Application for Certification – System Representative/System Manager /

Application for Certification

System Representative, System Manager
Quality incl. focus, Environment, OH&S, Health Care Sector

For admission to the certification examination for „System Representative“ or „System Manager“, admission requirements are defined in the certification program. You are requested to enter the required data into this form, to enclose copies of evidence and to return the completed application no later than 1 day prior to the examination to Quality Austria GmbH or to hand over it to the examiner during the examination. This application provides together with the successfully completed examination the basis for issuing the certificate(s). Non-submission of the application and/or insufficient evidence of practice result in issuing the certificate(s) with the status “Candidate”.

Please return the completed application by mail, fax or e-mail to:

Quality Austria GmbH

Attn: Petra Astleitner

Am Winterhafen 1

A-4020 Linz

Fax: (+43 732) 34 23 23

Tel: (+43 732) 34 23 22-19

1.  Name, E-mail address

Family name:
First name:
Title:
E-mail:

2.  Intended Certificate

Discipline / System Representative / System Manager
Quality Management Systems
Hygiene Management
Quality Management for Medical Devices
Environmental Management Systems
Occupational Health and Safety Management Systems
Quality Management Systems in the Health Care Sector
Requirements / Planned examination date / Check note
Participation in the Quality Austria course series „Integrated Management Systems“, Quality, Environmental, Occupational Health and Safety Management Systems, Health Care Sector, Hygiene Management and Quality Management for Medical Devices1
I apply for recognition of an equivalent training. Please send me the requirements for the training program.

3.  Specific training and examination

1 Please enter the planned examination date. Checking whether the training has been completed is carried out by the certification body.

4.  Requirements regarding qualification, work experience and professional practice

Certificate / Requirement / Requirement met / Evidence 2 enclosed / Ful-
filled
Quality Systems Representative / 2 years of qualified professional practice, including one year in Quality Assurance or Management / Yes
No / Yes
No
Quality Systems Manager / 4 years of qualified professional practice, including two years in Quality Assurance or Management / Yes
No / Yes
No
Quality Systems Representative (with focus on Food Safety) / 2 years of qualified professional practice, including one year in Quality Assurance or Management / Yes
No / Yes
No
Quality Systems Manager (with focus on Food Safety) / 4 years of qualified professional practice, including two years in Quality Assurance or Management / Yes
No / Yes
No
Quality Systems Representative (with focus on Medical Devices) / 2 years of qualified professional practice, including one year in Quality Assurance or Management / Yes
No / Yes
No
Quality Systems Manager (with focus on Medical Devices) / 4 years of qualified professional practice, including two years in Quality Assurance or Management / Yes
No / Yes
No
Environmental Management Representative / 2 years of qualified professional practice, including one year in the area of Environmental Management / Yes
No / Yes
No
Environmental Systems Manager / 4 years of qualified professional practice, including two years in the area of Environmental Management / Yes
No / Yes
No
Occupational Health and Safety Management Representative / 2 years of qualified professional practice, including one year in the area of Occupational Health and Safety Management / Yes
No / Yes
No
Occupational Health and Safety Systems Manager / 4 years of qualified professional practice, including two years in the area of Occupational Health and Safety Management / Yes
No / Yes
No
Quality Systems Representative in the Health Care Sector / 2 years of qualified professional practice, including one year in the area of Quality Management in the Health Care Sector / Yes
No / Yes
No
Quality Systems Manager in the Health Care Sector / 4 years of qualified professional practice, including two years in the area of Quality Management in the Health Care Sector / Yes
No / Yes
No

2… (Evidence by e.g. self-declaration, interim reference letter, confirmation by the employer).

I confirm the correctness of all information provided. Copies of evidence are enclosed with this application.

Place / Date / Signature
Yes / Issuing of the Certificate
No / Issuing of the Certificate “Candidate“
Place / Date / Signature Certification Body

qualityaustria-check note:

The requirements for issuing the Certificate are met according to the information available:

No.: FO_27_06_002 / Issue: 2013/12 / Page 2 of 2 / A-4020 Linz, Am Winterhafen 1, Telefon: (+43 732) 34 23 22,
Fax: (+43 732) 34 23 23, Homepage: www.qualityaustria.com, Email:
Created: Rußegger / Reviewed: Koubek/Kreiter / Approved: Scheiber