Escolar Documentos
Profissional Documentos
Cultura Documentos
...
(Indicate exactly how the name of the organisation is to appear on the certificate)
Address:
Tel. no.:
Fax. no.:
... .
Website:
...
Contact person:
E-mail:
.....
Designation:
...
2. LABORATORY DETAILS
(If different from above)
Name:
(Indicate exactly how the name of the laboratory is to appear on the certificate)
Address:
Tel. no.:
Fax. no.:
..
Website:
....
Contact person:
..,
E-mail:
...
Designation:
..
Registration number:
Legal status:
...
Implementation period:
.....
year(s)
..
..
(If applicable)
..
Services provided:
(Please tick in an appropriate box)
Page 1 of 5
(Please provide as much as possible details such as organisation charts, extracts from quality manual, organisations latest annual report or publicity brochure)
LA 201C/T
Issue 11, 18-June-14
b) Structure of laboratory:
(Please provide the organisation chart showing the line of authority within the laboratory and if relevant, the laboratorys position in the overall structure of the parent
organisation. If it is available in the Quality Manual, please state the relevant section of the location of the laboratorys structure)
d)
Quality manual *
Standard operating procedure (SOP) *
Test method *
Working instructions (WI)
Forms
Reference documents
List of equipments
Others, please state:
TESTING
Chemical
Mechanical/Physical
Biological/Microbiological
Electrical
Non-destructive testing (NDT)
Thermal
Radioactivity
Bioefficacy of Household pesticide
Toxicity
Veterinary
Electromagnetic compatibility (EMC)
Genetically modified organism (GMO)
Nucleic acid
Forensic Science
Information Technology Security Testing
Software Testing
Others: (please state)
CALIBRATION
Heat & temperature
Electrical
Optical & photometric
Dimensional
Acoustic & vibration
Radioactivity
Mass & mass-related quantities
Others: (please state)
Note: For details of the scope, please complete the scope of accreditation sought in page 4 or 5.
Page 2 of 5
LA 201C/T
Issue 11, 18-June-14
Name
Designation
Qualifications
Experience
Permanent laboratory
On-site
Category:
II
III
Type of tests /
Properties measured
Nominated signatories
No.
Note:
Name
I.C. No./IKM
No.
Field
Qualification
Years of
Experience
Permanent laboratory
On-site
Category:
II
III
* The expanded uncertainties are based on an estimated confidence probability of approximately 95% and have a
coverage factor of k=2 unless stated otherwise.
Page 3 of 5
LA 201C/T
Issue 11, 18-June-14
Instrument
calibrated/
Measurement
parameter
Range
Remarks **
Nominated signatories
No.
Name
I.C. No.
Field
Qualification
Years of
Experience
CATEGORY I: Site calibration/testing is performed by staff sent out on-site by a permanent laboratory that holds SAMM accreditation.
CATEGORY II: Site calibration/testing is performed in a site Laboratory or mobile laboratory, (or by staff sent out by a site laboratory or
mobile laboratory), which is under the responsibility of the permanent laboratory that holds SAMM accreditation.
CATEGORY III: Site calibration/testing is performed on site by calibration/testing personnel of an organisation that does not have a
permanent calibration/testing laboratory.under Category III, calibration/testing may be performed using:
a site laboratory
a mobile laboratory or
7. DECLARATION
Declaration
The Organisation/Laboratory hereby undertakes:
(i)
to comply with Accreditation Standard MS ISO/IEC 17025:2005 and the relevant SAMM requirements
and to abide by SAMM Policy 1 (SP1) - Terms and Conditions Governing the SAMM;
(ii)
to pay1 all fees and costs connected with the accreditation process irrespective of the eventual
granting of accreditation;
Page 4 of 5
LA 201C/T
Issue 11, 18-June-14
(iii)
(iv)
to provide access to information, documents and records as necessary for the assessment and
maintenance of the accreditation;
(v)
to provide access to those documents that provide insight into the level of independence and
impartiality of the lab from its related bodies, where applicable; and
(vi)
Submission of Documentations
We enclosed herewith a copy each of the following for your examination:
(i)
(ii)
(iii)
Test/Calibration Method
(iv)
(v)
(vi)
Name of applicants
authorised representative:. Organisation stamp / seal: .
Please return duly completed forms to: Director General
Department of Standards Malaysia
Century Square
Level 1 & 2, Block 2300
63000 Cyberjaya, Selangor
Attention: Director of Accreditation
Note:
1
The laboratory will be invoiced upon acceptance of application. Application will be considered lapsed if the laboratory
fails to obtain accreditation within 2 years from the date of application acceptance.
Standards Malaysia reserves the right to exempt Adequacy Audit if the application forms for several branches are sent at the
same time; using the same common Quality Manual.
Standards Malaysia reserves the right to exempt Pre-Assessment if the laboratory complies with the exemption criteria as set
out by Standards Malaysia.
Should the laboratory fail to submit corrective actions for compliance assessment within 6 months from the date of compliance
assessment, the team of assessors shall conduct a verification assessment.
Page 5 of 5