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Dewangga Lazuardi
Appendix 1
To Research Respondents
My name is Dewangga Lazuardi, i was student on Master of Occupational
Health and Safety Program of Public Health Faculty of Airlangga University. I am
currently doing a research (thesis) with the title "Factors Associated with
Compliance Against Site Operational Procedure (SOP) Machine Tools Grinding
In Maintenance Worker Contractor PT. Holcim Indonesia Tbk. Tuban Plant”. For
that, I ask Mr. / Mrs to answer some questions in the next attachment. An honest
answer would be valid data and later can be related improvement suggestions
Labor occupational health and safety section Tools Grinding machine PT. Holcim
Indonesia Tbk Tuban Plant. Before you fill out the willingness sheet, here is an
explanation of my research.
A. Research Objectives
The purpose of this research is to analyze factors related to compliance to
SOP Grinding Tools machine by maintenance contractor worker di PT.
Holcim Indonesia Tbk Tuban Plant.
B. Research Benefits for Research Resondents
Benefit of participation in this research is Mr / Mrs will obtain information
and knowledge about factors that play a role in compliance to Grinding SOP
Tool Machine in the form of giving booklets to workers.
C. Right to Self-Defeating
The participation of Mr / Br in this study is voluntary and Mr / Mr entitled to
resign at any time, without causing any adverse consequences for you.
D. Treatment of Research Respondents
1. Mr / Mr will get an explanation about the implementation of the research
2. Mr. / Mr will be required to sign the consent form to be an Informed
Consent if you express his / her participation is voluntary and non-
coercive, and there are no consequences whatsoever regarding your
work.
3. After signing the Informed Consent, Mr. / Mr is officially declared the
respondent of this research.
4. Mr. / Mr will be asked to fill out a questionnaire containing the
individual factors (age, education, years of work, knowledge, personality,
and motivation), occupational factors (supervision and availability of
facilities), organizational factors (training and communication), and
questionnaires adherence to SOP Grinding Tools machine.
5. Filling out the questionnaire takes approximately 60 minutes.
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Appendix 2
Witness
(…………………………………)
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Appendix 3
RESEARCH QUESTIONNAIRE
(Identity and Respondent's Characteristics)
No. Respondent :_________________________________ (filled researchers)
With respect,
This questionnaire is a tool used for research conducted by Master
Program of Health and Safety Studies Program, Faculty of Public Health,
Airlangga University, Surabaya.
This questionnaire is intended ntuk know the data yourself and your
work. All data and information obtained is the data that is CONFIDENTIAL and
your answers will not affect the performance and the performance of this work
site. Researchers hope you can provide information honestly and candidly.
For your attention and cooperation and concern in the willingness to fill
in this questionnaire we really thank you.
Identity of Respondent
1. Name :
2. Age : ………………. Year
3. Years of services : ………………. Year
4. Pendidikan : a. Elementary School d. Diploma 3
b. Junior High School e. Diploma 4/Bachelor
c. Senior High Sc hool f. Master
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Appendix 4
Knowledge of Work Procedures
In The Unit Grinding Tools
Appendix 5
Filling Instructions:
Here are some characteristics that match or do not suit on yourself. For example, do
you agree that you are a person who likes to spend time with others? Check (√) next
to each statement, to indicate how far you agree or disagree with the statement.
Meaning of abbreviations on the questionnaire sheet:
STS : Very Unsuitable
TS : Unsuitable
S : Suitable
SS : Very Suitable
No Statement: STS TS S SS
A. Openess to Experience
1. I am interested in socializing with others at work
2. I am able to do many things at work
3. I have peace of mind in working
4. I have many ideas in working
5. I discussed a difficult job with fellow workers
6. I'm bossy co-workers at work
7. I often lower my colleagues
8. I'm not interested in complicated work
9. I am easily offended when my colleagues work
lowers me in my work
10. I avoid difficult work
B. Concientiousness
11. I understand many things related to my work
12. I have a strong ability to think at the time of
encounter difficulties at work
13. I was able to feel the feelings of others in my work
environment
14. I do the work until all is perfect
15. I take the time to communicate with fellow
workers
16. I do not have the ability to think well when having
difficulty in a job
17. I find it difficult to understand a difficult task
18. I easily feel uneasy at work
19. I like to waste time at work
20. I do not work to completion
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No Statement: STS TS S SS
C. Extraversion
21. I was able to enliven the atmosphere in the
workplace
22. I'm doing a job carefully
23. I am easy to make friends with fellow workers
24. I love to start a conversation while interacting with
colleagues
25. I was able to introspect ourselves if there is an
error in an employment
26. I put the working tools are not in place
27. I easily forget to do a job
28. I easily change the mood of getting the job if I can
not finish
29. I use my own understanding, not in accordance
with SOP, related to a job
30. I like to be alone at work
D. Agreeableness
31. I often feel ready to run the job
32. I remain calm in any situation at work
33. I often finish my job well
34. I quickly understood something new work
35. I do not mind being a role model for co-workers
36. I was able to make co-workers feel comfortable in
the work environment
37. I think about the feelings of co-workers if I have
an error while interacting
38. I like to help co-workers if there are difficulties in
working
39. I readily concerned with the results of my work
40. I get angry when my job is not perfect
E. Neuroticism
41. I do not talk much when working
42. I feel comfortable with my work environment
43. I sympathize with the feelings of my co-workers
44. I have a lot of brilliant ideas related to a job
45. I love talking to many colleagues in the workplace
46. I follow a work schedule that has been set by the
company
47. I do not like to disturb co-workers at work
48 I often ignore my work
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No Statement: STS TS S SS
49. I easily feel sad when my work is not done
50. I easily feel disappointed if the results of work do
not match my expectations
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Appendix 6
Work motivation
Physiological Needs 1 2 3 4 5
1. Salary as an employee in this company has
sufficient economic needs of the family
2. Salary earned as an employee in this company is in
accordance with the work done
3. Income received from this company has been very
satisfactory
4. The current salary can be set aside to meet personal
needs
5. Allowances earned from working in this company
are feasible and satisfactory
6. Needs received every month can meet the basic
needs of the family
7. The salary received today can meet the needs of
family clothing
8. The benefits I get from the company are sufficient
for the needs of today's life
9. The company is very concerned about the welfare
of its employees
10. Incentive given by the company to employees is
fair
11. Health insurance provided by the company is quite
good
12. The salary earned by employees is given on time
13. The breaks given by the company are enough
14. Workers at this company can guarantee my life in
the old days
Security Needs 1 2 3 4 5
15. The condition of the working space used is quite
safe
16. Equipment and equipment working in this company
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Appendix 7
Supervision
Appendix 8
Fill in the fields below using the sign (√) based on the actual conditions.
Appendix 9
Training of SOP
Appendix 10
Communication
Appendix 11
Instructions on filling:
1. Fill in the questionnaire below by using the sign (√)
2. The answer to the questionnaire is divided into four levels, ie starting from 'never'
to 'always'
Appendix 12
Instructions on filling:
Fill in the questionnaire below by using the sign (√)