155V1 Attached certificate
Eco Mark Product Category No.155 “Imaging Equipment
Such As Copiers, Printers, etc. Version1”Attached Certificate
This attached certificate shall be submitted accompanied with “Application for Eco Mark product certificate and utilization” when applying for the product category No. 155 “Imaging Equipment Such As Copiers, Printers, etc. Version1”.
Date of application:Brand Name
Applicant
(company name) / (company seal)
<How to Prepare Attached Certificates>
1. Required items on the product under application shall be checked or entered in “Fill in this Column” or “Compliant/ noncompliant”.
2. Prepare the certificates specified in “Certificate to be submitted”. Submit these certificates with this attached certificatewhen applying for Eco Mark Product certification and use.
* Shaded areas in “Certificate to be submitted” do not require a submission.
3. Refer [Form] for preparing each certificate.
4. “The issuer(s) of the certificate to be submitted”shall prepare the “Certificate to be submitted”.
Item / Fill in this Column / documents attached
(check all items that apply)
Planned Display of Eco Mark
* in principal, Eco Mark shall be indicated on the product, packaging, instruction, product manual (pamphlet, etc), etc. / Product Packaging Instruction
Product manual (Catalogue/leaflet) Web
Other ( )
Planned design of Eco Mark indication
Please refer Eco Mark use guideline for indication of Eco Mark / Please submit the design drawing of Eco Mark indication (Format free, draft)
Reason (to plan) not to indicate Eco Mark
[ ]
Item / Fill in this Column
(check all items that apply) / Certificate to be submitted / issuer(s) of the certificate to be submitted
Company which developed the product / < > Other company
< > Own company / If developed by other companies, attach Approval of Eco Mark Application(Form0) / Approver of the application
If a product certified under this product category is applied as another brand / Are there any changes in addition to brand name?
< > Yes < > No / - A copy of notice of Eco Mark certification
-Correspondence table between certified model and applying model, identical proof by each item (or indication on this Attached certificate)
- Documents on 4-1-1.(5)-(7), (9)-(13), 4-1-2.(15), 4-1-4.(32), (33) and certifying changes
Model/product number
Type / □Copier / □Printer / □Fax (facsimile machine) / □Scanner/□Multifunctional device
Size / □Standard format (A3 size□accommodate □not accommodate)/□Large format/
□Small format
Marking Technologies(not required for scanners) / □Electoro-Photographic/□InkJet/□High performanceIJ/□Direct Thermal/
□ Dye Sublimination / □ Impact/□Solid Ink/□ Thermal Transfer
Monochrome / colour / □Colour / □Monochrome
Module for Colourant, Container(no entry required when these are not used) / □Toner cartridge / □Toner container / □Ink cartridge / □ Ink ribbon cartridges
Product number of cartridge/module / Eco Mark cerfication number (if certified) / Name onForm 7 / Name on SDS / Name on the result of Ames test (if no result of Ames test on SDS)
Main purpose of use / □ Office use / □Household use / □ Other [ ]
Model/product number
Type / □Copier / □Printer / □Fax (facsimile machine) / □Scanner/□Multifunctional device
Size / □Standard format (A3 size □accommodate □not accommodate) / □Large format /
□Small format
Marking Technologies(not required for scanners) / □Electoro-Photographic / □InkJet / □High performanceIJ / □Direct Thermal /
□ Dye Sublimination / □ Impact / □Solid Ink / □ Thermal Transfer
Monochrome / colour / □Colour / □Monochrome
Module for Colourant, Container (no entry required when these are not used) / □Toner cartridge / □Toner container / □Ink cartridge / □ Ink ribbon cartridges
Product number of cartridge/module / Eco Mark cerfication number (if certified) / Name on Form 7 / Name onSDS / Name on the result of Ames test (if no result of Ames test on SDS)
Main purpose of use / □ Office use / □Household use / □ Other [ ]
*Duplicate the above table and fill out the form if 3 or more types/models are used at one application.
Testing Bodies / Fill in this column*Check or Fill in the applicable items..
□Plan to utilize MRA with foreign ecolablling programs / □ No
4-1-2.(15)
Energy Efficiency / Name of testing body
Address of testing body
Requirements of testing body / <Third-party testing laboratory, Manufacturer’stesting laboratory
□ Certified by ISO/IEC 17025(corresponding JIS Q17025). (ENERGY STAR Accreditted laboratory (LAB)(
Certified / registered number[ ]
Program name [ ]
□Operating in accordance with ISO/IEC17025ISO/IEC17025(corresponding JIS Q17025).
□ Satisfying the requirements defined by Appendix A: “Requirements for the operation of a Witnessed Manufacturers’ Testing Laboratory (WMTL) or Supervised Manufacturers’ Testing Laboratory (SMTL) program” in the “Conditions and Criteria for Recognition of Laboratories for the ENERGY STAR® Program”
<Manufacturer’stesting laboratory
□ monitors sampling and analysis processes
□received accreditation to perform analysis and testing by the supervisory agency
□Has established a quality system including sampling and analysis and is maintaining ISO9001 (corresponding JIS Q9001).
□Performs measurements in accordance with a quality control system including sampling and analysis conforming to ISO9001.
4-1-3.(19)-(21)
Emission of Hazardous Substances / Name of testing body
Address of testing body
Requirements of testing body / <Third-party testing laboratory, Manufacturer’stesting laboratory
□ Certified by ISO/IEC 17025(corresponding JIS Q17025). (ENERGY STAR Accreditted laboratory (LAB)(
Certified / registered number[ ]
Program name [ ]
□Operating in accordance with ISO/IEC17025ISO/IEC17025(corresponding JIS Q17025).
<Manufacturer’stesting laboratory
□ monitors sampling and analysis processes
□received accreditation to perform analysis and testing by the supervisory agency
□Has established a quality system including sampling and analysis and is maintaining ISO9001 (corresponding JIS Q9001).
□Performs measurements in accordance with a quality control system including sampling and analysis conforming to ISO9001.
4-1-3.(31)
Noise / Name of testing body
Address of testing body
Requirements of testing body / <Third-party testing laboratory, Manufacturer’stesting laboratory
□ Certified by ISO/IEC 17025(corresponding JIS Q17025). (ENERGY STAR Accreditted laboratory (LAB)(
Certified / registered number[ ]
Program name [ ]
□Operating in accordance with ISO/IEC17025ISO/IEC17025(corresponding JIS Q17025).
<Manufacturer’stesting laboratory
□ monitors sampling and analysis processes
□received accreditation to perform analysis and testing by the supervisory agency
□Has established a quality system including sampling and analysis and is maintaining ISO9001 (corresponding JIS Q9001).
□Performs measurements in accordance with a quality control system including sampling and analysis conforming to ISO9001.
Item / Applicable Criteria and
Fill in this Column / Compliant/noncompliant / Documents to be
Submitted / issuer(s) of the certificate to be submitted
4-1-1.
(1) / Equipment shall conform to “Product Design Checklist”. / Yes
No / Form 1 / person responsible for design
4-1-1.
(2) / Modules for Colourants or containers for colorants used for the equipment shall conform to “Product Design Checklist” / Yes
No
□ No Modules for Colourants or containers for colorants used
4-1-1.
(3) / Each individual plastic casing part of more than 25g shall be made of one single polymer or polymer blends. / Yes
No / Form 2 / person responsible for design
In addition, all plastic parts of more than 25g used for casing parts shall be made of four or fewer types of mutually separable polymers or polymer blends. / Yes
No
4-1-1.
(4) / For equipment that falls under the Designated Resources Reutilizing Industry of the Act on the Promotion of Effective Utilization of Resources, any one of parts weighing more than 25g shall be a recycled plastic part or reused plastic part at a minimum. / Yes
No
□ Equipment not applicable / Form 3 / person responsible for design or in charge
For any equipment that does not fall under the Designated Resources Reutilizing Industry (equipment covered by the Act on Promotion of Recycling of Small Waste Electrical and Electronic Equipment and scanners), it may also be acceptable if any one of parts is a recycled plastic part or reused plastic part at a minimum. / Yes
No
□ Equipment not applicable
4-1-1.
(5) / Collection systems shall be available for toner cartridges, toner containers or ink cartridges. / Yes
No
□ No toner/ ink cartridges, toner cartridges used. / Explanatory documents for the collection systems of toner containers or toner/ink cartridges. / Control manager or person in charge
4-1-1.
(6) / Systems shall be available for the material recycling of toner cartridges or ink cartridges / Yes
No
□No toner /ink cartridges used
(no entry required below) / Explanatory documents describing the total weight of toner/ink cartridges, reuse and material recycling rates of parts, and the purposes of reuse and material recycling.(Form 4) / Control manager or person in charge
Reuse/material recycling rate of collected toner/ink cartridge parts shall be 50% or more for the toner cartridges, and 40% or more for the ink cartridges of the total weight of collected used products (excluding toner/ink). / Yes
No
4-1-1.
(7) / The recovery rate of collected toner cartridges, toner containers or ink cartridges shall be 95% or more of the total weight of collected used products (excluding toner/ink). / Yes
No
□No toner cartridges, toner containers or ink cartridges used (no entry required below) / Documents explaining the recovery rate and demonstrating that the system for processing/disposing of any part that cannot be recovered has been established (capacity of processing, content of processing, etc.).
(Form 4) / Control manager or person in charge
Parts of collected toner cartridges, toner containers or ink cartridges which cannot be recovered shall not be simply landfilled but be appropriately processed after the weight reduction. / Yes
No
4-1-1.
(8) / If paper to be used falls under a. to c. listed below, based on the provisions on quality control of each company, use of at least one or more type of paper shall be possible:
- Applicable scope “PPC paper, business forms and coated paper for color printers (paper for ink jet printing)” of Eco Mark Product Category No. 106 “Paper for Communication Version 3”
- Applicable scope “Printing paper (Excluding drawing papers included in the “writing and art papers” category designated in the “Paper and Pulp Statistics Annual Report” by the Ministry of Economy, Trade and Industry.) of Eco Mark Product Category No. 107 “Printing Paper Version 3”
- [Information Paper] “Copier paper, forms, coated inkjet color printer paper”, and [Printing Paper] “Non coated printing paper, coated printing paper” of “2. Paper” of the Law Concerning the Promotion of Procurement of Eco-Friendly Goods and Services by the State and Other Entities
Manufacturer
Brand name
Eco Mark certification no.
* Eco Mark certification No. shall be specified only when certified paper is used
* If several types of paper are available, indicate the major type. / Yes
No
□applies to a scanner and imaging equipment which uses only thermal paper, continuous forms, large format forms or photo / postcard paper.
4-1-1.
(9) / Equipment to which TEC of ENERGY STAR® Product Specification for Imaging Equipment Version 2.0 is applied shall meet the requirements of the automatic duplexing function in Table 1. However, this item does not apply to equipment intended to print on special single-sided media for the purpose of single sided printing (e.g., release coated paper for labels, direct thermal media, etc.).
Equipment to which the Operation Mode is applied (excluding scanners) or equipment to which the automatic duplexing function as described above is not applied shall have a printer driver with the capability of reducing paper usage (reduced printing, page layout printing, etc.). / Yes
No
□ Equipment not covered / each model, a certificate describing the automatic duplex function (e.g., a written notice on products using the ENERGY STAR® logo) or a document on the capability of reducing paper usage (e.g., a hard copy of the printer driver). / Person in charge
4-1-1.
(10) / Maintenance and repair subcontract systems shall be available, and repairs shall be carried out as requested by the users (repair system).
The following items a to c shall be satisfied to improve the system:
a. Information that repair services are available shall be provided;
b. Information that the scope of repair (details of services), repair time, costs, how services are provided to users, etc. shall be provided.
c. The system shall be such that maintenance of equipment (referring to maintenance to be provided by an operator) is performed only by persons who have undergone training and persons with the required technical expertise. / Yes
No / For a. and b, copies of product documentation showing that the proper system is available (processing ability, details of provided information specified in criteria, etc.).
4-1-1.
(11) / Supply of the spare parts shall be ensured for 5 years after production of the product stops. / Yes
No / Copies of product documentation indicating the matters related to this item.
4-1-1.
(12) / Equipment that falls under the Designated Resources Reutilizing Industry of the Act on the Promotion of Effective Utilization of Resources shall have a system for equipment collection and part reuse, or a material recycling system for materials. / Yes
No
□ Equipment not covered / Explanatory documents indicating the collection, reuse, material recycling, recovery of the products and establishment of the system for processing/disposing of any part that cannot be recovered (details of the collection system, collection rate, reuse, material recycling, content of recovery, capacity of processing, content of processing, etc. Form 4)or those (printouts of the website, etc.) on efforts to increase the collection rate, etc..
<refer the Interpretaion> / Control manager or a person in charge
For equipment that does not fall under the Designated Resources Reutilizing Industry (equipment covered by the Act on Promotion of Recycling of Small Waste Electrical and Electronic Equipment and scanners), efforts to establish a collection and recycling system and to increase the collection rate, reuse/material recycling rate and recovery rate are made. / □established a collection and recycling system
□ made effort to increase the collection rate, etc.
No
□Equipment not applicable
The recovery rate of collected equipment shall be 75% or more. / Check if the in-house collecting system is available.
Yes
No
Parts that cannot be recovered shall not be simply landfilled but be appropriately processed after the weight reduction. / Check if the in-house collecting system is available.
Yes
No
4-1-1.
(13) / Systems for collecting and material recycling of photoconductor drums shall be available. / Yes
No
□ Equipment not applicable / explanatory documents indicating the collection, material recycling, recovery of photoconductor drums and establishment of the system for processing/disposing of any part that cannot be recovered (details of the collection system, material recycling, content of recovery, capacity of processing, content of processing, etc.). Form 4 / Control manager or a person in charge
The recovery rate of collected photoconductor drums shall be 75% or more. / Yes
No
□ Equipment not applicable
Parts that cannot be recovered shall not be simply landfilled but be appropriately processed after the weight reduction. / Yes
No
□ Equipment not covered
4-1-1.
(14) / Packaging or packing of equipment shall be as simple as possible and give consideration to ease of reuse and environmental burden when packaging or packing materials are disposed of (compliant with “Packaging Material Check List”). / Yes
No / Form 5 / Person responsible for design or in charge
4-1-2.
(15) / A product shall conform to the ENERGY STAR® “Product Specification for Imaging Equipment: Eligibility Criteria” that is applied at the time of application. / Yes
No / a written notice on products using the ENERGY STAR® logo, etc,
(If the submission is difficult at the time of application, a signed consent form shall be submitted.) / Person in charge
4-1-3.
(16) / Polymer containing halogen shall not be used for plastic casing parts. In addition, organohalogen compounds as flame retardants shall not be added as prescribed constituents.
This item shall not apply to a part that falls under one or more of the following a. to e.:
a. Fluoroorganic additives (for example, anti-dripping agents, etc.) used to improve the physical properties of plastics, provided that they do not exceed 0.5wt%.
b. Fluoroplastics, for example, PTFE, etc.
c. Plastic materials of 25g or less (this criterion applies to keys of the keyboard even if it weighs 25g or less.)
d. Plastic parts installed adjacent to heating and fusing units.
e. Large-sized reused plastic parts which are marked in accordance with Appendix 1 “Product Design Checklist” B10. / Yes
No / Form2 / Person responsible for design or in charge
(please clarify the confirmation method)
□Aconfirmation is performed based on JIS Z 7201 “Management of chemical substances in products - Principles and guidelines”
□B. Applicant (or manufacturer) confirms by tests
□C. Applicant (or manufacturer) prepares “green procurement criteria”, etc. including the applicable materials and confirms the inclusion (amount) with parts supplier.
Name of Green procurement criteria:
URL (if posted):
*if not posted, submit it at the first certification and when revising the criteria.
□D. Applicant (or manufacturer) requires a parts supplier to submit test results of the applicable material.
□E. Other ( )
4-1-3.
(17) / Each substance listed in the following a. to e. shall not be added to plastic casing parts as prescribed constituents.
- Carcinogenic substances based on Category 1A or 1B of Table 3.1 in Annex VI of EC Regulation 1272/2008/EC
- Mutagen based on Category 1A or 1B of Table 3.1 in Annex VI of EC Regulation 1272/2008/EC
- Reproductive toxic substances based on Category 1A or 1B of Table 3.1 in Annex VI of EC Regulation 1272/2008/EC
- Persistent, bio-accumulative and toxic substances (PBTs) or very persistent or very bio-accumulative substances (vPvBs) based on the criteria in Annex XIII of the REACH Regulation
- Substances of very high concern in the list (so-called “list of SVHC candidates”) in REACH Regulation, Article 59, para. 1.
No / Form2 / Person responsible for design or in charge
Please clarify the confirmation method in this item.(refer confirmation methods A to D in 4-1-3.(16))
□A / □B / □C /□D
□E Other:[ ]
4-1-3.
(18) / The content rate of lead, mercury, cadmium in the product, hexavalent chromium compounds, Polybrominated biphenyl (PBB) or Polybrominated diphenylether (PBDE) in the product shall comply with Annex II (Table 2) of the amended RoHS Directive (2011/65/EU).
However, this does not apply to those substances specified in Annex III.
In addition, the product shall have no flame retardant of short-chain chlorinated paraffin (the number of chained C is 10 to 13 and contained chloride concentration is 50% or over) added as formulated components. / Yes
No
Please clarify the confirmation method in this item.(refer confirmation methods A to D in 4-1-3.(16))
□A / □B / □C /□D
□E Other:[ ]
4-1-3.
(19) / For electrophotographic equipment, values obtained with the measuring method defined by RAL-UZ171 shall confirm to Table 3 for emission of hazardoussubstances during operation of monochrome equipment as well as during the monochrome and color operation phases of color equipment.