SV.

DIMDANG NYOS
Form 1.
SANITATION AUDIT FORM
CATATAN AUDIT SANITASI

Date:………………Month:………….Year:………..
TIME PRE-ON
PASS/FAIL TIME BREAK TIME POST-OP COMENTS/
SANITATION CONDITION JAM PASS/FAIL PASS/FAIL CORECTION
KONDISI SANITASI SEBELUM JAM ISTIRAHAT JAM SELESAI KETERANGAN/
LULUS/GAGAL LULUS/GAGAL LULUS/GAGAL KOREKSI

[Link] CLEANING AND

SANITIZING
KEBERSIHAN DAN SANITASI
PERALATAN
a. Equipment cleaned and sanitized
before star-up.
Peralatan dalam keadaan bersih
dan disanitasi sebelum memulai
produksi

b. Product residue remove from

equipment during break
Pembersihan sisa-sisa produksi
yang menempel pada peralatan
selama istirahat
2. EMPLOYE ATTIRE
PERLENGKAPAN PAKAIAN
KARYAWAN
Gloves and aprons clean in good
repair
Sarung tangan dan avron
karyawan dalam keadaan bersih
3. CROSS CONTAMINATION
KONTAMINASI SILANG
a. Employs hands, gloves and
utensil that contact unsanitary
objects are washed and sanitized
before contacting product.
Tangan, sarung tangan, peralatan
karyawan yang bersangkutan
dengan benda yang tidak
bersihkan harus dicuci
b. Employs on raw side wash
and sanitize hand, gloves,
equipment and aprons before
entering processing area.
Karyawan dari bagian
penanganan bahan baku mencuci
tangan, sarung tangan dan avron
sebelum masuk dalam ruangan
pengolahan..
[Link] WASHING AND
SANITIZING FACILITY
FASILITAS CUCI TANGAN DAN
SANITASI

Head of QC: Checked by:

INTERNAL VALIDATION
VALIDASI INTERNAL
Date :
Signature :
1. 2.
a. Adequate supplies of soap at
each entrance to processing area
Persediaan sabun yang cukup
untuk setiap wastafel di setiap
pintu masuk ruangan pengolahan.
b. Hand washing using 5 %alcanios
SF 20
Pencucian tangan menggunakan
air dengan 5% alcanios SF 20
c. Washing Basket, box, table using
5% alcanios SF 20
Pencucian keranjang, box, meja
menggunakan larutan 5% alcanios
sf 20.
5. PROTECTION FROM
ADULTERANS
PERLINDUNGAN TERHADAP
SALAH PAKAI
a. Cleaning compounds labeled and
storage
Pemberian label dan penyimpanan
bahan pembersih yang baik
b. Lubricants labeled and stored
properly
Pemberian label dan penyimpanan
bahan pelumas yang baik.
c. Product protected from condensate
Pestisida diberi label dan
disimpan dengan baik
d. Pesticides labeled and stored
properly
Pestisida diberi label dan
disimpan dengan baik
e. Product protected from floor
splash.
Produk terhindar dari percikan air
dari lantai
6. COLD STORAGE
Packed product separated from raw
material.
Sebelum dipak, produk jadi terpisah
dari produk mentah.
7. EMPLOYE HEALTH
KESEHATAN KARYAWAN
Employees do not show signs of
medical problems that could
compromise product.
Karyawan tidak menunjukan gejala
gangguan kesehatan yang dapat
mempengaruhi produk
8. TOILET FACILITIES
FASILITAS TOILET
Toilets are cleaned and properly
function.
Toilet dalam keadaan bersih dan
berfungsi dengan baik.
9. PEST
SERANGGA &BINATANG
PENGGANGGU

Head of QC: Checked by:

INTERNAL VALIDATION
VALIDASI INTERNAL
Date :
Signature :
1. 2.
No pest present in the processing area
Tidak ada serangga & binatang
penggangu di area pengolahan

Head of QC: Checked by:

INTERNAL VALIDATION
VALIDASI INTERNAL
Date :
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1. 2.
 CV. DIMDANG NYOS
Form 2.
CHECKING NOTE OF EQUIPMENT/UTENSIL AND EMPLOYEES HEALTH
CATATAN PERLENGKAPAN KERJA DAN KESEHATAN KARYAWAN

DATE:…………………….Month:…………………..Year:…………

EQUIPMENT/ COMMENT
NO. NAME OF EMPLOYEE HEALTH
UTENSIL CORRECTION
1.
2.
3.
4.
5.
6
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.

Head of QC: Checked by:

INTERNAL VALIDATION
VALIDASI INTERNAL
Date :
Signature :
1. 2.
 [Link] NYOS
Form 3.
RECORD OF RECEIVING RAW MATERIAL
CATATAN PENERIMAAN BAHAN BAKU

Date : Spesies :
Inpection time : Size :
Supplier : Tonnage :
NO. DESCRIPTION STANDART REMARKS
0
1. Temperature ≤3 C
2. Odor Natural
3. Texture Hard shell
4. Appearance Fresh
5. Color Natural
6. Black spot None
7. Foreign material None
8. Broken None

Date : Spesies :
Inpection time : Size :
Supplier : Tonnage :
NO. DESCRIPTION STANDART REMARKS
1. Temperature ≤30C
2. Odor Natural
3. Texture Hard shell
4. Appearance Fresh
5. Color Natural
6. Black spot None
7. Foreign material None
8. Broken None

Head of QC: Checked by:

INTERNAL VALIDATION
VALIDASI INTERNAL
Date :
Signature :
1. 2.
 CV. DIMDANG NYOS
Form 4.
RECORD OF PROCESS TEMPERATURE
CATATAN SUHU PROSES/PENGOLAHAN

DATE:…………………….

INSPECTION TIME
NO STEP REMARKS
08.00 10.00 13.00 15.00

1. Receiving

2. Gross weighing

3. Washing I

- Deheading
4.
- Peeling

5. Washing II

6. Sorting

7. Deveining (PD)

8. Washing III

9. Checking

10. Actual weighing

11. Washing IV

12. Final weighing

13. Washing V

14. Layering in pan

15. Water filling

16. Glazing

Head of QC: Checked by:

INTERNAL VALIDATION
VALIDASI INTERNAL
Date :
Signature :
1. 2.
 CV. DIMDANG NYOS
Form 5.
FORM LETTER OF GUARANTEE
CATATAN SURAT JAMINAN

Who signature at bottom :

Name (supplier) :
Address :
To this with we have a statement that shrimp to sale to PT Ujung Timur with specification as follows:
Species :
Size :
Tonnage (Kg) :
Do not using antibiotic and others chemical material that dangerous to human healthy when culturing at
ponds.

If the next time in reality founded about the material that we have agree if shrimp return to us and moneys
that we have according will be returning to PT. Ujung Timur.

Date:
Who give statement

Head of QC: Checked by:

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VALIDASI INTERNAL
Date :
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1. 2.
 CV. DIMDANG NYOS
Form 6.
RECORD OF CHECKING
CATATAN CHECKING

DATE SPESIFICATION SIZE COLOR GRADE REMARKS

Head of QC: Checked by:

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VALIDASI INTERNAL
Date :
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 CV. DIMDANG NYOS
Form 7.
FORM FINAL WEIGHING
CATATAN PENIMBANGAN AKHIR

CEK RESUT
DATE SPESIFICATION SIZE LABEL WEIGHT/PAN REMARKS
SIZE LULUS/GAGAL

CV. DIMDANG NYOS

Form 8.
RECORD OF FROZEN PRODUCT
CATATAN PRODUK BEKU

Head of QC: Checked by:

INTERNAL VALIDATION
VALIDASI INTERNAL
Date :
Signature :
1. 2.
 DATE SPESIFICATION BLOCK SHAPE GLAZING REMARKS

CV. DIMDANG NYOS

Form 9.
RECORD OF METAL DETECTION
CATATAN METAL DETEKTOR

Head of QC: Checked by:

INTERNAL VALIDATION
VALIDASI INTERNAL
Date :
Signature :
1. 2.
 METAL FILTH,
DATE SPESIFICATION SIZE FOREIGN REMARKS
MATERIAL

CV. DIMDANG NYOS

Form 10.
RECORD OF PACKING AND LABEL
CATATAN PAKING DAN LABEL

INNER MASTER
DATE POLYBAG LABEL REMARKS
CARTON CARTON
Head of QC: Checked by:

INTERNAL VALIDATION
VALIDASI INTERNAL
Date :
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1. 2.
 CV. DIMDANG NYOS
Form 11.
RECORD OF DAILY THAWING
CATATAN THAWING HARIAN

DATE:
No ITEMS 1 2 3 4 5 6
1. Type of product

Head of QC: Checked by:

INTERNAL VALIDATION
VALIDASI INTERNAL
Date :
Signature :
1. 2.
2. Production date

3. Production code

4. Size

5. Weight before defrost

6. Weight after defrost

7. Total PCS/pan

8. PCS/lbs I

9. PCS/ lbs II

10. PCS/ lbs III

11. PCS/ lbs IV

12. PCS/ over weight

13. Small 10 %

14. Big 10 %

15. Broken ring

16. Soft shell

17. Smell/odor

18. Broken

19. Broken tail/black tail

20. Black spot

21. Mix color

22. Uniformity

CV. DIMDANG NYOS

Form 12.
RECORD OF EXPORT INSPECTION
CATATAN INSPEKSI EKSPOR

Head of QC: Checked by:

INTERNAL VALIDATION
VALIDASI INTERNAL
Date :
Signature :
1. 2.
 Name of buyer
Contract order
L/C Number
Date of loading
Destination
Container number
Type of product

Gross weight
Net weight
Temperature before loading
Temperature after loading
Container condition
Result of inspection

Comment/correction

CV. DIMDANG NYOS

Form 13.
RECORD OF FREEZING TEMPERATURE
CATATAN SUHU PEMBEKUAN

TIME TEMPERATURE COMMENTS/

DATE CPF
LOADING UNLOADING LOADING UNLOADING CORRECTION

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VALIDASI INTERNAL
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 CV. DIMDANG NYOS
Form 14.
RECORD OF COLD STORAGE TEMPERATURE
CATATAN TEMPERATUR COLDSTORAGE

TEMPERATURE
DATE TIME REMARKS
CS I CS II
07.00

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VALIDASI INTERNAL
Date :
Signature :
1. 2.
 08.00
09.00
10.00
11.00
12.00
13.00
14.00
15.00
16.00
17.00
18.00
19.00
20.00
21.00
22.00
23.00
24.00
01.00
02.00
03.00
04.00
05.00
06.00

CV. DIMDANG NYOS

Form 15.
RECORD OF WATER TREATMENT
CATATAN PEN GOLAHAN AIR

Date Kaporit Tawas Ulta Violet Remarks

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VALIDASI INTERNAL
Date :
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 CV. DIMDANG NYOS
Form 16.
RECORD OF PEST CONTROL
CATATAN PENGAWASAN BINATANG PENGGANGGU

Date Trap Trap Trap Trap Trap Trap Trap Trap Trap Trap Trap Trap Trap Trap Reamarks
1 2 3 4 5 6 7 8 9 10 11 12 13 14

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VALIDASI INTERNAL
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 CV. DIMDANG NYOS
Form 17.
HARVESTING REPORT
CATATAN PANEN TAMBAK

AT POND
Date of Harvest : …………………………………………………………….
Area : …………………………………………………………….
Owner : …………………………………………………………….
No. Pound : …………………………………………………………….

Head of QC: Checked by:

INTERNAL VALIDATION
VALIDASI INTERNAL
Date :
Signature :
1. 2.
 Size sampling : …………………………………………………………….
Time of harvesting : …………………………………………………………….
System of harvesting : …………………………………………………………….
Source of washing water : …………………………………………………………….
Chlorine water : …………………………………………………………….
Quantity : …………………………………………………………….
Remark : …………………………………………………………….
AT PLAN
Date of receiving : …………………………………………………………….
Time : …………………………………………………………….
No. Truck : …………………………………………………………….
Temperature of shrimp : …………………………………………………………….
Quantity : …………………………………………………………….
Condition of shrimp : …………………………………………………………….

Harvested Coord. Verivied Receiving Coord.

Purchasing Quality control Head of Purchasing

CV. DIMDANG NYOS

Form 18.
TPC ANALYSIS REPORT
CATATAN ANALISIS TPC

Date Object Description TPC Remarks

Head of QC: Checked by:

INTERNAL VALIDATION
VALIDASI INTERNAL
Date :
Signature :
1. 2.
Head of QC: Checked by:

INTERNAL VALIDATION
VALIDASI INTERNAL
Date :
Signature :
1. 2.