REQUEST FOR CERTIFICATION OF MEASURING INSTRUMENT

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					                                                                                       Measurement Standards – Laboratory
                                                                                                            ABN 9132 9800 417
                                                                           321 Selby Street North (rear) Osborne Park WA 6017
                                                                             Postal: Locked Bag 14, Cloisters Square WA 6850
                                                                              Tel: 08 9282 4317 or Ext 4316 Fax: 08 9282 5615
                                                                                              Email: tsblab@commerce.wa.gov.au

    REQUEST FOR CERTIFICATION OF MEASURING INSTRUMENT
PART A: To be completed by the person requesting certification (details required for certificate).
REGISTERED NAME OF COMPANY OR BUSINESS


STREET ADDRESS                                                  SUBURB                                    P/CODE



POSTAL ADDRESS            (For issue of Invoice etc)            SUBURB                                    P/CODE


TELEPHONE No.                         FACSIMILE No.                                ORDER No. (if any)


DESCRIPTION OF MEASURING INSTRUMENT                                                                SERIAL / ID No.
1

2

3

4

*WHAT ACCURACY DO YOU REQUIRE ?                         .
**WHAT CERTIFICATE DO YOU REQUIRE ?                                 for advice – see attachment or contact us

        < Certificate of Verification                  < Calibration Certificate            < Do you require the report
            Regulation 13 & Report                      (& report where issued)                NATA endorsed ?

***DOES YOUR QUALITY SYSTEM SPECIFY A MAXIMUM CALIBRATION PERIOD ?                                .              .years
(Note, period may be specified by legal or other mandatory requirements)                         enter the period above
**** PLEASE ATTACH A COPY OF ANY PREVIOUSLY ISSUED CERTIFICATE FOR THE INSTRUMENT(s).
NAME OF PERSON REQUESTING                               POSITION                          SIGNATURE


PART B: MEASUREMENT STANDARDS LABORATORY USE ONLY
Date in:                   Received                                                   Cert No.
                           in by:                                                     Issued:
Customer                                                         Person
Advised, date:                                                   Advised:
Date out:                                                        Issued
                                                                 out by:
Courier or                                 Person:                                    Sign
Company:                                   I/D No.                                    Here >
IDENTIFICATION TAGS                           COMMENTS


                                                        More space overleaf
INFORMATION ON COMPLETING THE ‘REQUEST FOR CALIBRATION’ FORM.

PART A of the attached request form only.

COMPANY NAME AND ADDRESS                            For inclusion on your certificate
POSTAL ADDRESS                                      For mailing of: certificates, covering letters and invoicing.
TELEPHONE / FAX Nos                                 To contact you for: further details, advice of job completion.
ORDER No                                            An order number is not a mandatory requirement.

DESCRIPTION OF MEASURING INSTRUMENT
Enter a brief description of the item(s) and any serial or identification numbers.
Alternatively enter ‘as attached’ or similar and attach the information to the form.

*WHAT ACCURACY DO YOU REQUIRE ?
The maximum variation from nominal value and / or uncertainty required by you or your customer.
This can discussed with Laboratory staff if you are unsure of the accuracy you require.
For instance if the item is a test weight for checking the accuracy of a laboratory balance you will need to
tell us the capacity of the balance, how many decimal places it reads to and the graduation value.
To assist you further we may need:
Information on what the item will be used for, how it will be used, and possibly, where it will be used.

**WHAT CERTIFICATE DO YOU REQUIRE ?
1. Certificate of Verification - Regulation 13     (commonly referred to as a ‘regulation 13 certificate’)
Is a Certificate of Verification issued under Regulation 13 of the National Measurement Regulations.
It is a document that provides evidence of legal traceability to national and international standards. If your
certified item is used to calibrate instruments that are used for trade purposes it is the certificate you need.
It is also useful to have such a certificate if your use of the certified item should ever result in a legal action
as it ‘may be received in evidence’ ‘in any court’ during its period of currency. (in part from Regulation 90)

2. Calibration Certificate
Is a certificate issued when the above is not required, or a calibration is not done, or cannot be done, in
accordance with the requirements of the National Measurement Regulations. These certificates can state
‘values’ and ‘accuracies’ equal to the above document and can indicate traceability to certain national and
international standards.       These generally are not legally recognised certificates.

3. Do you require the report NATA Endorsed
The Laboratory is accredited for compliance with ‘AS ISO/IEC 17025 - General requirements for the
competence of testing and calibration laboratories’ by the National Association of Testing Authorities.
Laboratory staff can therefore issue endorsed reports under the terms of that accreditation, these indicate
traceability to certain national and international standards. The NATA Emblem, statements and
endorsements are included on the document.            The Laboratory registration number is 15010.

***DOES YOUR QUALITY SYSTEM SPECIFY A MAXIMUM CALIBRATION PERIOD ?
   (Note, period may be specified by legal or other mandatory requirements)
Your quality system or your accrediting body may specify the period between calibrations for your test
equipment, if so you may request an expiry date to be entered on your certificate. Laboratory staff can
advise you on a suitable period if requested to do so.
Certificates of Verification issued under Regulation 13 must state an expiry date as periods for the
re-calibration of various equipment is determined by regulation.

**** PLEASE ATTACH COPIES OF ANY PREVIOUSLY ISSUED CERTIFICATE(s) FOR THE INSTRUMENT(s).
If you have a previous certificate please attach a copy, the value stated can be compared against the new
value and will indicate the stability of the item.

To contact you for: further details, advice of job completion:
NAME OF PERSON REQUESTING                           POSITION                    SIGNATURE


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Description: REQUEST FOR CERTIFICATION OF MEASURING INSTRUMENT .