Send the action plan to kumara.agni@sgs.

com

within 5 working days

Corrective Action Request

Organisation: Puskesmas Turi
Organisation Representative: dr. Helmanu
Site(s) audited: Randusongo Donokerto Turi, Sleman, Yogyakarta

Auditor(s): Kumara Agni

Date(s) of audit(s): 12/07/13

CAR No: 1 of 2

Category:

Standards: ISO 9001:2008

Standard Ref.: Clause 6.3 & 7.5.5

Area/Department/Process: KB

Document Ref. and Issue No/ Rev.No: QM

Major

Minor

CAR Close out date: Next visit

Details of Non-Conformity:

Organization does not always ensure that work environment conform the requirements with evidence
Implant & IUD consumables that require below 25 C storage were found in KB room without AC and
temperature monitoring

Organization Representative: dr. Helmanu

Auditor: KUA

ACTION PLAN (to eliminate the cause of non-conformity in order to prevent recurrence):
Menyimpan (menitipkan) peralatan dan bahan yang membutuhkan suhu dibawah 25 C (contohnya
Implant dan IUD) di Gudang Obat Puskesmas Turi yang telah dilengkapi AC (disetel pada suhu dibawah
25 C ) dan thermometer ruangan, kemudian mencatatnya di dalam buku bantu penitipan alat dan bahan.

Organization Representative:

Date:

Acceptance of Corrective Action / Comments (use additional sheets if necessary):

Auditor:

Date:

Response required:

Major

Corrective Action must be addressed within time frame stated.

Verification of action will occur at next visit. Additional follow up
may be required as indicated.

Job n: ID/JKT-3064
CONFIDENTIAL

Report date:
Document:

12/07/2013
GS0401_I

Define

Minor
Close Out

Define

Visit Type: SUR

Issue n:4_Rev.3

Close Out

Visit n:
Page n:

4
1

Send the action plan to kumara.agni@sgs.com

within 5 working days

Corrective Action Request

Organisation: Puskesmas Turi
Organisation Representative: dr.Helmanu
Site(s) audited: Randusongo Donokerto Turi, Sleman, Yogyakarta

Auditor(s): Kumara Agni

Date(s) of audit(s): 12/07/13

CAR No: 2 of 2

Category:

Standards: ISO 9001:2008

Standard Ref.: Clause 7.5.1

Area/Department/Process: KIA

Document Ref. and Issue No/ Rev.No: QM & PTKIA-08

Major

Minor

CAR Close out date: Next visit

Details of Non-Conformity:

KIA service provision was not always carried out under controlled condition with example ANC patient Ms.
Mitra; MR #112050; visit date 3-7-13; Hb 10.6; was not recorded on risk pregnancy monitoring book and
identified with green marker.

Organization Representative: dr. Helmanu

Auditor: KUA

ACTION PLAN (to eliminate the cause of non-conformity in order to prevent recurrence):
1. Menempel PROTAP Kriteria Ibu Hamil Resiko Tinggi di dinding ruang KIA-ANC. Protap tersebut
berisi antara lain: kriteria ibu hamil faktor resiko dan resiko tinggi, serta prosedur penandaan pada
rekam medis dengan warna dan prosedur pencatatan dalam buku Register Resiko Tinggi (RISTI)
Ibu Hamil
2. Mensosialisasikan kembali PROTAP Kriteria Ibu Hamil Resiko Tinggi pada seluruh Bidan
Puskesmas Turi
3. Melakukan pencatatan dalam buku Register Resiko Tinggi (RISTI) Ibu Hamil dan penandaan
rekam medis ibu hamil faktor resiko dan resiko tinggi sesuai prosedur
Organization Representative:

Date:

Acceptance of Corrective Action / Comments (use additional sheets if necessary):

Auditor:

Date:

Response required:

Major

Corrective Action must be addressed within time frame stated.

Verification of action will occur at next visit. Additional follow up
may be required as indicated.

Job n: ID/JKT-3064
CONFIDENTIAL

Report date:
Document:

12/07/2013
GS0401_I

Define

Minor
Close Out

Define

Visit Type: SUR

Issue n:4_Rev.3

Close Out

Visit n:
Page n:

4
2