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PRELIMINARY EVALUATION FORM

This form is to be used to provide the information necessary for QSI to develop a proposal for management system certification. Please answer the questions below; considering only those areas and activities of the organization that would fall within the scope of the certification sought.

   
* Legal Name of the Organization
* Address
* City
* State/Province
* Postal Code
* Country
* Phone
Mobile Phone
* Email
Fax
Website
* Total Employees

* required fields

 

Please select the standards to which your organization seeks certification:

 
ISO 9001 - Quality Management
ISO 13485 - QMS for Medical Devices
ISO 14001 - Environmental Management
OHSAS 18001 - Health and Safety Management
ISO 22000 - Food Safety Management
ISO 20000 - Technology Service Management
ISO 27001 - Information Security Management
ISO 28001 - Security Management
ISO 50001 - Energy Management
 
 

Please define the Certification Scope

 
* Please describe the activities to be included.
* Please list and explain any exclusions.

If there are none please type "NONE"

Is this a multi-site certification?
* Number of Sites
Number of Employees @ Principal Site
Number of Employees @ Largest Site
Number of Employees @ 2nd Largest Site
Number of Employees @ Smallest Site
Number of Employees @ 2nd Smallest Site
Average Number of Employees - All Sites
Please lists the countries where the above sites are located:
 
 

Planning and Preparation Details

 
* Approx. Date for the Stage 1 Certification Audit (mm-dd-yyyy)
* Approx. Date for the Stage 2 Certification Audit (mm-dd-yyyy)
* Will an (optional) Initial Review/Pre-Assessment be required?
* Has a Policy Manual been issued?
* Has a complete Internal Audit been conducted?
* Has a complete Management Review been conducted?
 
 

Management Representative Information

 
* Name of Management Rep.
* Position
* Phone
* Email
Additional Comments

* required fields

 
 

 

RBP If you were referred by a Regional Business Partner select their code below; otherwise select 999.
 
 

Note: To avoid an error message proper values must be entered in the required fields. If an error message is obtained please hit back on your browser to retain the information entered.

 
 

 


© 2012 QSI America, Inc. All rights reserved. "QSI" refers to QSI America, Inc, a Florida Corporation and its global network or of Business Partners, each of which is a separate and independent legal entity.