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ANSI
-
ASQ National Accreditation Board/ACLASS


ACLASS Form 4
2

PT Provider

Application

September 4, 2012

Page
1

of
11

ACLASS APPLICATION FOR
PROFICIENCY TEST PROVIDER

ACCREDITATION


(
Please
Submit Electronically)

Organization Name:


(As to be officially listed on certifi
cate and scope of accreditation
.)


Accreditation Location:


(As to be officially listed on certificate and scope of accreditation.)


Mailing Address:

(If different from Accreditation location)


Web Site Address:


Telephone:


Facsimile:


Email:


(Note: Please supply an email
address tha
t is checked on a daily basis.
ACLASS uses email to communicate when reports have been
uploaded, invoicing, and changes to requirements.)

Authorized Representative:


Legal Status:


Corporation/LLC

Not for Profit

Governm
ent Body


Other
_________



Staff Size:

Managerial:



Technical:
_________



Applying for Scope of:


ISO/IEC 17043



TNI PT Provider


TNI SSAS Provider

Has the organization ever been accredited
as a PT Provider
?


Yes


No

(Note: If previously

or are currently accredited as a PT provider
please

attach copies of certificate, scope, and previous reports issued by
your accreditation body. The process cannot begin until these reports are received.)

If Yes, has the organization ever been suspended in the past 12 months?


Yes


No


Other qualifications
:


Is

your

organization accredited to ISO/IEC
17025
?

Is

your

organization
certified to ISO 9001
?

Is

your

organization
accredited to ISO Guide 34
?

Does

your

organization
maintain any

other ISO Standards
?

Please list below:



Yes


No


Yes


No


Yes


No


Yes


No




(Note: If previously or are currently accredited to
the above standards,

please attach copies of
your
certificates and scopes of
accreditation, as appropriate.


Attach Draft Scope of Accreditation
1
:

(Guidance for preparation of the draft Scope for
PT Provider

Accreditation
is provided on the following pages attached to this application.)

My organization has submitted payment for the non
-
refundable application fee. We understand that ACLASS will
invoice us for other accreditation activities when they are performed, and that all invoices are due net 30 days.

We understand that ACLASS will
use its best efforts to schedule accreditation services on dates which are agreeable
to us and that once we agree to specific dates ACLASS will confirm the dates in writing.

We understand that if we
cancel confirmed dates within thirty days prior to the f
irst confirmed date, ACLASS will charge us 50% of the daily
fee for each canceled date.

We further understand that there may be additional charges for review of corrective
action(s) and/or a follow
-
up visit for any non
-
conformance.



1

Your d
raft scope of accreditation must be completed and submitted in order for ACLASS to better serve you. Please be advised that
failure to
submit a draft scope of accreditation prior to the assessment may result in your assessment being delayed.



ANSI
-
ASQ National Accreditation Board/ACLASS


ACLASS Form 4
2

PT Provider

Application

September 4, 2012

Page
2

of
11

We certify that we have

read and agree to comply with the applicable requirement(s) and ACLASS’ Accreditation
System, ACLASS Document
6
, including use of the ACLASS symbol.

We certify that we have read and agree to
the Responsibilities and Obligations of the Customer, in Append
ix A of this application.

We agree to cooperate
fully and supply all information and documentation needed before, during and after the accreditation process to
ACLASS
.
I am authorized by my organization to apply to ACLASS for accreditation.

I am further
authorized to
agree that my organization will pay ACLASS for any charges billed for services leading to accreditation rendered at
the request of my organization.

We attest that our organization is a legal and identifiable entity and have the
appropriate
resources to service our customers.

Authorized Signature:


Date:



ACLASS Form 4
2

PT Provider

Application

September 4, 2012

Page
3

of
11


ACLASS Preparation of Draft Scope
of Accreditation

for
Calibration

PT Providers
Only


The following information must accompany the
Application for Accreditation

to assist in
preparation of the Scope of Accreditation (please use the attached scope template table below

and
fill in the relevant information):


1.

A l
isting of
parameters the PT Provider seeks accreditation
.


2.

The artifacts supplied to the laboratories
.


3.

The range of the artifact and the frequency of the test
.


4.

The estimated
Calibration and Measurement C
apabili
ty

(
CMC
)

of the artifact.


5.

Identification of method(s) used to perform the

proficiency

tests
. These may be
laboratory
-
specific, but whenever possible they should be based on internationally
accepted calibration procedures.



ACLASS requires the
C
MCs
be expressed as an expanded uncertainty which is obtained by the
following formula:
U = ku
c
(y)
where


U = expanded uncertainty


k = coverage factor


u
c
(y) =

combined standard uncertainty of measurement process


In line with current international p
ractice and National Institute of Standards and Technology
(NIST) policy, the coverage factor of

k

= 2 (level of confidence of approximately 95 percent)
will satisfy the majority of situations encountered in calibration work. Values of
k

other than 2
should only be used for specific applications dictated by established and documented practices.
Some guidance documents for determination of uncertainty are:




ANSI/NCSL Z540
-
2
-
1997
, American National Standard for Expressing Uncertainty
-
U.S.

Guide to the Expression of Uncertainty in Measurement
-

http://www.ncsli.org/




NIST Technical Note 1297, 1994 Edition,
Guidelines for Evaluating and Expressing
the Uncertainty of NIST Measurement Results,
Taylor & Kuy
att
-

https://srmors.nist.gov/referencelinks/references/TN
-
1297.pdf




NISTIR 6919


Recommended Guide for Determining and Reporting Uncertainties for
Balances and Scales
-

http://www.aclasscorp.com/guidancedocs.cfm


The table will be used to develop the draft Scope of Accreditation for your laboratory. A list
of suggested measurement areas/parameters follows the table
. All measurement
capabilities/uncertainties will be reviewed and validated by the technical assessors prior to
and during the assessment visit.


ACLASS Form 4
2

PT Provider

Application

September 4, 2012

Page
4

of
11

DRAFT SCOPE OF ACCREDITATION


CALIBRATION


Please complete the following table
by
TYPING

and submitting
ELECTRONICALLY

in
Microsoft Word to allow for future modifications.



Parameter

Artifact

Range

/ Frequency

Artifact
Uncertainty


Specification,
Standard Method, or
Technique Used


Example

Thermodynamic

Mercury
-
in
-
Glass

Thermometer

(0 to 230) °F

x
1 °F

On
-
going

0.1 °F

ASTM E77

ASTM E563

Example

Dimensional

Gage blocks

(0.050 to 4.000) in

Quarterly

3.5 µin

ASME
B89.1.9
-
2002

Example

Mechanical

Scales

/ balances

Up to 200 g

Annual

8 mg

NIST Handbook 44











































ACLASS Form 4
2

PT Provider

Application

September 4, 2012

Page
5

of
11

Calibration/Measurement Areas and Parameters

Instructions
: The following are examples of parameters within each calibration area. Check those
calibration parameters for which your
organization

is seeking accreditation. If you do not see
your
parameter, check “other” and specify in the space provided. This document is used in conjunction with the
draft scope of accreditation above. To electronically check boxes
,

double click

on box

with your mouse
button.

Dimen
sional


angular

ity

gage blocks

hand tools(mics, cal
ipers)

step gages

measuring wires


laser frequency/wavelength

UMM/bench micrometers

roundness

surface texture


optical reference planes

OD cylindrical diameter

ID cylindrical diameter

CMMs


threaded pro
duct

height gages

surface plates

radius gages

indicators, LVDTs


microscopes

video/optical measuring machines

(other
-
specify):


Mechanical


air speed

flow rate (air or liquid)

hydrometers

mass

volume

force

density



ultrasonic reference block


ultrasonic transducer

vibration

torque

pressure/vacuum


hardness testers

acoustics

scal
es and balances


pipettes

(other
-
specify):


Thermodynamic


humidity

thermometry

IR thermometry

thermocouples/pyrometer indicators


(other
-
specify):


Electromagnetic
-

DC/Low Frequency


DC voltage


AC voltage


DC current

AC current


resistance

capacitance


inductance

voltage/current converters (to 1 Mhz)


current transformers


high voltage resistors


LF power/energy


ma
gnetic

mixed dividers


phase meters


power
-
frequency


DMMs



pulse waveform


resistance dividers



o
scilloscopes


voltage transformers


Calibrators


RTD/thermocouples

(other
-
specify):


Electromagnetic
-

RF/Microwave


RF power

attenuation

phase

amplitude modulation

frequency modu
lation

distortion


harmonics

electromagnetic field strength


HF capacitance


HF inductance


Q
-
standards


reflection

transmission

SWR

(other
-
specify):


Time & Frequency


frequency/time (source/measure)

time dissemination

timers & stopwatches


(other
-
specify):


Ionizing Radiation


dosimetry

radioactive sources

(other
-
speci
fy):


Chemical Quantities


pH


conductivity


viscosity


refractometry

(other
-
specify):


Optical Radiation


laser power energy

photometric

radiometri
c

spectrophotometric


wavelength


UV radiometric
-
standard detectors


UV radiometric
-
standard sources


attenuation


(other
-
specify):





ACLASS Form 4
2

PT Provider

Application

September 4, 2012

Page
6

of
11

ACLASS Preparation of Draft Scope of Accreditation
for

Testing

PT Providers

Only


The following information must accompany the
Application for Accreditation

to assist in
preparation of the Scope of Accreditation (please use the attached scope template table below

and
fill in the relevant information):


1.

A l
isting of
parameters the PT Provider seeks accreditation
.


2.

The artifacts supplied to the laboratories
.


3.

The range of the artifact and the frequency of the test
.


4.

The estimated
Calibration and

Measurement Capabi
lity (C
MC
)

of the artifact.


5.

Identification of method(s) used to perform the

proficiency

tests
. These may be
laboratory
-
specific, but whenever
possible they should be based on internationally
accepted calibration procedures.



The table found below will be used to develop the draft Scope of Accreditation
.

A list of
suggested test areas follows the table. Please check all that apply.


ACLASS Form 4
2

PT Provider

Application

September 4, 2012

Page
7

of
11


DRAFT SCOPE OF ACCREDITATION


TESTING


Please complete the following table
by
TYPING

and submitting
ELECTRONICALLY

in
Microsoft Word to allow for future modifications. For examples of accredited laboratory scopes
please visit
www.aclasscorp.com

and click on “Accredited Laboratories.”


Parameter

Artifact

Range

/ Frequency

Artifact
U
ncertainty


Specification,
Standard Method, or
Technique Used


Example

Material hardness

Hardness test
blocks

RB and RC

Semiannual

0.4 to 1.1

ASTM E 18

Example

Material analysis

Aluminum and
Aluminum Alloys

Annual

5%

ASTM E607
Spectrometric Analysis

Nitrogen Atmosphere










































ACLASS Form 4
2

PT Provider

Application

September 4, 2012

Page
8

of
11

Testing Areas and Parameters

Instructions
: The following are examples of parameters within each testing area. Check those testing
parameters for which your
organization

is seeking accreditation. If you do not see your parameter, check
“other” and specify in the space provided. This d
ocument is used in conjunction with the draft scope of
accreditation above. To electronically check boxes, double click on box with your mouse button.



Acoustics & Vibration





Biological / Microbiological:



Pharmaceutical / Nutraceutical



Biotechnology / Biochemical





Chemical:



Animal Drug Testing


Paint



Fasteners



Fertilizers



Metals



Solvents



Inorganics / Organics


Coal




Other (specify):




Construction Ma
terials



Dimensional Inspection / Measurement



Electrical



Environmental:



Air




Asbestos



Environmental Lead


Water



Bioassay



Radon



Underground Storage




Solid/Hazardous Wastes



Other (specify):



Mechanical



Fasteners & Metals


Paint




Plastics



Rubber



Windows & Doors


Paper



Other (specify):



Non
-
Destructive



Optical/Photometric/Radiometric:



Ionizing Radiation



Thermal



Other (specify):



Multi
-
disciplinary



Information Technology



Medical/Veterinary



Forensic



Occupational



Health/Hygiene



Food/Beverage




FOR TNI PT

& TNI
-
SSAS

PROVIDERS



Chemistry


Potable Water (Safe Drinking
Water)


Inorganic


Organic


Non
-
Potable Water (Water
Pollution, RCRA)


Soil, Chemical Materials


Tissues


Air Emissions



Microbiology


Potable Water (Safe Drinking
W
ater
)


Non
-
Potable Water ( Water
Pollution, RCRA)


Soil, Chemical Materials


Tissues



Radioch
emistry


Potable Water (Safe
Drinking
Water
)


Non
-
Potable Water ( Water
Pollution, RCRA)


Soil, Chemical Materials


Tissues


Air



Environmental

Toxicology



Other __________________


ACLASS Form 4
2

PT Provider

Application

September 4, 2012

Page
9

of
11

DRAFT SCOPE OF ACCREDITATION


TNI
PT Providers
Only


Please complete the following table
by
TYPING

and submitting
ELECTRONICALLY

in Microsoft
Word to allow for future modifications.


Program Areas

Analyte Groups

Frequency

Specification,

Standard Method, or
Technique
s

to be
Used

Analytes /
Parameters Included

Example

Drinking Water

Non
-
potable Water

Solid / chemical
Materials

DMRQA

Metals

Semiannual

ICP / AA

Aluminum

Antimony

Arsenic

Barium

Etc.

Example

Drinking Water

Non
-
potable Water

DMRQA

Microbiology

Annual

Various

Total
coliform

Heterotrophic plate
count

Staphylococcus

Salmonella

Etc.

Example

Drinking Water

Non
-
potable Water

Solid / Chemical
Materials

Volatiles

Quarterly

GC

Acetone

Acetonitrile

Benzene

tert
-
Butyl Alcohol

Etc.
































ACLASS Form 4
2

PT Provider

Application

September 4, 2012

Page
10

of
11


Appendix A


Responsibilities and Obligations of the Customer


By signing the application, the customer hereby requests ACLASS to perform ISO/IEC
17043
and/or TNI PT

accreditation activities pursuant to the application submitted to ACLASS by

customer (“Accreditation Activities”).
ACLASS shall perform the Accreditation Activities in accordance with ACLASS' then current Accreditation
System. ACLASS shall make available to the customer at the customer’s request, the documents comprising
ACLASS
’ ISO/IEC
17043
and/or TNI PT

Accreditation System.


ACLASS shall determine in its sole discretion whether the customer meets ACLASS' requirements for accreditation
to the applicable requirement(s) as set forth in ACLASS' ISO/IEC
17043

and/or TNI PT

Accreditation System
(“Accreditation Criteria”). In the event ACLASS determines that the customer meets the Accreditation Criteria,
ACLASS shall deliver to the customer ACLASS' Certificate and Scope of Accreditation which shall include a copy
of ACLASS' s
ymbol. The Certificate and Scope of Accreditation shall be deemed to be the evidence of the
customer’s status as being accredited pursuant to ACLASS' Accreditation Criteria.


ACLASS shall have the right to carry out surveillance and reassessment pursuant
to ACLASS’
Accreditation
Activities

to verify the customer’s continuous compliance to the Accreditation Criteria.


The customer shall conform to the following:


a.

Maintain impartiality and integrity for all services provided under their scope of accreditati
on;


b.

Commit to meet the requirements of ACLASS’ Accreditation Criteria including adapting to
changes in the requirements for accreditation.


c.

Take such actions as necessary to allow ACLASS to perform the Accreditation Activities, including
provide for the examination of documentation and the assessment of all areas, records and
personnel for the purposes of assessment, surveillance, reassessment
, resolution of complaints and
access to relevant documents that provide insight into the level of independence and impartiality
from any related body;


d.

Record and address complaints, report complaints to ACLASS and otherwise continuously comply
with all
relevant provisions of the Accreditation Criteria and claim accreditation only in respect of
requirements and scope for which customer has been granted accreditation (ACLASS certificate
and scope of accreditation does not cover subcontracted calibrations)
;


e.

Notify ACLASS within 30 days of changes to customer’s laboratory
ownership,
management
system or changes significantly affecting customer (such as a change of ownership, change of
location, change in key personnel, including top management, main polici
es, resources, or change
in equipment or if analysis of a complaint or other information indicates that customer no longer
complies with the Accreditation Criteria) (“Change”).


f.

Allow ACLASS to conduct surveillance and/or reassessment of customer in the event of a Change;


g.

Not expose assessors or others representing ACLASS to unsafe working conditions or
environments, and to provide all assessors and others appropriate protective

equipment;


h.

Arrange witnessing of services performed at the request of ACLASS including allowing third
parties selected by ACLASS to witness ACLASS’ assessments.


i.

Do not use its accreditation in a manner that may bring ACLASS into disrepute.


j.

Pay ACLASS
for the Accreditation Activities as set in ACLASS’ procedures.


ACLASS Form 4
2

PT Provider

Application

September 4, 2012

Page
11

of
11


The ACLASS Logo is a registered trademark solely owned by ACLASS. So long as the customer maintains its
status as being accredited by ACLASS pursuant to ACLASS’ Accreditation Criteria, the cu
stomer shall have the
non
-
exclusive and non
-
transferable right to use the Certificate and Scope of Accreditation and the ACLASS Symbol
(except as provided for directly in the paragraph below) in customer’s advertising, and marketing materials and
campaigns
, certificates and reports. In no event shall the customer use the Certificate and Scope of Accreditation
and the ACLASS Symbol (or a confusingly similar certificate and scope of accreditation or symbol) in a misleading
or unauthorized manner, including,
but not limited to, representing that the Certificate and Scope of Accreditation
and the ACLASS Symbol exemplifies a product, service or performance conformity certification; using the
Certificate and Scope of Accreditation or the ACLASS Symbol in connecti
on with requirements or activities not
approved by ACLASS; or otherwise acting to bring ACLASS or the ACLASS Symbol in disrepute.


If ACLASS expresses any concern with respect to the use of the Certificate and Scope of Accreditation or the
ACLASS Symbol as

being inconsistent with or impermissible under this Application or ACLASS’ ISO/IEC
17043

Accreditation System, ("Improper Use"), ACLASS may request the customer to cease and desist the Improper Use,
and it shall be deemed to be a condition to the customer
's continued accreditation that such Improper Use is
immediately discontinued. In addition, in the event of such Improper Use or in the event ACLASS determines that
the customer is not complying with any obligation of the customer under this Agreement or
the Accreditation
System, ACLASS shall have the right upon written notice to the customer to (a) suspend its Accreditation Activities
until the customer complies with its obligation, (b) determine that the customer is no longer entitled to identify itself
as accredited by ACLASS and to require customer (temporarily or permanently) to cease using in any manner the
Certificate and Scope of Accreditation (and to return such Certificate and Scope of Accreditation), the ACLASS
Symbol and/or Accreditation Mark, (
c) refuse to issue a Certificate and Scope of Accreditation to the customer, (d)
require a corrective action, (e) publish customer’s transgression or (f) take other legal action. In the event ACLASS
takes any of the foregoing actions, ACLASS shall not be
required to reimburse any amounts to the customer.


ACLASS and its assessor shall perform the Accreditation Activities in a workmanlike manner consistent with
ACLASS’ then current Accreditation System. The warranty set forth in this section is the sole and exclusive
warranty of ACLASS under this application

and the services contemplated to be provided herein and no other
express or implied warranties exist, including but not limited to any warranty of merchantability and any warranty of
fitness for a particular purpose. Customer acknowledges that ACLASS doe
s not warrant and has no liability or
responsibility for (and such liability and responsibility belongs solely to customer) the
customer’s facility
and safety
of any product or service produced, manufactured, delivered, sold or otherwise distributed by cus
tomer.


ACLASS and the customer are independent parties and nothing set forth in this Application creates a joint venture,
partnership or other concerted activity.


If, in ACLASS' sole discretion, an assignment and/or activity by the customer effects a Cha
nge to customer’s
management system under this Application and/or changes made by ACLASS to the Accreditation Criteria,
customer shall cooperate and take the actions necessary to allow the assignment to occur based on a reassessment
and/or surveillance vis
it or such other activity as ACLASS reasonably deems necessary.


These Responsibilities and Obligations of the Customer shall be governed by, and construed and enforced in
accordance with, the laws of the State of Wisconsin. Any dispute under this Applica
tion shall be resolved pursuant
to the appeals procedure adopted by ACLASS from time to time. In the event the customer makes any claim that a
dispute is not subject to the appeals process or has not been adjudicated pursuant to the rules provided therein
, the
customer shall not have the right to bring any action with respect thereto before a court of law or equity, but shall
only have the right to seek a determination from one arbitrator pursuant to the rules of the American Arbitration
Association as to
whether such dispute was subject to the appeals process or was adjudicated pursuant to the rules
provided therein. Such arbitration shall be conducted in the State of Wisconsin, and each party shall bear its own
expense for such arbitration.