試験所・校正機関認定申請書 【英文】

(JAB RFL01E REV.21)

to: President,

Japan Accreditation Board

Date:　 DD / MM / YYYY

Application for Accreditation

(

for Testing/Calibration Laboratory

)

We apply for accreditation as a testing/calibrationlaboratory with the information below:

1. Type of application □ Initial assessment

□ Reassessment (Accreditation No. )

□ Extension of the scope of accreditation (Accreditation No. )

2. Accreditation criteria:

□ JIS Q17025:2005（ ISO/IEC 17025:2005) □ ISO/IEC 17025:2017 (□ Option A)

□ ISO/IEC 17025:2017 (□ Option B)

Note) Management system requirements Option B is applicable only in case of all premises applied

for are included in the scope of ISO 9001 certification.

3． Name/Address/of the applicant laboratory: as stated on Attachment

Note) Please be advised that Company's name and URL (domain) shall not include "ISO" or "IEC".

4. Applied scope of accreditation: as stated on Attachment

5. Commercial status: as stated on Attachment

Representative of the legal entity of the applicant body: Signature/Name:

Title:

(JAB RFL01E REV.21)

Accreditation No.

Attachment 1

■ Commercial status :

□ Commercial service only

□ Commercial service is also available □ Commercial service is not available

■Contact person :

Name :

Division and title: Address :

TEL : FAX

:

e-mail :

URL :

Do you wish to be listed on the JAB website of the URL address above? Yes ( ) No ( )

【Please refer NOTES below on entry to Attachment 2】

1. On Initial application, box of Accreditation No. will be left blank.

2. Items inside thick frames are reflected AS IS on Accreditation Certificate, so please fill information carefully.

3. Entry for Premises

1)If some of the premises are located at different address but not far from one another, you may select one of them to represent others. However any premise more than 10km from others should be listed separately in the list. i.e. Each name and address of such premise should be unique.

2)If one premise contains satellite premise within 10km distance, and address of which is different, such satellite premise should be listed separately.

3)Please fill the name of premises as well as its scope of accreditation, one premise by one separately on the Attachment 2. Copy and Paste will be helpful for adding information of multiple premises.

4)Different type of Attachment 2 is attached for each of the testing or calibrating categories. Please select appropriate list according to the applying scope.

4. On Re-assessment or Extension of Scope application, use the copy of the original Attachment and edit information as necessary with MS-Word’s Revision History Function, which is to make sure changed information can be clearly recognized.

5. In case of Notification of Change includes description change on the Accreditation Certificate, use the copy of the original Attachment and edit information as necessary with MS-Word’s Revision History Function, which is to make sure changed information can be clearly recognize.

Please submit the revised Attachment with the Notification Change Cover sheet.

6. Please submit Attachment 1 and 2 ( MS-Word version ) by E-Mail or through Internet Storage Service. 7. If accreditation scope includes “opinion and interpretation”, either calibration procedure or test method

standard should clearly state that such method includes opinion and interpretation. Please contact JAB secretariat in such cases.

8. On applying for Renewal assessment or Extending assessment, add / delete / modify current accreditation scope with history of editing. MS word’s revision view functions will be preferably used.

9. When submitting Notification of Change regarding to small changes of accreditation scope, please use attachment 2 to clearly show the changes. In this case MS-word’s revision view functions will be preferably used.

10. When submitting attachment 2, original MS-Word file is required. Such file may be submitted via email or internet storage service.

Accreditation No.

(JAB RFL01E REV.21)

Accreditation No.

Attachment 2

（

Calibration Laboratory

）

- 1 /

2-Type of Laboratory Calibration Laboratory Name of Laboratory

Address

Management system requirements □ Option A □ Option B

1) Premises on which calibration activities are performed Name of

Premises Address of

Premises Postal _Code Address Calibration service at permanent facilities or on site calibration service

□ Calibration service at permanent facilities □ On site calibration service

Address of premises

(If physical address is different from that of abovementioned premises, and if physical distance is less than 10 km) Scope of Accreditation

CODE OF CLASSIFICATION, QUANTITY MEASURAND / CALIBRATION ITEM RANGE OF

CALIBRATION UNCERTAINTY EXPANDED 1) CALIBRATION PROCEDURE,_REMARKS

1) _{Information on the}

coverage factor

□

_□

□

Accreditation No.

Attachment 2

（

Calibration Laboratory

）

- 2 /

2-2) Premises on which key activities except calibration are performed Name of

Premises Address of Premises

Postal code Address Key activities performed in the premises

(check the checkbox)

□Policy formulation

(JAB RFL01E REV.21)

Accreditation No.

Attachment 2

（

Testing Laboratory

）

- 1 /

5-Type of Laboratory _{Testing Laboratory} Name of Laboratory

Address

Management system

requirements

□ Option A □ Option B

1) Premises on which testing activities are performed

Name of Premises Address of

Premises Postal code Address Testing service at

permanent facilities or on site testing service

□ Testing service at permanent facilities □ On site testing service

Address of premises

(If physical address is different from that of abovementioned premises, and if physical distance is less than 10 km)

Scope of Accreditation

FIELD M21 Electrical Testing

CODE OF CLASSIFICATION,

NAME TEST METHOD STANDARD

(NOTE)

Scope of Accreditation

FIELD M25 Mechanical Testing *1 CIT: Classification of Item to be Tested *2 TCT: Technical Classification of Test

Accreditation No.

Attachment 2

（

Testing Laboratory

）

- 2 /

5-CODE & NAME OF

TCT*2 _{STANDARD OPERATING PROCEDURE}TEST METHOD STANDARD OR (SECTION NO. LIMITED OR

EXCLUDED)

TEST CONDITION etc.

(NOTE)

Scope of Accreditation

FIELD M26 Chemical Testing *1 CIT: Classification of Item to be Tested *2 TCT: Technical Classification of Test

CODE OF CIT*1 NAME OF CIT

CODE & NAME OF

TCT*2 PROPERTIES_{MEASURED STANDARD OPERATING PROCEDURE}TEST METHOD STANDARD /

(Note)

Scope of Accreditation

FIELD M27 Food and Drug Testing *1 CIT: Classification of Item to be Tested *2 TCT: Technical Classification of Test

CODE OF CIT*1 MATERIALS OR

PRODUCTS TESTED

CODE & NAME OF

TCT*2 PROPERTIES_{MEASURED STANDARD OPERATING PROCEDURE}TEST METHOD STANDARD /

(NOTE)

(JAB RFL01E REV.21)

Accreditation No.

Attachment 2

（

Testing Laboratory

）

- 3 /

5-FIELD M28

Testing for Construction Materials

*1 CIT: Classification of Item to be Tested

*2 TCT: Technical Classification of Test

CODE OF CIT*1 NAME OF CIT

CODE & CLASS OF

TCT*2 _{STANDARD OPERATING PROCEDURE}TEST METHOD STANDARD /

(NOTE)

Scope of Accreditation

FIELD M29

Test Regarding the Fire Service Law

CODE OF CLASSIFICATION,CLASS TEST METHOD STANDARD AND DETAILS

(NOTE)

Scope of Accreditation

FIELD M30 Ship test

CODE AND CLASS OF

CLASSIFICATION, TEST METHOD STANDARD AND DETAILS

(NOTE)

Scope of Accreditation

FIELD M31

Accreditation No.

Attachment 2

（

Testing Laboratory

）

- 4 /

5-CODE AND CLASS OF

CLASSIFICATION, TEST METHOD STANDARD AND DETAILS

(NOTE)

Scope of Accreditation

FIELD M32

Biological Sciences Testing

*1 CIT: Classification of Item to be Tested *2 TCT: Technical Classification of Test

CODE OF CIT*1 NAME OF CIT

CODE & NAME OF

TCT*2 PROPERTIES_{MEASURED STANDARD OPERATING PROCEDURE}TEST METHOD STANDARD /

(JAB RFL01E REV.21)

Accreditation No.

Attachment 2

（

Testing Laboratory

）

- 5 /

5-Type of Laboratory _{Testing Laboratory} Name of Laboratory

Address

Management system

requirements

□ Option A □ Option B

2) Premises on which key activities except testing are performed Name of

Premises Address of

Premises Postal

code Address Key activities performed in the premise

(check the checkbox)

□Policy formulation

□Process and/or procedure development □Contract review □Plan tests □Review on the results of tests