Accreditation Application – North American Independent Laboratories

A printable version of this application can be downloaded HERE and mailed to: Assn. of North American Independent Laboratories for Protective Equipment Testing, 7087 Commerce Circle, Unit B
Pleasanton, CA. 94588

ASSOCIATION OF NORTH AMERICAN INDEPENDENT LABORATORIES FOR PROTECTIVE EQUIPMENT TESTING APPLICATION FOR ACCREDITATI0N OF TESTING LABORATORIES GENERAL INSTRUCTION

All questions must be answered. If questions are not applicable, answer by “NA”. If the answer is “none”, answer by “none” On Yes/No questions, answer by “X’ in the appropriate blocks. Where space on this application form is insufficient, additional pages keyed to the appropriate question and marked “Supplemental”, should be attached to this form.

Please give particular attention to the following sections in filling out the application:

1, 2, 3 If there are two or more branches, enter name, address, telephone number, and contact person of main laboratory; list name, address, telephone number, and contact person for each branch in an added keyed supplement.

4 Under “Other”, if University, Foundation, Trade Association, etc., give name of laboratory if an integral part of the parent organization: if a wholly-owned subsidiary, give also the name and address of the parent organization.

5 (b) If you have no testing experience in one or more of the products applied for, attach a brief keyed statement of basis for qualification for testing.

6 An accreditation fee shall accompany this application. If there is more than one location, please note “exception”.

9 NAIL for PET lists the normally tested products in this section and the corresponding test standards that apply. If you test products not listed, the Accreditation Inspector will assist you if contacted.

12 Following acceptance of your application, an on-site survey and audit will be scheduled to obtain information only obtainable by such a visit. The subject of this question may be more fully explored at that time.

I. Specific Information:

Date *

1. Name of Laboratory: *

2. Laboratory Location Address 1: *

Address 2: *

City: *

State: *

Zip: *

3. Contact Person: *

Phone Number: *

Fax Number:

Email *

4. Type of Owning Organization

Name of Owning Organization

Years of Experience testing at a fixed location *

Years of experience testing via a mobile facility *

5a. Testing Experience Product 1

Testing Experience 1. Fixed Location(Years) *

Testing Experience 1. Mobile (Years) *

5b. Testing Experience Product 2

Testing Experience 2. Fixed Location(Years)

Testing Experience 2. Mobile (Years)

5c. Testing Experience Product 3

Testing Experience 3. Fixed Location(Years)

Testing Experience 3. Mobile (Years)

5d. Testing Experience Product 4

Testing Experience 4. Fixed Location(Years)

Testing Experience 3. Mobile (Years)

5e. Testing Experience Product 4

Testing Experience 4. Fixed Location(Years)

Testing Experience 4. Mobile (Years)

5f. Testing Experience Product 5

Testing Experience 5. Fixed Location(Years)

Testing Experience 5. Mobile (Years)

5g. Testing Experience Product 6 (copy)

Testing Experience 6. Fixed Location(Years)

Testing Experience 6. Mobile (Years)

5h. Testing Experience Product 7

Testing Experience 7. Fixed Location(Years) (copy)

Testing Experience 7. Mobile (Years) (copy)

5i. Testing Experience Product 8

Testing Experience 8. Fixed Location (Years)

Testing Experience 8. Mobile (Years)

5j. Testing Experience Product 9

Testing Experience 9. Fixed Location (Years)

Testing Experience 9. Mobile (Years)

5k. Testing Experience Product 10

Testing Experience 10. Fixed Location (Years)

Testing Experience 10. Mobile (Years)

5l. Testing Experience Product 11

Testing Experience 11. Fixed Location (Years)

Testing Experience 11. Mobile (Years)

5m. Testing Experience Product 12

Testing Experience 12. Fixed Location (Years)

Testing Experience 12. Mobile (Years)

5n. Testing Experience Product 13

Testing Experience 13. Fixed Location (Years)

Testing Experience 13. Mobile (Years)

5o. Testing Experience Product 14

Testing Experience 14. Fixed Location (Years)

Testing Experience 14. Mobile (Years)

Fees

Checkboxes *

Physical Lab, First Time Accreditation for 2 years $4,450.00
Physical Lab, First Time Reaccreditation for 2 years $3,550.00
Physical Lab, 2nd Time Reaccreditation for 3 years $3,550.00
Stand-alone Mobile Lab, First Time Accreditation for 2 years $4,450.00
Stand-alone Mobile Lab, First Time Reaccreditation for 2 years $3,550.00
Stand-alone Mobile Lab, 2nd Time Reaccreditation for 3 years $3,550.00
Additional Mobile Lab, with Physical Lab (each) $500.00

Exception:

7. Do you maintain a master file of relevant test standards? *

8. Do you maintain receiving, handling, and shipping controls for products submitted for testing? *

9. Do you have written test procedures based on the appropriate testing standards?

10. Do you have appropriate test equipment available?

11. Do you maintain a system of calibration equipment, standards & procedures?

12. Indicate standards to which your calibration standards are traceable.

National Institute of Standards and Technology (N.I.S.T.), formerly the National Bureau of Standards (N.B. S.).
State
Other

Organization:

Address 1:

Address 2:

City:

Zip:

13. Affiliation The laboratory is owned or controlled by a parent company or organization.

13b. If owned or controlled by others, list the names and main office addresses of the parent company or organization and list all other affiliated member companies.

Name

Title:

Signature:

15. If the laboratory has previously been evaluated or accredited by other organizations, please name up to three previous accreditations: state whether accreditation has ever been denied or revoked: and what steps have been taken to correct the cause of any denial or revocation.

16. Within the five years preceding this application, has the laboratory been involved in any litigation regarding:

(a) Its procedures?

(b) Its test results?

(d) Alleged improper use of test results?

17. (supplemental 16) General Comments: If the laboratory wishes to submit any additional inforrnation relative to its application for accreditation, enter this information here:

II. Supplemental Information: Mail copies to: Assn. of North American Independent Laboratories for Protective Equipment Testing, 919 Adams Street, Great Bend, KS 67530.

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