SITE ASSESSOR EVALUATION FORM by 5Y5U7F0

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									                                   Request for Addition of Method Form
Date:                                                         Laboratory ID:



Laboratory Name:                                              Laboratory Contact Name (for questions on this form):



Laboratory Contact Telephone:                                 Laboratory Contact E-mail:


AIHA LAP, LLC Contact:                                        Technical Advisory Panel due date (to
                                                              be entered by AIHA LAP, LLC):




  Per Policy 3.10, this form is submitted to request the addition of a method within an already accredited Field of
  Testing (FoT) and/or Core Scope Category. If your laboratory is seeking to become accredited for a method in an
  FoT/ Core Scope Category in which your laboratory is not currently accredited, please review Policy Module 3,
  Section 3.9.

                            Method Addition Requested in the Following Program:
                            IHLAP      ELLAP       EMLAP          FoodLAP

                                     Laboratory Method Number and Published             Plan for Demonstration of
           Currently Accredited
                                            Method Reference Citation                   Proficiency (e.g. Required
             Field of Testing                (e.g., SOP M-1 and NIOSH 7300)            PT, Round Robin, Internal)




  For each method requested please include the following attachment. Clearly label the attachment with the Method
  number.

  Attachment: Please attach an SOP for each method requested.

  Policy Modules and Scope Tables are available on the AIHA LAP, LLC website at:
  http://www.aihaaccreditedlabs.org

  This form and attachments should be sent to the Laboratory Accreditation Specialist by e-mail to Olena Bulgakova
  (obulgakova@aiha.org ), Chris Sacdalan, (csacdalan@aiha.org ), or Edmund Wong
  (ewong@aiha.org) or faxed to (703) 207 – 8558.




  Rev. 4                                           01/08/2009                                         Page 1 of 2
____________________________________________________________________________________________
For Technical Advisory Panel use only:

Is the method addition approved? □ YES               □ NO (complete section below)


____________________________________                ______________________________________________
TAP Name                                            TAP Signature & Date


Comments:




This form and attachments should be sent to the Laboratory Accreditation Specialist by e-mail to Olena Bulgakova
(obulgakova@aiha.org ), Chris Sacdalan, (csacdalan@aiha.org ), or Edmund Wong
(ewong@aiha.org) or faxed to (703) 207 – 8558.




Rev. 4                                         01/08/2009                                      Page 2 of 2

								
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