Printed: July 14, 2017
NSF International Strategic Registrations Application
To help ensure that we develop the most accurate quote for your facility/organization, please complete this form as thoroughly as is possible. Aspects which are
not adequately identified may result in changes to audit days after the commencement of the onsite audit. For quote requests, only the shaded sections are
necessary.
*
Items with an must be completed at a minimum when upgrading to or adding another certification to an existing
certification. ‫ בשאלות יש לפנות לאיש הקשר המפורט בדף האחרון‬,‫יש למלא את כלל הסעיפים למעט המוגדרים כרשות‬
Corporate Information:
Corporate Name:
Corporate Address:
Israel
Street
City/State/Province
Postal/Zip
Street
City/State/Province
Postal/Zip
Country
Mailing Address:
(If different than corporate address)
Israel
Phone:
Contact:
Toll Free: n/a
Mr.
Mrs.
Ms.
Country
Fax:
Dr.
Contact Phone:
E-Mail:
Fax:
Billing Address:
(If different than corporate address)
Israel
Street
City/State/Province
Postal/Zip
Country
Billing Contact:
Billing E-Mail:
Are you part of a larger
corporation?
Yes
No
If yes, please explain. Include all activities corporate is responsible for.
* Identification of Location/Building to be Audited (If more than one location, please request an Additional Location Form, not
needed if the facility data is the same as the corporate data) ‫או שמו שונים מהמפורט בסעיף הקודם‬/‫נדרש למילוי רק אם כתובת המפעל הנסקר ו‬
Facility Name:
(PROVIDE THE FULL, LEGAL
NAME FOR THE FACILITY)
Location/Building Address
(NO PO BOXES):
Street
City/State/Province
Postal/Zip
Country
Street
City/State/Province
Postal/Zip
Country
Mailing Address:
(If different than location address)
Phone:
Management Representative:
Toll Free:
Mr.
Management Rep Phone:
Mrs.
Ms.
n/a
Fax:
Dr.
E-Mail:
Fax:
Billing Address:
(If different than corporate address)
Street
City/State/Province
Postal/Zip
Country
Billing Contact:
(If different than corporate contact)
Billing E-Mail:
(If different than corporate e-mail)
Holidays/Closings:‫סעיף חובה‬
AESOP 10742; ISSUE 22; STATUS-PUBLISHED; EFFECTIVE 15 NOV 2016 UNCONTROLLED NSF IQC ONLY
This is a confidential document and may be reproduced only with the permission of NSF-ISR.
Page 1 of 4
Printed: July 14, 2017
NSF International Strategic Registrations Application
Standards for which certification is requested (Check all that apply)*
ISO 9001 (with design)
ISO 9001 (without design)
AS 9100 (with design)
AS 9100 (without design)
AS 9110 (with design)
AS 9110 (without design)
ISO 22000
HACCP & Food Safety Systems
HACCP 9000
GMP
B2
FSSC 22000
AS 9120 (for distributors only)
ISO/TS 16949 (with design)
ISO/TS 16949 (without design)
CIPRS
ISO 20000-1
ISO 27001
ISO 14001
RC 14001
RCMS Option 1
RCMS Option 2
OHSAS 18001
ANSI Z10
On Product Labeling
ISO 13485
ISO 50001
Other
Is / are the locations to be audited already certified to any other management system standards?
If yes, please identify the Standard(s) to which the location(s) is/are certified. If available, attach current
certificate to application:
Yes
No
Primary Language Spoken On-site
Other Languages Spoken On-site
Number of locations/buildings seeking registration:
Number of personnel in the company
If more than one location/building, do you prefer
Note: All locations/buildings under one certificate
must be operated under a common management system
Individual registrations for each location/building
All locations/buildings covered by one registration
Tentative Audit Dates – ‫בקשת הארגון לחודשי הסיקור‬
Desk Audit:
Onsite Readiness Review:
Registration Audit:
‫מועד בו הנהלים מוכנים‬
‫ – מקדים בארגון‬1 ‫שלב‬
‫ – ההתעדה בארגון‬2 ‫שלב‬
Scope of Registration*
Please describe the operations conducted by your
organization: ‫תארו מה אתם עושים‬
What is your intended Scope of Registration? (i.e. the
Company’s activities for which registration is being
requested, including products or services, as it will appear
on your certification.) ‫מהו תחום העיסוק שאתם רוצים שיופיע על‬
.‫התעודה‬
TS Only: If your location is non design responsible please
provide justification and attach supporting evidence.
Leave empty
Please identify the relevant Industry Sector Codes
(NACE industry classification ‫לבחור מהרשימה בלינק‬
http://www.iaf.nu/upFiles/IAFID1QMS_EMS_Codes2014
0610.pdf):
Are there any portions of your operations / organization
which will not be included in the scope of registration? If
yes, please provide a brief explanation: ‫האם יש תחום עיסוק‬
?‫בארגון שאינו עובר ההתעדה‬
If more than one building is part of this registration, then
AESOP 10742; ISSUE 22; STATUS-PUBLISHED; EFFECTIVE 15 NOV 2016 UNCONTROLLED NSF IQC ONLY
This is a confidential document and may be reproduced only with the permission of NSF-ISR.
Page 2 of 4
Printed: July 14, 2017
NSF International Strategic Registrations Application
please identify the specific processes that occur at each
location (e.g. 123 Main Street – Purchasing):
Please state the total area of the facility in square feet or
acres. (If there are multiple facilities / locations, please
state the area for each facility/location separately.)
General Information*]
Yes
No
Are there factors such as travel between buildings/locations, security or access restrictions, safety or health
briefings, etc. Which would total more than 30 minutes per day? If yes, please explain.
Yes
No
Do you outsource any processes (e.g. manufacturing)? If yes, please provide information regarding
outsourced processes that could affect conformity to requirements (if any).
Yes
No
Do you use a management system consultancy? If yes, please provide the name, address, and phone number
of the consultant (person and company).
Yes
No
If you are registering multiple locations/buildings, pls write down the multiple locations/buildings and
prepare another 10742 for each location.
Do they have a common system in the following items?
Yes
No 1) Strategic planning, policy making,
Yes
No 2) Contract review, where local acceptance of orders is permitted
Yes
No 3) Approval of suppliers
Yes
No 4）Evaluation of training needs(activity may have local aspects)
Yes
No 5）Quality management system documentation (Level 1 and Level 2) and changes in same
Yes
No 6）Management review
Yes
No 7）Evaluation of corrective actions
Yes
No 8）Internal audit planning and evaluation of the result
Yes
No 9）Quality planning and continuous improvement activities(activity may have local aspects)
Yes
No 10）Design activities
Yes
No
Are there any legal obligations that relate to the proposed scope of registration or that govern production,
environmental, safety or service activities (e.g. CFRs, ITAR, NOV’s)? If yes, then please list along with the
associated regulatory body (e.g. FAA, EPA, OSHA, State Environmental Agency).
‫מדובר על מגבלות‬
‫ מגבלות חוקיות ותקנות המגדירות את פעילות הארגון‬,‫רשיון ייצוא ידע ומידע אמריקאים‬
Yes
No
Is there any other company sharing the same location/building ? If yes, pls describe it:______________
.‫ שטח – לא מדובר על בניני תעשיה גדולים אלא על מנת שהסוקר ידע למה לצפות‬/ ‫האם ישנן חברות נוספות באותו בנין‬
For AS9100/9110/9120 Customers Only*:
The revenue for aviation, space, and defense industry, as a proportion of the total revenue per Top 5 customer (%)
Customer
% of Revenue
AESOP 10742; ISSUE 22; STATUS-PUBLISHED; EFFECTIVE 15 NOV 2016 UNCONTROLLED NSF IQC ONLY
This is a confidential document and may be reproduced only with the permission of NSF-ISR.
Page 3 of 4
Printed: July 14, 2017
NSF International Strategic Registrations Application
NSF Contact Information:
Business Development Manager:
Phone:
E-Mail:
Shai Kidon
054-5388388
[email protected]
To Be Completed at the Time of Application:
‫ להעביר לאיש הקשר לעיל בדוא"ל‬,‫למלא את פרטי ממלא הדוח (בעל סמכות) תאריך והערות שלכם לסוקר – לא נדרש לחתום‬
I have reviewed the completed information on behalf of the Corporate as set forth on page one of this application; and to
the best of my information and knowledge the completed information is true and accurate.
Name:
Title:
Date:
Comments:
AESOP 10742; ISSUE 22; STATUS-PUBLISHED; EFFECTIVE 15 NOV 2016 UNCONTROLLED NSF IQC ONLY
This is a confidential document and may be reproduced only with the permission of NSF-ISR.
Page 4 of 4