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Please prepare the following form by tabbing to the available field and enter either text or press the space bar to check the Yes or No box. Important: All questions marked with a YES, must have supporting documentation attached to this questionnaire. Manufacturers Full name:CV. GARUDA BALI Manufacturer address:JL. RAYA MAS, DSN/BR. ABIANSEKA, DESA MAS, UBUD, GIANYAR, BALI - INDONESIA, 80571 Name and title of person completing this form:KADEK SUADNYANA 1. Is the building constructed of materials that resist unlawful entry? Yes No 2. Is the integrity of the building maintained by Periodic inspection and repair? 3. Is the facility surrounded by a fence? 4. Are international, domestic, high value and dangerous goods properly segregated by fence, safe or cage with access restricted to need and Properly marked? 5. Is fencing regularly inspected for integrity and Damage? 6. Are gates through which vehicles Enter and/or exit manned or monitored? 7. Are all external and internal windows, gates and Fences secured with locking devices? 8. Do management or security personnel control The issuance of all locks and keys? 9. Are private passenger vehicles prohibited from parking in or adjacent to the cargo handling And storage areas? 10. Is internal and external lighting provided in the Following areas? Yes Yes No No
No No No No No
Yes
No
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IMAX C-TPAT Questionnaire (continued) a. Entrances b. Exit c. Cargo handling areas d. Cargo storage areas e. Fence lines f. Parking areas 11. Are alarm systems and video surveillance used to monitor the premises and prevent unauthorized Access to cargo handling and storage areas? 12. Does the facility have security guards During non-operating hours? 13. Is the facility in a Free Trade Zone or Industrial Park that provides additional security features? 14. Are there communications procedures in place To contact local law enforcement? Yes Yes Yes Yes Yes Yes No No No No No No
No No No No
Yes Yes
No No
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C-TPAT Questionnaire for UTi, United States, Inc. 7. Are procedures in place to control and record Deliveries? 8. Are drivers required to show proper identification Before entering your facility? 9. Do you record, identify, and escort all visitors?
(Continued)
Yes
No
No No No
10. Do you have written policies and procedures to Challenge and remove unauthorized/unidentified personnel?
Procedural Security
1. Is there an employee and/or security officer designated to supervise the introduction or Removal of cargo? 2. Do you use security policies, procedures and practices to guard against the inserting of illegal Or unauthorized material into a shipment? 3. Is outgoing finished merchandise marked, Counted, weighed and documented? 4. Are all cartons/merchandise weighed? 5. Are shortages or overages detected and Reported? 6. Are shortages or overages investigated? 7. Do you have procedures for reporting Abnormalities in the movement of cargo? 8. Are procedures in place to notify local law enforcement in cases where illegal activities are Detected or suspected? Yes No
No No No No No No
Yes
No
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Container Security
1.Are all containers of solid construction and in good condition including: a. Walls b. Floors c. Ceiling/Roof d. Inside/Outside Doors e. Outside/Undercarriage 2. Do you have written procedure to control and Affix seals to loaded containers? 3. Is there an employee and/or security officer designated to distribute container seals for Integrity purposes? 4. Are seal numbers recorded on the shipping instructions and records kept of seal numbers And verified at arrival point? 5. Do you have procedures in place for recognizing and reporting compromised seals to the proper Authorities? 6. Are containers (full or empty) stored in a Secure area? 7. Are method(s) in place by which unauthorized access is prevented for the introduction of Un-manifested and unauthorized material? 8. How is container transferred to the forwarder, Carrier, port, or airport? a. By your own company truck and or trailer b. By and independent trucking company c. Transfer is arranged by the forwarder d. Transfer is arranged by the carrier Yes Yes Yes Yes Yes Yes No No No No No No
Yes
No
Yes
No
Yes Yes
No No
Yes
No
No No No No
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(Continued)
No No No No
Yes
No
Personnel Security
1.Do you conduct pre-employment screening and Interviewing of prospective employees? 2. Do you conduct background checks and Application verifications where permitted by law? a. If yes, are these background checks Conducted by you or an outside agency? b. If no, will you be implementing any form of Personnel checks in the near future? 3. Do you conduct periodic checks of current employees based on cause and/or the Sensitivity of the employees position where Permitted by local law? 4. Do you have procedures in place to remove identification, facility, and system access for Terminated employees? Yes Yes Facility Yes No No Agency No
Yes
No
Yes
No
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Educational Training
1. Does your company provide a security Awareness training program to employees? Yes No a. If yes, please provide details of program as an attachment to this form b. If no, will you be implementing any form of Security training in the near future? Yes No
Yes
No
Factory ________________________________ (signature) Print Name: Agent / Vendor; _________________________ (Signature) Print Name:
Date: ____________________________________
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