R-10.C-iss0408
(Team Summary)

Page

2.a (optional)

ROS 2007

ACTIVITY REPORT
Report Number
Organizations Representative (s)

2010/37571/OA1
Audit Team Member (s) Man-days* Specialist (s) Translator (s)

Mr. Sumardiyana, S.Pd Ms. Yaleswati, S.Pd Other management staffs

Yanuar Wijanarko

2.0

N/A

N/A

Total Man-days for the Activity

2.5

Indicate the number of man-days for each auditor (to the nearest half day)

Status of corrective actions taken to address any previous concerns raised: Not Applicable Acceptable Not Acceptable Current Activity (indicate as appropriate)

Indicate as required

Note
If the Audit Team confirms that the corrective actions taken to address any previous concerns raised are Not Acceptable, then a concern must be raised in this report.

On-site Audit

Surveillance

Re-Cert

Special

Action Required by Client as a result of this Activity None* Consider the Comments Raised For the Next Activity Send in a Corrective Action Plan for the Discrepancy Point(s) Raised Send in a Corrective Action Plan plus Evidence for the discrepancy Point(s) Raised Send in a Corrective Action Plan plus Evidence for the Non-compliance Point(s) Raised

Required Receipt of Requested Information in Days from this Report 10 working days

Notes 1. If None* is indicated above, then either no findings have been raised during this activity, or the auditor has seen corrective action(s) and evidence, where required, and this is indicated by the auditors signature of acceptance on the concerns page. 2. On the case of certain schemes e.g. TS16949, any concerns must be closed-out prior to any future certification activity taking place (consult the ROS group scheme specialist)

Audit Teams Conclusion Certification is Recommended proceed to issue Certificate

Indicate as appropriate: Continued Certification and/or ReCertification is Recommended

Certification is Recommended subject to Continued Certification and/or Reany actions stated above being Certification is Recommended subject satisfactorily addressed proceed to issue to any actions stated above being certificate satisfactorily addressed A satisfactory Special visit is required prior to the Certification proceeding or continuation of certification Suspension of Certificate Recommended Withdrawal of Certificate Recommended

Note: The Audit Teams initial certification audit conclusions must be based on analysis of all information and audit evidence gathered during the Stage1 and Stage 2 audits.

Form R-10.Diss0408(Conclusion)

Page

ROS 2007

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Report Number Standard & Clause ISO 9001

2010/37571/OA1
Functions seen at this activity Regulatory Affairs* Audits Documentation & Data Control Corrective Actions Complaints Policy Review Other (if relevant) Indicate as seen

Indicate as seen

OFI

PNC

NC

4.1 4.2 5.1 5.2 5.3 5.4 5.5 5.6 6.1 6.2 6.3 6.4 7.1 7.2 7.3 7.4 7.5 7.6 8.1 8.2 8.3 8.4 8.5
Use of logo

Totals

1 1 2

1 1 2 1 5

1 1 1 3

Notes: i) We have used the term *Regulatory Affairs to denote the department or person(s) that is/are responsible for the control aspects of the management system(s) being audited.

ii) The audit team leader must ensure that the above functions in the "regulatory affairs" department are checked at each activity this must be indicated in the relevant boxes above.
Ensure that the Management Rep. has been made aware of those PNCs raised during this activity that would result in serious concerns (Ds or NCs) being raised at the next visit.

YES NO

The table below is only required to be completed if the Client is a Multi-site or operates within other locations e.g. a construction site / installation site and these locations were visited during this activity.

Permanent location seen at this activity other than HO (state N/A City/Town)

Temporary location seen at this activity (e.g.: Construction Site, Customer Site, etc.) N/A

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Form R-10.E-iss0408
(Findings Summary)

Page

4.ISO9001

ROS 2007

Report Number

2010/37571/OA1

Comments from this Activity - Opportunity For Improvement (OFI) and/or Potential NonCompliance (PNC) Item Number 1 OFI Indicate as appropria PNC Indicate as appropria Describe the Nature of the comment(s) below Verification of RPP (Learning Teaching Plan) had been conducted in Curriculum, but some of verification records were not maintained, e.g. PKLH (class 7, 8, 9), IPS (class 7), Seni Budaya (class 8, 9), etc (7.1) 2 Teacher supervision had been conducted, however the relevant records was not properly maintain in Curriculum, e.g. Mr. Suprapto (mathematic), Ms. Kusmiati (mathematic) (7.5) 3 The activity of BK (counseling) had been recorded in Kartu Bimbingan & Konseling and Catatan Kejadian Harian, however it was not properly registered into Buku Pribadi Bimbingan & Konseling Siswa (7.5) 4 Monitoring (pemantauan) from BK after counseling should be recorded & documented to ensure the effectiveness of action taken (7.5) 5 Customer satisfaction measurement had been conducted, however analysis of data was not provided yet. Target for customer satisfaction (minimum point) also was not clear to make sure that the customer satisfy or not (8.4) 6 Inventory and infrastructure had been identified and registered, however it was not describe the actual condition, i.e. Lab IPA, Lab. Bhs Inggris, UKS, etc (6.3) Internal infrastructure/inventory mutation (peminjaman) should be recorded for easier traceability & control (6.3)

Notes
1. An OFI is a recommendation of the auditor(s), which may assist to improve the current system, or a pointer to alert the organization of other considerations that may be beneficial to the system and its control. 2. A PNC is an issue that if not addressed, could lead to a breach in the system that may result in a Discrepancy, or Noncompliance being raised in the future. 3. The client is not required to address OFI or PNC comments, but is encouraged to do so the auditor(s) will discuss and review any OFIs and PNCs raised during this activity at the next scheduled activity. 4. If this is a "Stage 1" activity, all comments must be reported as OFIs, or PNCs, only because the formal audit has not taken place it is the duty of the auditor to make it clear to the client which comments would be Discrepancies and/or Non-compliance points, should they be found during the formal audit.

Organizations Representative Signature

Mr. Sumardiyana, S.Pd

Lead Auditors Signature

Yanuar Wijanarko

ACTIVITY REPORT
Form R-10.F-iss0408 (Comments) Report Number Page

ROS 2007

2010/37571/OA1
State Standard / Scheme to ISO 9001:2008 which the concern(s) refers Indicate as Specify Clause and/or Procedure/Protocol/Guidance required

Concerns from this Activity What is the Requirement?

1. The Clause of the Standard / 5.4 Scheme 2. The Clients Stated Quality Objective (Sasaran Mutu) Requirement Discrepancy (D) and/or Non-Compliance (NC) concern(s) from this activity are listed below: State below a description of the concern(s) raised against the requirement stated and indicate whether it/they is/are a "D" or "NC" in the box provided D (Minor ) NC (Major )

Setting target of quality objective in each department (Unit Kerja) was not clear, to ensure that related objective could be monitored and measured on periodically basis.

Organizations Representative Signature

Mr. Sumardiyana, S.Pd

Auditor s Signature

Yanuar Wijanarko

Why did the above happen (what was the root cause of the concern(s) raised above)

How is the above going to be addressed (what is the proposed corrective action)

Proposed/Actual date of closure

Organizations Representative Signature

Mr. Sumardiyana, S.Pd

Acceptance/Confirmation of corrective actions/evidence seen by the auditor Auditors Signature Date

ACTIVITY REPORT
Form R-10.Giss0408(Concerns) Report Number Page

6.1

ROS 2007

2010/37571/OA1
State Standard / Scheme to ISO 9001:2008 which the concern(s) refers Indicate as Specify Clause and/or Procedure/Protocol/Guidance required

Concerns from this Activity What is the Requirement?

1. The Clause of the Standard / 8.2.3 Scheme 2. The Clients Stated SPO-11 Requirement Discrepancy (D) and/or Non-Compliance (NC) concern(s) from this activity are listed below: State below a description of the concern(s) raised against the requirement stated and indicate whether it/they is/are a "D" or "NC" in the box provided D (Minor ) NC (Major )

There was no clear method to ensure that standard competency/basic competency for each subject lesson (mata pelajaran), according to defined RPP/syllabus had been completely delivered during learning teaching process (KBM) semester-II year 2009/2010 in Curriculum.

Organizations Representative Signature

Mr. Sumardiyana, S.Pd

Auditor s Signature

Yanuar Wijanarko

Why did the above happen (what was the root cause of the concern(s) raised above)

How is the above going to be addressed (what is the proposed corrective action)

Proposed/Actual date of closure

Organizations Representative Signature

Mr. Sumardiyana, S.Pd

Acceptance/Confirmation of corrective actions/evidence seen by the auditor Auditors Signature Date

ACTIVITY REPORT
Form R-10.Giss0408(Concerns) Report Number Page

6.2

ROS 2007

2010/37571/OA1
State Standard / Scheme to ISO 9001:2008 which the concern(s) refers Indicate as Specify Clause and/or Procedure/Protocol/Guidance required

Concerns from this Activity What is the Requirement?

1. The Clause of the Standard / 6.3 Scheme 2. The Clients Stated SPO-11 Requirement Discrepancy (D) and/or Non-Compliance (NC) concern(s) from this activity are listed below: State below a description of the concern(s) raised against the requirement stated and indicate whether it/they is/are a "D" or "NC" in the box provided D (Minor ) NC (Major )

There was no clear method to ensure the traceability of books inventory (data base) in Library, i.e. location, identification, lost/broken books, etc.

Organizations Representative Signature

Mr. Sumardiyana, S.Pd

Auditor s Signature

Yanuar Wijanarko

Why did the above happen (what was the root cause of the concern(s) raised above)

How is the above going to be addressed (what is the proposed corrective action)

Proposed/Actual date of closure

Organizations Representative Signature

Mr. Sumardiyana, S.Pd

Acceptance/Confirmation of corrective actions/evidence seen by the auditor Auditors Signature Date

ACTIVITY REPORT
Form R-10.Giss0408(Concerns) Report Number Page

6.3
Scheduled Month/Year of next activity

ROS 2007

2010/37571/OA1

May 2011

If the audit team consider a special visit is necessary (i.e.: a substantial increase has been noted in the total employees of the client, or the concerns of this visit are of a N/A serious nature or the client has requested a scope extension) then the proposed month and year should be indicated. Important Note: If it is deemed necessary to carry out a special visit by the audit team, then a charge will normally be made as per our original quotation/certificate regulations. However, the decision to proceed with the special visit will be taken by the certification office and as such the date indicated above cannot be considered final.
Standard(s) / Scheme(s) to be audited next activity

ISO 9001:2008
On-site formal audit Re-cert

The Plan below relates to the next Certification Activity (indicate as appropriate) DAY 1 Start Time 08.30 09.00 09.00 10.00 10.00 11.00 11.00 12.00 12.00 13.00 13.00 14.00 14.00 15.00 15.00 16.00 16.00 16.30 16.30 17.00 Auditor

Surveillance

Special

DAY

Start Time Auditor

Department/Function Opening Meeting Kesiswaan Kurikulum/Curriculum Perpustakaan/Library Break/Lunch Tata Usaha/Personnel Laboratory Mgt Representative Report preparation Closing Meeting
Notes:

Department/Function Opening Meeting Closing Meeting

i) The plan MUST reflect the client's departments/functions, planning by clause of a standard is NOT acceptable e.g.: to state emergency preparedness for 14001 is not sufficient, if this part of the standard is controlled by the Regulatory Affairs officer, then state in the plan Regulatory Affairs. ii) If the activity requires additional planning use another R-10.H form. iii) The exact date of the next activity will be notified to the client by letter, e-mail or telephone and shall be agreed

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mutually between both parties.

Form R-10.H-iss0408 (Audit Plan)

Page

ROS 2007