Please Type Or Write Clearly in Block Letters

KENAS-TS-F-022-03

Kenya Accreditation Service

P.O. Box 47400-00100

NAIROBI

APPLICATION FOR ACCREDITATION

(Please type or write clearly in block letters)

(This form must be returned with a duly signed accreditation agreement (KENAS-TS-F-015))

1.Contact Details

Organisation
Address (Physical)
Address (Postal)
Telephone
Email
Website
Contact person
Position within the organisation
Type and Nature of business.
Does your organisation operate on several sites / Yes: No:
If yes, please provide details.

2.organisation Details

Indicate the Legal Status of your organisation
Total Number of Staff / Technical
Staff / Non-Technical Staff
List the conformity Assessment Services offered
Are your conformity Assessment activities part of a larger organisation / Yes: No:
If yes, specify other organisation activities
Previous Accreditation held ( State the scope of accreditation, year accredited and the Accrediting body)
Current Accreditation held ( State the scope of accreditation, year accredited and the Accrediting body)
Indicate the Conformity assessment Standard to which you are seeking accreditation.

3.SCOPE OF ACCREDITATION.

Please indicate below the scope/field to which you are seeking accreditation

SCHEME

/ SCOPE/FIELD
Medical Testing (15189) / No. / Medical Field / Examination Technique / Equipment / Specimen / Components / Analytes / Reference to Standardised Procedure / Measurement Range / Test Location
Veterinary Testing (17025 + OIE) / No. / Vet. Field / Examination Technique / Equipment / Specimen / Components / Analytes / Reference to Standardised Procedure / Measurement Range / Test Location
Calibration (17025) / No. / Calibration
Field / Calibration Object / Measurand / Calibration Method / Standard / Calibration and Measurement Capability (CMC) / Calibration Site
General Testing (17025) / No. / Testing
Field / Type of Test / Test Method / Test Object / Matrix / Test Parameter / Measurement Range / Test Location
Inspection (17020) / No. / Field
of Inspection / product / Service / Type of inspection / Range of Inspection / Codes/Regulations/Methods / Inspection Location
Certification (MS) (17021) / No. / Management System Sub-scope / EA Codes / NACE Codes / No. of Certifications / No of Auditors
Certification (product) (17065) / No. / Scheme / Product / Code/ Regulations/Std.
Certification (Persons) (17024) / No. / Scheme / Code / Regulations/Std.
Proficiency Testing (17043) / No. / Field / Protocol / Equipment /Artefact / Standard / Parameter / Measurement Capability

4.PARTICIPATION IN PT SCHEMES / ILCs

Please indicate below the PT schemes / ILCs that you have participated in.

Note: Participation in PT/ILC is a prerequisite to accreditation

SCHEME NAME / PARAMETERS / FREQUENCY OF PARTICIPATION

5.SUBMISSION OF DOCUMENTS

Cross reference matrix of internal documents against the Normative standard. / Yes: No:
Quality Manual (Attached) / Yes: No:
Operating Procedures/ Methods (Attached) / Yes: No:
Evidence of PT / ILC / Yes: No:
Application Fee paid / Yes: No:

Declaration

I/We hereby declare that the above information is correct. I/We agree to abide with the terms and conditions of accreditation as stated in the accreditation agreement and any other amendments as well as regulations that KENAS may determine from time to time.

Name
Organization
Designation
Signature
Date

Review by KENAS

Application form complete? / Yes: No:
Application fee payment confirmed? / Yes: No:
Applicable documents seen? / Yes: No:
Applied Scope confirmed? / Yes: No:
Adequacy of resources confirmed? / Yes: No:
Explain any No response and Action
Reviewed by;
Designation
Signature
Date

………………………………………………….End………………………………………………..

Rev. No. / Date / Reason for Revision
01 / 04-AUG-2011 / New
02 / 22-AUG-2013 / Change in layout of application
03 / 01-MAR-2014 / To include details in the scope.
Addition of review of PT/ILC
Remove conditions and introduce accreditation agreement

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