Ver 1.

To enable us to provide a quotation for the certification of your company, please complete all sections of this questionnaire in as much detail as needed to give use a clear overview of your operations and activities. On receipt, we will compile a firm quotation, which will include both costs and timescales over the three-year certification period. Quotations and certification activities are based on the information contained in this questionnaire; should the information be found to be incorrect, it may invalidate any quotation and subsequent certification.

1. COMPANY DETAILS Company Name Physical Address Physical Address Physical Suburb Postal Address Postal Street Address Postal Suburb Country Phone Mobile E-mail Address Website Management Representative Position
1

Physical City

Physical State

Postal City

Postal State

Fax

2. SITE DETAILS (Please complete the following table for all sites to be registered) Site Address Number of Staff Street Address Suburb City (FTE*)

Number of Shifts

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* FTE Number of fulltime equivalents

3. STANDARDS FOR ASSESSMENT (Mark with an X) ISO 9001 AS 9100 ISO 14001 AS9110 OHSAS 18001 AS9120 AS/NZS 4801 TQS-1 RAWS Product certification

ISO 13485 ISO 22000 HACCP Warranty BRC Global HACCP

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4. CERTIFICATION SCOPE (Detail the activities, products, or services to be assessed for certification)

5. MAJOR PROCESSES (Please detail the main manufacturing and/or service processes)

6. HEALTH & SAFETY HAZARDS (Please detail any significant health & safety hazards)
* Only applicable for Health and Safety Management system certification

7. ENVIRONMENTAL IMPACTS (please list the actual or potential impacts on the environment)
* Only applicable for Environmental Management system certification

8. OTHER CERTIFICATIONS (please list all other certifications and/or registrations)

9. REGULATORY / LEGISLATIVE REQUIREMENTS (please list all applicable legislation, regulations, codes of
practice to which the company subscribes)

10. NEWSLETTER & UPDATES Do you wish to receive our newsletters and updates regarding certification 11. DESIGN AND DEVELOPMENT Do you design your products.

Yes

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AUTHORISATION Name Position Date

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Please forward your completed questionnaire to International Certifications Ireland: Contact: Patricia McMahon, Certification Manager, International Certifications Ireland Tel: +353.87.2399919 or +353.65.6838853 Fax: +353.65.6838854 Email: patricia@icireland.ie

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this questionnaire in as much e a firm quotation, which will

d the information be found to

Post Code

Post Code

Number of Shifts

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cation)

nt)

tion, regulations, codes of

Yes

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d: eland

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