/ Case No:1
Customer Manager / Lead Assessor:1

Application[2]

for accreditation as a testing laboratory / calibration laboratory

In accordance with DIN EN ISO/IEC 17025:2005, for the laboratory named below, we apply for:

- the initial accreditation
- the extension of accreditation
- the reaccreditation
Name / Identity of the laboratory:[3]
Address: /
Street:
Code: / Place: / PO box / Code:
Telephone: / Fax: / E-Mail:
Website:
Head of the laboratory:
Deputy head:
Contact partner: / Tel.:
Number of laboratory staff members:
Legal status of the laboratory:
Owner of the laboratory:
Address of the owner:
Authorized representative of the owner:
Does the laboratory operate on several sites: / Yes / No
Sites of the testing/calibration laboratory [4]
Street: / Code: / Place:
Street: / Code: / Place:
Street: / Code: / Place:
Street: / Code: / Place:
Org. chart/s: Please attach the organisational structure of the testing/calibration laboratory and, where relevant the structure within an organisation.
Testing/calibration fields for which accreditation is requested (e. g. mechanical-technological analysis of ..., chemical analysis of ..., naming the test/calibration items - e.g.: welding samples, water)

Test methods applied: (Please attach stating the number, the edition date and the title of the test method/s or in-house / laboratory-developed methods)

For application as a calibration laboratory please use the form 72 FB 005.2_e and specify your calibration item, range, procedure, and best measurement capability.

Standard test methods
Non-standard test methods (in-house / laboratory-developed methods)

General information

Is the laboratory already accredited by another
accreditation body (including local and overseas? /
Yes
/ /
No
/
Has an application for accreditation been made
to another accreditation body? / Yes / No
Name of the accreditation body:
Date of application: / Date of application
Fields of testing/calibration which are accredited or for which accreditation has been applied:
Certifications, approvals and other recognitions of the laboratory:
Has DAkkS already sent a cost estimate to the laboratory? / Yes / No
If yes, indicate the reference number (if available):

Staff of the laboratory

Staff / Other staff
(part-time workers)
Staff with university education:
Staff with technical school education:
Staff specially trained as laboratory assistants:
Staff specially trained as technicians:
Staff without special training:
Staff trained in quality management:

Persons authorized to sign test/calibration reports: [5]

Testing/calibration field / Name, first name / Qualification / Work experience
(in years)

Management system

Does the laboratory have a quality system? / Yes / No
Has a quality manager been appointed? / Yes / No
If yes, name and qualification:
Does the laboratory have appropriate and sufficient equipment and apparatus to carry out its services? / Yes / No

Questions regarding the local accreditation body:

1) Applicant within Europe

Within Europe DAkkS follows EA (European co-operation for Accreditation) Policy, that an EA member shall not promote or market its accreditation services in the country or economy of another EA member (EA 2/13).

Has the local accreditation body any arrangement with EA? / Yes / / No /
Does the local accreditation body offer the required scope? / Yes / / No /
Which part of the required scope is not covered by the local accreditation body:

2) Applicant outside Europe

Applicants from outside the EA-Community will be processed according the “Cross Frontier Accreditation Principles for Avoiding Duplication” of ILAC - International Laboratory Accreditation Cooperation (ILAC-G21).

Is there a local accreditation body? / Yes / / No /
Is the local accreditation body a signatory to the arrangement of ILAC ? / Yes / / No /
Does the local accreditation body offer the required scope? / Yes / / No /
Do you permit, / /
… that DAkkS informs the local accreditation body about your application
and the development of the accreditation process? / Yes / / No /
… that the local accreditation body may send an observer to join
the assessment? / Yes / / No /
… that the local accreditation body may send (an) assessor/s
(joint assessment for a dual accreditation)? / Yes / / No /
Considering the questions above, what are the reasons for choosing DAkkS instead of the local accreditation body?

As the applicant body, we hereby declare that we recognise and take note of the DAkkS Accreditation Procedure and the DAkkS Rules.

(Stamp)

Place, Date / /
Signature
/
/
Name in print
/

72 FB 006.1_17025_e / Rev. 1.1 Page 1 of 4

[2]1 Will be entered by Deutsche Akkreditierungsstelle GmbH (DAkkS)

2 The applied accreditation does not fall into the scope of the EU-Directive 765/2008

[3] The name as stated here will appear on the accreditation certificate

[4] If place is not sufficient, please add annex

[5] If place is not sufficient, please add annex