PAC | Pennsylvania Accreditation Centre

Part I : General Information

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INSTRUCTIONS:

1. Your application cannot be processed unless attached with the required document in soft(pdf/docs/jpg/png) copies.
									2.	Additional advice or information may be obtained by contacting the relevant PAC accreditation manager as displayed on PAC website or by emailing us on info@pacofusa.org.
									3.	Granting accreditation will be subject to the applicant entity fully complying with the accreditation criteria, PAC accreditation requirements and PAC regulation.
									4.	The applicant is specifically advised to read relevant PAC information pack before applying for accreditation.
									5.	If the applicant does not receive an Acknowledgement of receipt of this form, please contact PAC relevant accreditation manager by emailing us on info@pacofusa.org.

A) INFORMATION ABOUT CAB

CAB Full Name

CAB Address

City/State

PO Box/Zip Code

Country

Website (URL)

Email ID

Phone/Mobile No.

Contact Person Name

Designation

Phone/Mobile No

Email ID

B) PLEASE COMPLETE THE BELOW INFORMATION REGARDING CAB

CAB Key Location: Entities performing and/or managing key management system certification activities, on behalf of accredited certification bodies, which are wholly or partly owned or employed by the CAB.

YES

Name

Address

Subcontractor Key Location: Entities performing and/or managing key management system certification activities, on behalf of accredited certification bodies, which are not wholly or partly owned or employed by the CAB.

YES

Name

Address

Subcontractor: Entities performing and/or managing processes related to management system activities, on behalf of accredited certification bodies, which are not wholly or partly owned or employed by the CAB (processes include; marketing, communications, outreach, etc. This list is not all-inclusive; any non-key activity related to the accredited CB's certification program is applicable.)

YES

Name

Address

C) Information About Ownership (Legal status of your organization)
Please tick the appropriate box.

Owned by an Individual	Part of an Academic Institution
Owned by a Private Company / Partnership	Part of Learned / Technical Institution
Owned by a Public Body / Nationalized Industry	Owned by Public Limited Company
National / Governmental Organization	Other
(*) Attach Support Document

D) OTHER DESCRIPTION OF THE THE ORGANIZATION SEEKING ACCREDITATION

Total no. of Employees
(in Digit)

Number of Employees involved in area(s)
seeking Accreditation (in Digit)

(*) Attach an organization chart indicating the
structure of the areas to be accredited

Name and position (Director level) of person authorizing this application

Title

Name

Position

Technical/Scheme Manager

Name

Technical Qualifications

Position within the organization

Quality Manager

Name

Qualifications

Position within the organization

E) INDICATE EXACTLY HOW THE NAME OF YOUR CAB APPEARS ON THE ACCREDITATION CERTIFICATE

F) INTERNAL AUDIT AND MANAGEMENT REVIEW

Last Internal Audit Report (*)

Last Management Review Report (*)

G) LOCAL REGULATION
Please mention the current regulation / law that related to your organization activities.

Name of the Regulation/Law	Issue Date	Item(s) related to the applied scope

H) OTHER ACCREDITATION/CERTIFICATIONS (INCLUDING PAC ACCREDITATION)

Are you currently accredited or have you been accredited within the past five years.

YES

If YES, please provide the name of Accreditation body and the current expiration date of accreditation. If no longer accredited, provide the approximate end date of accreditation.
Please note below if your accreditation has ever been Suspended/Cancelled
Suspended	Cancelled	Never Suspended/Cancelled
Please provide the approximate date of Suspension/Cancellation
Reason For Suspension/Cancellation
Was your Accreditation fully reinstated after the Suspension/Cancellation	Yes	No	Not Applicable

I) APPLICANT OUTSIDE USA
Applicants from outside country will be processed according to ILAC-G21(Cross-Frontier Accreditation Principles for Cooperation), IAF MD12 (Accreditation Assessment of Conformity Assessment Bodies with Activities in Multiple Countries)

Considering the questions above, what are the reasons for choosing PAC instead of the local accreditation body?

J) NAME(S) OF COUNTRIES WHERE CAB INTENDS TO PROVIDE PAC ACCREDITED CERTIFICATIONS

K) RELATIONSHIP AND SISTER CONCERN RELATED INFORMATION

Other activities of CAB	Details
Relationship in a larger entity if any, addresses of all its physical location(s) and, information on activities conducted at all locations including virtual site(s)	Not Applicable
Related Bodies of CAB's top management (Please include complete details of all BODs & share holders)	Not Applicable
Activities executed by the related bodies	Not Applicable
Requirement for preliminary visit prior to the commencement of assessment process	Not Applicable

Part II: Inforamtion About Scheme Seeking Accreditation

SELECT THE SCHEME SEEKING ACCREDITATION

Testing Laboratory (TL) - ISO/IEC 17025 (Section 2.1)	Calibration Laborator (CL) - ISO/IEC 17025 (Section 2.2)
Medical Laboratory (ML)- ISO 15189 (Section 2.3)	Inspection Body (IB) - ISO/IEC 17020 (Section 2.4)
MS Certification Body (MsCB)- ISO/IEC 17021-1:2015 (Section 2.5)	Proficiency Testing Provider (PTP) - ISO/IEC 17043 (Section 2.6)
Product Certification Body (PdCB) - ISO/IEC 17065 (Section 2.7)	Person Certification Body (PsCB) - ISO/IEC 17024 (Section 2.8)

Section II.I : For Testing Laboratory Applicant

A. FIELD FOR WHICH ACCREDITATION IS SOUGHT: (Please tick the appropriate boxes)

B. SCOPE OF TESTING FOR WHICH ACCREDITATION IS SOUGHT:

Materials/Product Tested	Types of Test/Properties Measured Range of Measurement	Standard/Specifications/Techniques used

C. PLEASE INDICATE THE TYPE OF CALIBRATION FOR THE TESTING LAB EQUIPMENT:

External Calibration

Internal Calibration

* In case of internal calibration for equipment used, please fill in the following details for the scope of the internal calibration.

Please indicate the type of calibration sites:
Customers Premises	Mobile Facilities
The locations of temporary sites	Collection sites (premises that only collect sample)
Other

Measured Quantity	Range	Calibration & Measurement Capability (#) Uncertainity	Brief Description of Measurement and Equipment Used

Part III : Declaration by the Applicant

Declaration:

I declare that I am authorized, on behalf of the organization to submit this application, and that the information contained herein is both correct and accurate to the best of my knowledge and belief.
Upon accreditation the organization agrees to comply with PAC requirements.
I will enclose a copy of the quality manual (if any), PAC relevant Assessment Checklist Report, relevant procedures, the application fees and any needed documentation(s).
I understand the manner by which the accreditation system operates and functions.
I agree to cooperate with the visit assessment team appointed by PAC for examination of all relevant documents by them and their visits to those parts of the CAB which are part of the scope of the accreditation.
I agree to comply with the accreditation procedures, pay all the costs for pre-assessment (if any), initial assessment, sequential assessment and re-assessment.

Position

Full Name

Signature (jpg)

Is there a local accreditation body?	Yes No
Is the local accreditation body a signatory to the arrangement of ILAC, IAF?	Yes No
Does the local accreditation body offer the required scope?	Yes No
Do you permit:
That PAC informs the local accreditation body about your application and the development of the accreditation process?	Yes No
That the local accreditation body may send an observer to join the assessment?	Yes No
That the local accreditation body may send (an) assessor/s (joint assessment for a dual accreditation)?	Yes No

Chemical Analysis	Microbiology, Hydrobiology & Toxicity
Civil Engineering and Materials Testing	Electrical & Electronics
Environmental including Ambient Air Monitoring	Heat & Temperature
Mechanical	Non-destructive
Optics and Radiometry	Veterinary
Pharmaceutical	Others*

Apply For Accreditation

Apply For Accreditation

Part I : General Information

Part II: Inforamtion About Scheme Seeking Accreditation

Section II.I : For Testing Laboratory Applicant

Part III : Declaration by the Applicant

Declaration: