form material supplier questionnaire

7/29/2019 Form Material Supplier Questionnaire

1/27

Category Document

File Name Revision

1. GENERAL INFORMATION

1.1. Name of your Company (nama perusahaan)

NPWP

Head Office Address (alamat kantor)

City (kota) Zip (kode pos)

Country (Negara)

Phone (tlp) Email

Facsimile (Fax) Website (Alamat websi

Contact Person:

Techincal Contact Phone FacsimileNo. bag. Teknis tlp fax

Commercial Contact Phone Facsimile

No. bag. Sales tlp fax

Delivery/Shipping Contact Phone Facsimile

MSQ-SUP-OTH (DP-Frey-S-3.4-02C).xlsx

MATERIAL SUPPLIER QUESTIONNAIRE

OTHER DP-Frey-S-3.4-02C

06 / 1 Agustus 2010


2/27

No. bag. Pengiriman tlp fax

Emergency Contact* Phone Facsimile

No. Darurat tlp fax

* Person who can be contacted outside working hours*(nomor yang bisa dihubungi di luar jam kerja)

Does your company belong to a group?

(Apakah perusahaan anda masuk grup?)

If YES, please give: (Jika Iya, berikan informasi berikut:)

Group Name #1 (Nama Grup) Group Name #2

1.2.

Activities #1 (Aktifitas) Activities #2

Manpower

(susunan perusahaan)

Please provide your companys organisation chart. (Tolong berikan informasi struktur

How many people are working in your Company?

(Berapa banyak orang yang bekerja di perusahaan anda?)

The distribution of manpower:

(Distribusi Jabatan)

Executives Permanent Staff Sales/Marketing Staff

(bag. Exekutif) (bag. Staff tetap) (bag. Staff marketing)

1.3. Managers Outsourcing Staff Sales Support

(bag. manager) (bag. Staff tidak tetap) (bag. Pembantu marke

Supervisors Skilled Warehouse Staff

(bag. supervesor) (bag. teknis) (bag. Staff gudang)

Operators Semi-skilled Delivery Staff

(bag. operator) (bag. Semi teknis) (bag. Staff pengiriman)


3/27

Main Customer

(Data Kostomer)

Customer Name #1 (Nama kostomer 1) Main Sector #1

1.4.Customer Name #2 (Nama kostomer 2) Main Sector #2


1.5.



Products or services range that you can provide:

(Produk/jasa yang bisa anda berikan)

1.6.

Please list the main Material that you used in the Products (will be) supplied to FREY and wher(tolong berikan daftar material yang anda gunakan dalam produk anda dan dari mana asalnya)

Main Material #1 (Nama Material) Source #1 (Sumber)



Please list down the type of products (will be) supplied to FREY, the Principal details and the re

(tolong berikan info tentang list produk, detail produk, dan tipe kerjasama

Product Type #1 Principal Name #1

Address #1


4/27

City #1 Zip #1

Country #1

Contact Person #1 Relationship with Princ


Address #2

City #2 Zip #2

Country #2


1.7.


Address #3

City #3 Zip #3

Country #3



5/27

Do you use any sub-contractors for certain service at any time?

If YES, please state the companys name and address and the product(s) sub-contracted.

Product/Service Type #1

Sub-contractor Name #1

Address #1

City #1 Zip #1

Country #1

Phone #1 Email #1

Facsimile #1



Address #2

City #2 Zip #2

Country #2

Phone #2 Email #2


6/27

Facsimile #2



1.8.

1.8.A. Address #3

City #3 Zip #3

Country #3

Phone #3 Email #3

1.8.B. Facsimile #3

Please inform the facilities that owned by your company/principal/sub-contractor.

Production (for fabrication or producer company)

Location #1 Location #2

Activities #1 Activities #2

1.8.C.

Facilities #1 Facilities #2

Laboratory (for chemical industry, Pest Control, Independence Laboratory services)



7/27

Ownership #1 Ownership #2

Testing Types #1 Testing Types #2

Warehouse (for all suppliers)


1.8.D.

Address #1 Address #2

Product to be stored #1 Product to be stored #

Areal Size (meter squares) #1 Areal Size (meter squa

Ownership #1 Ownership #2

Facilities #1 Facilities #2

Transportation (for all suppliers)

1.8.E.

Ownership Outsourcing Company

Open topped Trucks (capacity): Open topped Trucks (

Enclosed Trucks / Truck with Box (capacity): Enclosed Trucks / Truc

1.8.F. Flat Truck with Container (capacity): Flat Truck with Contai

Others:


8/27

Capacity: No of Trucks:

Working Equipments & Tools (for all suppliers)

Working Equipments #1 Working Equipments #

2.

2.1.

Working Tools #1 Working Tools #2

2.2. Safety Equipments & Tools (for all suppliers)

Safety Equipments #1 Safety Equipments #2

2.3. Safety Tools #1 Safety Tools #2

2.4. MANAGEMENT RESPONSIBILITIES

Please explain your companys mission statement.

2.5.

Does the company have an ethics policy statement?

If YES, please enclose 1 copy.

Does your company have an EHS (Environmental, Health & Safety) policy statement?


Does your company have safety procedure(s)?


9/27


Customer Complaint.

A. Do you have Customer Complaint Procedures?

B. Do you keep the record of Customer Complaint?

2.6.

C. Do you decide Corrective & Preventive action?

D. Do you communicate your Corrective & Preventive action to customer?

2.7. E. How many complaint did you received within last year?

F. How many complaint did you solved within last year?

2.8.

G. What is the main problem of the complaint you received within last year?

Does your company evaluate and monitor Principal/Sub-contractor Performance?

3. If YES, please describe it.

3.1.

Please describe the order-taking flow process in your company.

Does your company have a Customer Satisfaction Measurement Procedure?

If YES, please describe it.


10/27

3.2. QUALITY MANAGEMENT AND PROCESS

Please list official certification held by your company/principal/Subcontractor for quality, envir

safety such as ISO9000, ISO14001, ISO22000, HACCP, OHSAS18001, SNI, Laboratory testing. (A

certificate(s) that your company and/or your principal had achieved).

Certification Type and No. #1 Achieved by #1




Please choose which documents your company capable to provide.

Product Specification / Product Data Sheet

Certificate of Analysis

Material Safety Data Sheet (MSDS)

3.3.

Food Grade certificate / Sertifikat Food Grade

Technical Drawing

Trading License

Others #1:


11/27

Others #2:

Please send one example copy of each above document which you commit to provide.

Warranty of your Products / Services

3.4. A. Warranty Period

B. Warranty including Spare Part

C. Warranty including Service / Technician

D. Warranty service on site

3.5. E. Replacement Product/Unit or Re-work if not suitable

F. Recovery cost if your company caused the accident/damage

3.6.

Technical Support:

A. Technical Consultation

B. Providing Technical training

C. Providing Documentation we need

Does your company capable to make a Customized products/services based on Customer Req

Please inform what kind of employee training that already delivered to your team:

A. Product Technical Knowledge training


12/27

B. Product Maintenance training

C. Product Repairing training

D. Production Training

E. Personnel Hygiene training (for Catering only)

4.

4.1. F. Customer Service Training

G. Environment, Health and Safety awareness

4.2.

H. How to use Safety equipment

I. Management System awareness

J. Others:

4.3. OTHER INFORMATION

A. Min. quantity per order:

B. Min. quantity per delivery:

Payment Method:

Cash

Credit

Days after invoice


13/27

Others

Bank Details:

Signed by Date

Position

ACKNOWLEDGE


14/27


15/27

Email

(Nama Grup)

(Aktifitas)

organisasi perusahaan anda)

Technicians

(bag. Teknisi/enginerr)

Project Manager

ting) (bag. Manajer proyek)

Technical Support

(bag. Asisten teknisi/enginerr)

R & D Staff

(bag. HRD)


16/27

(Bidang pekerjaan) #1





e it come from.

Origin Country #1 (asal negara)



lationship type.


17/27

ipal #1

ipal #2

ipal #3


18/27


19/27


20/27

2

es) #2

Name

o of trucks):

with Box (no of trucks):

er (no of trucks):


21/27

2


22/27


23/27

onment and/or

dd a copy of the


24/27

irements?


25/27


26/27


27/27

YES OWNED-B AC FORK-LIFT OWNED-B SOLE-DISTRIBUTOR

NO OUTSOUR NON-AC HAND-PAL RENT DISTRIBUTOR

CRANE AGENT

OTHERS RE-SELLER

form material supplier questionnaire

Documents