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FORMULIR PELAPORAN TINDAKAN FRAUD
Nomor : XXX-XXXX-XX-2018
A. DATA DAN INFORMASI
1.
Nama Pelapor
:
Divisi/ Departmen/ Fungsi
:
--Choose Divisi--
U M U M
BOARD OF DIRECTOR
DIVISI OPERATION
PRODUCTION DEPARTMENT
PRODUKSI PIPA
PLANT KT-24
PLANT MM-1
PLANT VAI-4
PLANT WTM-8
PLANT WTM-16
SLITTING PLANT
KAWAT PLANT
GALVANIZE
STEEL CONSTRUCTION
DEPT. TECHNOLOGY
MAINTENANCE
PPC/OS
PPIC & TRANS
PROCUREMENT
PRODUCTION CONTROL
OPEN STORAGE/LOGISTIC
SALES ADMINISTRATION
DEPART. MAINTENANCE
MTN. MM-1
MTN. VAI-4
MTN. SLITTING
MTN. WTM-8
MTN. WTM-16
MTN. KT-24
MTN. WORKSHOP
MTN. UTILITY
MTN. BUILDING
MTN. INSTRUMENT
MTN. IMPROVEMENT
MTN. CAD CENTRE
MTN. HOUSE KEEPING
DIVISI H.R & DEV.
REMUNERATION
SEKRETARIAT
INDUSTRIAL RELATION
QAE / QC
LAB SERVICE
DEPART. LAB
SAFETY
METHOD & TECHNOLOGY
COATING
MARKETING
MARKETING
MARKETING
MARKETING
DIVISI FINANCE & ACCOUNTING
DEPT. PURCHASING
DEPT. ACCOUNTING
COST ACCOUNTING
GENERAL ACCOUNTING
BUDGET
DEPT. FINANCE/TREASURY
DEPT. TEKNOLOGI INFORMASI
DIVISI SALES
BPR
Talang Tirta
PROJECT
Azhari
PROYEK - BILL BOARD
PROYEK EXPANDED MTL
LAB SERVICE2
Alamat yang bisa dihubungi
:
Nomor Telepon/ Fax/ E-mail
:
Telp
Fax
Email
2.
Nama Terlapor
:
Divisi/ Departmen/ Fungsi
:
--Choose Divisi--
U M U M
BOARD OF DIRECTOR
DIVISI OPERATION
PRODUCTION DEPARTMENT
PRODUKSI PIPA
PLANT KT-24
PLANT MM-1
PLANT VAI-4
PLANT WTM-8
PLANT WTM-16
SLITTING PLANT
KAWAT PLANT
GALVANIZE
STEEL CONSTRUCTION
DEPT. TECHNOLOGY
MAINTENANCE
PPC/OS
PPIC & TRANS
PROCUREMENT
PRODUCTION CONTROL
OPEN STORAGE/LOGISTIC
SALES ADMINISTRATION
DEPART. MAINTENANCE
MTN. MM-1
MTN. VAI-4
MTN. SLITTING
MTN. WTM-8
MTN. WTM-16
MTN. KT-24
MTN. WORKSHOP
MTN. UTILITY
MTN. BUILDING
MTN. INSTRUMENT
MTN. IMPROVEMENT
MTN. CAD CENTRE
MTN. HOUSE KEEPING
DIVISI H.R & DEV.
REMUNERATION
SEKRETARIAT
INDUSTRIAL RELATION
QAE / QC
LAB SERVICE
DEPART. LAB
SAFETY
METHOD & TECHNOLOGY
COATING
MARKETING
MARKETING
MARKETING
MARKETING
DIVISI FINANCE & ACCOUNTING
DEPT. PURCHASING
DEPT. ACCOUNTING
COST ACCOUNTING
GENERAL ACCOUNTING
BUDGET
DEPT. FINANCE/TREASURY
DEPT. TEKNOLOGI INFORMASI
DIVISI SALES
BPR
Talang Tirta
PROJECT
Azhari
PROYEK - BILL BOARD
PROYEK EXPANDED MTL
LAB SERVICE2
Jabatan
:
3.
Identifikasi Tindakan Fraud
:
--Choose Id Fraud--
Uang
Barang
Diskon
Komisi
Tiket Perjalanan
Fasilitas Penginapan
Perjalanan Wisata
Fasilitas Lainnya
Jenis Tindakan Fraud
:
--Choose Jenis Fraud--
Korupsi
Penggelapan Asset
Penyuapan / Bribery
Pembocoran Informasi Perusahaan
Kejahatan Lainnya
Bukti - bukti awal yang dimiliki
:
1.
2.
3.
*) Bukti - bukti awal dapat dilampirkan pada lembar terpisah apabila tidak mencukupi
B. KETERANGAN SINGKAT
No.
Pertanyaan
Keterangan
1.
Selain daripada Terlapor, apakah ada pihak lain yang terlibat?
Tidak
Ya
Nama
Divisi/ Departmen/ Fungsi
--Choose Divisi--
U M U M
BOARD OF DIRECTOR
DIVISI OPERATION
PRODUCTION DEPARTMENT
PRODUKSI PIPA
PLANT KT-24
PLANT MM-1
PLANT VAI-4
PLANT WTM-8
PLANT WTM-16
SLITTING PLANT
KAWAT PLANT
GALVANIZE
STEEL CONSTRUCTION
DEPT. TECHNOLOGY
MAINTENANCE
PPC/OS
PPIC & TRANS
PROCUREMENT
PRODUCTION CONTROL
OPEN STORAGE/LOGISTIC
SALES ADMINISTRATION
DEPART. MAINTENANCE
MTN. MM-1
MTN. VAI-4
MTN. SLITTING
MTN. WTM-8
MTN. WTM-16
MTN. KT-24
MTN. WORKSHOP
MTN. UTILITY
MTN. BUILDING
MTN. INSTRUMENT
MTN. IMPROVEMENT
MTN. CAD CENTRE
MTN. HOUSE KEEPING
DIVISI H.R & DEV.
REMUNERATION
SEKRETARIAT
INDUSTRIAL RELATION
QAE / QC
LAB SERVICE
DEPART. LAB
SAFETY
METHOD & TECHNOLOGY
COATING
MARKETING
MARKETING
MARKETING
MARKETING
DIVISI FINANCE & ACCOUNTING
DEPT. PURCHASING
DEPT. ACCOUNTING
COST ACCOUNTING
GENERAL ACCOUNTING
BUDGET
DEPT. FINANCE/TREASURY
DEPT. TEKNOLOGI INFORMASI
DIVISI SALES
BPR
Talang Tirta
PROJECT
Azhari
PROYEK - BILL BOARD
PROYEK EXPANDED MTL
LAB SERVICE2
Nama
Divisi/ Departmen/ Fungsi
--Choose Divisi--
U M U M
BOARD OF DIRECTOR
DIVISI OPERATION
PRODUCTION DEPARTMENT
PRODUKSI PIPA
PLANT KT-24
PLANT MM-1
PLANT VAI-4
PLANT WTM-8
PLANT WTM-16
SLITTING PLANT
KAWAT PLANT
GALVANIZE
STEEL CONSTRUCTION
DEPT. TECHNOLOGY
MAINTENANCE
PPC/OS
PPIC & TRANS
PROCUREMENT
PRODUCTION CONTROL
OPEN STORAGE/LOGISTIC
SALES ADMINISTRATION
DEPART. MAINTENANCE
MTN. MM-1
MTN. VAI-4
MTN. SLITTING
MTN. WTM-8
MTN. WTM-16
MTN. KT-24
MTN. WORKSHOP
MTN. UTILITY
MTN. BUILDING
MTN. INSTRUMENT
MTN. IMPROVEMENT
MTN. CAD CENTRE
MTN. HOUSE KEEPING
DIVISI H.R & DEV.
REMUNERATION
SEKRETARIAT
INDUSTRIAL RELATION
QAE / QC
LAB SERVICE
DEPART. LAB
SAFETY
METHOD & TECHNOLOGY
COATING
MARKETING
MARKETING
MARKETING
MARKETING
DIVISI FINANCE & ACCOUNTING
DEPT. PURCHASING
DEPT. ACCOUNTING
COST ACCOUNTING
GENERAL ACCOUNTING
BUDGET
DEPT. FINANCE/TREASURY
DEPT. TEKNOLOGI INFORMASI
DIVISI SALES
BPR
Talang Tirta
PROJECT
Azhari
PROYEK - BILL BOARD
PROYEK EXPANDED MTL
LAB SERVICE2
Nama
Divisi/ Departmen/ Fungsi
--Choose Divisi--
U M U M
BOARD OF DIRECTOR
DIVISI OPERATION
PRODUCTION DEPARTMENT
PRODUKSI PIPA
PLANT KT-24
PLANT MM-1
PLANT VAI-4
PLANT WTM-8
PLANT WTM-16
SLITTING PLANT
KAWAT PLANT
GALVANIZE
STEEL CONSTRUCTION
DEPT. TECHNOLOGY
MAINTENANCE
PPC/OS
PPIC & TRANS
PROCUREMENT
PRODUCTION CONTROL
OPEN STORAGE/LOGISTIC
SALES ADMINISTRATION
DEPART. MAINTENANCE
MTN. MM-1
MTN. VAI-4
MTN. SLITTING
MTN. WTM-8
MTN. WTM-16
MTN. KT-24
MTN. WORKSHOP
MTN. UTILITY
MTN. BUILDING
MTN. INSTRUMENT
MTN. IMPROVEMENT
MTN. CAD CENTRE
MTN. HOUSE KEEPING
DIVISI H.R & DEV.
REMUNERATION
SEKRETARIAT
INDUSTRIAL RELATION
QAE / QC
LAB SERVICE
DEPART. LAB
SAFETY
METHOD & TECHNOLOGY
COATING
MARKETING
MARKETING
MARKETING
MARKETING
DIVISI FINANCE & ACCOUNTING
DEPT. PURCHASING
DEPT. ACCOUNTING
COST ACCOUNTING
GENERAL ACCOUNTING
BUDGET
DEPT. FINANCE/TREASURY
DEPT. TEKNOLOGI INFORMASI
DIVISI SALES
BPR
Talang Tirta
PROJECT
Azhari
PROYEK - BILL BOARD
PROYEK EXPANDED MTL
LAB SERVICE2
2.
Kapan kejadian terjadi?
Tanggal Kejadian
Waktu Kejadian
Frekuensi Kejadian
3.
Dimana kejadian ini terjadi?
4.
Bagaimana kejadian ini dapat terjadi?
5.
Apakah ada pihak lain yang dapat dijadikan saksi mata?
Tidak
Ya
Nama
Divisi/ Departmen/ Fungsi
--Choose Divisi--
U M U M
BOARD OF DIRECTOR
DIVISI OPERATION
PRODUCTION DEPARTMENT
PRODUKSI PIPA
PLANT KT-24
PLANT MM-1
PLANT VAI-4
PLANT WTM-8
PLANT WTM-16
SLITTING PLANT
KAWAT PLANT
GALVANIZE
STEEL CONSTRUCTION
DEPT. TECHNOLOGY
MAINTENANCE
PPC/OS
PPIC & TRANS
PROCUREMENT
PRODUCTION CONTROL
OPEN STORAGE/LOGISTIC
SALES ADMINISTRATION
DEPART. MAINTENANCE
MTN. MM-1
MTN. VAI-4
MTN. SLITTING
MTN. WTM-8
MTN. WTM-16
MTN. KT-24
MTN. WORKSHOP
MTN. UTILITY
MTN. BUILDING
MTN. INSTRUMENT
MTN. IMPROVEMENT
MTN. CAD CENTRE
MTN. HOUSE KEEPING
DIVISI H.R & DEV.
REMUNERATION
SEKRETARIAT
INDUSTRIAL RELATION
QAE / QC
LAB SERVICE
DEPART. LAB
SAFETY
METHOD & TECHNOLOGY
COATING
MARKETING
MARKETING
MARKETING
MARKETING
DIVISI FINANCE & ACCOUNTING
DEPT. PURCHASING
DEPT. ACCOUNTING
COST ACCOUNTING
GENERAL ACCOUNTING
BUDGET
DEPT. FINANCE/TREASURY
DEPT. TEKNOLOGI INFORMASI
DIVISI SALES
BPR
Talang Tirta
PROJECT
Azhari
PROYEK - BILL BOARD
PROYEK EXPANDED MTL
LAB SERVICE2
Nama
Divisi/ Departmen/ Fungsi
--Choose Divisi--
U M U M
BOARD OF DIRECTOR
DIVISI OPERATION
PRODUCTION DEPARTMENT
PRODUKSI PIPA
PLANT KT-24
PLANT MM-1
PLANT VAI-4
PLANT WTM-8
PLANT WTM-16
SLITTING PLANT
KAWAT PLANT
GALVANIZE
STEEL CONSTRUCTION
DEPT. TECHNOLOGY
MAINTENANCE
PPC/OS
PPIC & TRANS
PROCUREMENT
PRODUCTION CONTROL
OPEN STORAGE/LOGISTIC
SALES ADMINISTRATION
DEPART. MAINTENANCE
MTN. MM-1
MTN. VAI-4
MTN. SLITTING
MTN. WTM-8
MTN. WTM-16
MTN. KT-24
MTN. WORKSHOP
MTN. UTILITY
MTN. BUILDING
MTN. INSTRUMENT
MTN. IMPROVEMENT
MTN. CAD CENTRE
MTN. HOUSE KEEPING
DIVISI H.R & DEV.
REMUNERATION
SEKRETARIAT
INDUSTRIAL RELATION
QAE / QC
LAB SERVICE
DEPART. LAB
SAFETY
METHOD & TECHNOLOGY
COATING
MARKETING
MARKETING
MARKETING
MARKETING
DIVISI FINANCE & ACCOUNTING
DEPT. PURCHASING
DEPT. ACCOUNTING
COST ACCOUNTING
GENERAL ACCOUNTING
BUDGET
DEPT. FINANCE/TREASURY
DEPT. TEKNOLOGI INFORMASI
DIVISI SALES
BPR
Talang Tirta
PROJECT
Azhari
PROYEK - BILL BOARD
PROYEK EXPANDED MTL
LAB SERVICE2
Nama
Divisi/ Departmen/ Fungsi
--Choose Divisi--
U M U M
BOARD OF DIRECTOR
DIVISI OPERATION
PRODUCTION DEPARTMENT
PRODUKSI PIPA
PLANT KT-24
PLANT MM-1
PLANT VAI-4
PLANT WTM-8
PLANT WTM-16
SLITTING PLANT
KAWAT PLANT
GALVANIZE
STEEL CONSTRUCTION
DEPT. TECHNOLOGY
MAINTENANCE
PPC/OS
PPIC & TRANS
PROCUREMENT
PRODUCTION CONTROL
OPEN STORAGE/LOGISTIC
SALES ADMINISTRATION
DEPART. MAINTENANCE
MTN. MM-1
MTN. VAI-4
MTN. SLITTING
MTN. WTM-8
MTN. WTM-16
MTN. KT-24
MTN. WORKSHOP
MTN. UTILITY
MTN. BUILDING
MTN. INSTRUMENT
MTN. IMPROVEMENT
MTN. CAD CENTRE
MTN. HOUSE KEEPING
DIVISI H.R & DEV.
REMUNERATION
SEKRETARIAT
INDUSTRIAL RELATION
QAE / QC
LAB SERVICE
DEPART. LAB
SAFETY
METHOD & TECHNOLOGY
COATING
MARKETING
MARKETING
MARKETING
MARKETING
DIVISI FINANCE & ACCOUNTING
DEPT. PURCHASING
DEPT. ACCOUNTING
COST ACCOUNTING
GENERAL ACCOUNTING
BUDGET
DEPT. FINANCE/TREASURY
DEPT. TEKNOLOGI INFORMASI
DIVISI SALES
BPR
Talang Tirta
PROJECT
Azhari
PROYEK - BILL BOARD
PROYEK EXPANDED MTL
LAB SERVICE2
6.
Apakah ada kerugian yang akan ditanggung perusahaan akibat kejadian ini?
Tidak
Ya
7.
Apakah ada pihak eksternal yang lebih mengetahui kejadian ini?
Tidak
Ya
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PELAPORAN TINDAKAN FRAUD
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