质量环境管理体系认证申请书.doc

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1、质量环境管理体系认证申请书版本号Edition No。：6.0 修订号Revision No:0.0认 证 申 请 书 Application Form 合同编号: Contract No 在以下，中打勾“? Please tick in the proper box： ,ISO9001认证 ISO9001 Certification （， 国内证书？ , UKAS证书？ ， 初次认证？ , 复评？ , 其他?） ， ISO14001认证 ISO14001 Certification (, 国内证书？ , UKAS证书？ , 初次认证? ， 复评? ， 其他？) , 职业安全健康管理体系认证

2、OHSMS Certification （, 初次认证？ ， 复评? ， 其他?) ?Domestic Certificates ？UKAS Certificates ？Initial Assessment ？Re-assessment ?Others General Information of Applicant 名称Name： 邮编Post Code： 地址Address： 管理者代表Management Representative： 联系人Contact Person: 手机Mobil ： 电话Tel： 传真Fax： 电子邮件地址E-mail： 职工人数Number of Emplo

3、yees ： 工班数Number of Shifts ： 倒班人数Number of employees in shift work_ （特别声明:请如实填报职工人数，不在同一市、县的工地现场数，如现场审核时发现与实际不符,认证中心为保障审核的公正、有效性，将有权保留增加审核人日、审核费用的权利。 Note: The applicant shall fill in the numbers faithfully and accurately. If the information is found to be in unconformity with the actual situation d

4、uring onsite audits, CCCI reserves the right to increase audit days and audit fees to ensure the impartiality and effectiveness of audits。) 华夏认证中心 1/ 8 China Certification Center Inc. 厂区面积Plant Space： 建筑面积Floor Space ： 产值Turnover： 不在同一市、县的机构数Number of department or branches in other places: 个; 不在同一市

5、、县的工地现场Number of construction sites in other places 个。 （请附具体目录，详列名称和地点Please attach a detailed list with full names and addresses) 请提供两年内向本组织提供体系咨询的机构、人员名称 The names of organizations and people that have provided consultant services to the applicant in the past two years 组织目前所处认证状态是否为暂停或撤销： Whether

6、the certification qualification of the applicant has been suspended or withdrawn： ，暂停Suspension ，撤销Withdrawal， 请说明情况Please specify Scope covered by management system? 质量管理体系覆盖的产品范围及主要过程、活动范围和地域场所(属异地经营或生产的请说明情况） Product scope, main process, activities scope and sites covered by quality management sy

7、stem （Please specify if have multisite for activities or production） (主要过程指：设计开发、生产施工、安装等活动） （the main process refers to design/development， production and installation， etc. ） 对ISO9001:2000的删减情况Whether any clauses in ISO9001:2000 has been excluded： ，无None ， 7.3 , 7。4 ， 7.5 , 7.6 (如只删减了某章的部分内容，请注明删减

8、的小节序号if the clause has been partially excluded， please specify the section number ) ？ 环境管理体系和职业安全健康管理体系覆盖的产品和活动范围及地域场所Products and activities scope and sites covered by EMS and OHSMS 华夏认证中心 China Certification Center Inc. 2/ 8 Operation Date of System and Expected Audit Time 质量管理体系开始运行时间是The QMS was

9、 put into operation on 年Year 月Month 日Day； 环境管理体系开始运行时间是The EMS was put into operation on 年Year 月Month 日Day；职业安全健康管理体系开始运行时间是The OHSMS was put into operation on 年Year 月Month _日Day。 ?组织希望质量管理体系认证审核时间为The expected audit time for QMS is： ；组织希望环境管理体系第一阶段审核时间为The expected audit time for the first stage au

10、dit of EMS is： 第二阶段审核时间为The expected audit time for the second stage audit of EMS is： ；组织希望职业安全健康管理体系第一阶段审核时间为The expected audit time for the first stage audit of OHSMS is： ;第二阶段审核时间为The expected audit time for the second stage audit of OHSMS is: ；（说明：环境管理体系和职业安全健康管理体系的认证审核均分为两个阶段进行,其中第二阶段审核时间要根据第一阶

11、段审核的结果最终确定）(Note： The audit for EMS and OHSMS include two stages。 The audit time for the second stage audit depends on the result of the first stage audits。 ) Please provide the following information in applying for ISO14001 Certification 1、 排放的污染物（名称、浓度和总量）、排放方式(排放地点和去向）、排放标准(包括是否进行了监测及监测结果):The di

12、scharged contaminations (name， density and gross quantity）， the method of discharge （discharge place and discharge directions)， discharge standards (including whether supervision and measurements have been conducted and the results) 2、组织的活动、产品或服务（应包括主要过程及辅助的相关过程）：The applicants activities， products

13、or services （including major process and relevant supporting process） 华夏认证中心 3/ 8 China Certification Center Inc. 3、环境管理状况（组织的环境管理机构、机构负责人、近几年主要业绩）：Information about environmental management （environmental management department of the applicant, responsible person and major achievements in the recen

14、t years） 4、能源、资源年消耗量及在同行业中所处的水平（包括:主要原材料及水、电、燃料等）：Annual consumption of energy and resources and the position within the industry （energy and resources include: major raw material， water， electricity, fuel, etc。) 5、是否在近两年内受到过政府环保主管部门的处罚或发生过环境事故,如有请简述情况：Whether the applicant has been punished by the

15、environmental protection authorities in the past two years and whether any environmental accident has happened。 If any， please specify. 华夏认证中心 China Certification Center Inc。 4/ 8 Please provide the following information in applying for OHSMS Certification 1、近两年发生死亡、重伤情况;职业病情况：Information about deat

16、h and serious injuries in the past two years and information about occupationalrelated disease 2、可能造成特、重大事故的活动或设施:Activities or facilities that may cause major accidents 3、职业安全健康管理状况（职业安全健康管理机构、机构负责人、近几年主要业绩）:Information about occupational health and safety management (occupational health and safety

17、 management department of the applicant， responsible person and major achievements in recent years) 4、千人负伤（死亡、重伤、轻伤）率在同行业中所处的水平：Injury(death， serious injury and slight injury) rate per thousand employees and the position within the industry。 5、是否在近两年内受到过安全主管部门的处罚或发生过安全事故,如有请简述情况:Whether the applican

18、t has been punished by the safety authorities in the past two years or whether any safety accident has happened。 If any, please specify. ？有无特殊危险区域或限制及需说明的情况：Please indicate any dangerous area or restrictions 申请组织（公章)Stamped by the applicant 申请组织代表签名Signed by representative of applicant _ 职务Position

19、of representative：_ _年Year_月Month_日Day 华夏认证中心 5/ 8 China Certification Center Inc. 认证所需资料 Required Documents for Certification Documents for QMS 1、 法律地位的证明文件，如营业执照或组织机构代码证及年检证明复印件；Documents that certify the legal status of applicants, such as business licenses, certificate of organization code， or a

20、nnual surveillance proof; 2、 有效期内的许可证或资质证书及年检证明复印件;The valid permission license, qualification certificate and annual surveillance proof; 3、 组织简介;Introduction of organization; 4、 产品生产流程/工作过程简图；Production flowing chart/flowing chart of working process； 5、 企业质量体系覆盖范围内的不在同一市、县的机构目录（详列名称、地点）；List of dep

21、artments or branches in other places covered by the same quality management system (please specify full titles and detailed addresses)； 6、施工或勘测、设计、监理、物业管理、房地产开发、保洁等单位还应提供正在实施的所有工程项目的现场（包括工程规模、进度、地点等）清单(加盖公章）；For the organizations engaged in constructions, exploration， design，supervision and manageme

22、nt, property management, real estate development or cleaning industries， the list of project sites under construction shall be provided （including information about project scope， process and address)。 The list shall be stamped by applicants； 7、受控的质量手册和程序文件及必需的文件清单；The controlled quality manual, pro

23、cedure documents and necessary document lists； 8、除认证申请书中规定的认证所需资料外，华夏认证中心有权根据认证审核需要随时要求申请人补充提交资料。In addition to the documents required by the Application Form, CCCI has the right to require supplementary documents when necessary.华夏认证中心 China Certification Center Inc。 6/ 8 Documents for EMS/OHSMS 1、法

24、律地位的证明文件，如营业执照或组织机构代码证及年检证明复印件；Documents that certify the legal status of applicants， such as business licenses, certificate of organization code， or annual surveillance proof; 2、有效期内的许可证或资质证书及年检证明复印件;The valid permission license, qualification certificate and annual surveillance proof； 3、组织简介(即组织相关

25、的环境、安全状况简介);Introduction of organization （introduction of environment and safety situations related with to applicant); 4、环境安全监测报告；环境安全“三同时验收报告；The environment/safety monitoring and measurement reports； check and accept report of threeexisting； 5、“环评、“安评”批复；The approval of environment assessment/saf

26、ety assessment; 6、地理位置图及厂区平面示意图；The geographical map and sketch map of factories; 7、主要工艺流程及污染物的产出示意图；The major technical flowing chart and sketch of outputflow of contamination 8、申请ISO14001认证组织环境表现审查表，安全行政主管部门的证明；Evaluation report of environmental performance of the applicant for ISO14001 certificat

27、ion； proof from safety authorities; 9、环境管理手册、程序文件（包括重要环境因素清单、法律法规清单以及目标指标和环境管理方案）；Environmental management manual and procedure documents (including list of major factors affecting the environmental elements， list of laws and regulations， objective and targets and environmental management program）;

28、10、职业安全健康管理手册、程序文件(包括重大风险因素清单，法律法规清单及目标指标和管理方案）；Occupational health and safety management manual and procedure documents (including list of major risky elements, list of laws and regulations, objectives and targets， and management program)； 11、企业体系覆盖范围内的不在同一市、县的机构目录（详列名称、地点）；List of departments or b

29、ranches in other places covered by the same management system （please specify full titles and detailed addresses） 12、施工或勘测、设计、监理、物业管理、房地产开发、保洁等单位还应提供正在实施的所有工程项目的现场（包括工程规模、进度、地点等）清单(加盖公章）;For the organizations engaged in construction, exploration, design ，supervision and management， property manageme

30、nt， real estate development or cleaning industries, the list of project sites under construction shall be provided （including information about project scope, process and address). The list shall be stamped by applicants 13、建筑类企业要标出各现场敏感区位置,现场（包括敏感区）污染物排放监测结果；The construction organizations shall ind

31、icate the locations of sensitive areas in construction site and shall provide monitoring result of discharge of contamination on sites （including the sensitive areas）； 14除认证申请书中规定的认证所需资料外,华夏认证中心有权根据认证审核需要随时要求申请人补充提交资料。In addition to the documents required by the Application Form， CCCI has the right

32、to require supplementary documents when necessary。 华夏认证中心 7/ 8 China Certification Center Inc。 受审核方反馈信息单 Feedback Sheet from Auditee (Signed together with Certification Contract and Agreement） 我公司（厂)已收到贵方提供的有关质量管理体系/环境管理体系/职业安全健康管理体系认证方面的公开文件，并由此了解到： This is to certify that we have received the Open

33、 Documents regarding the certification of QMS/EMS/OHSMS from CCCI and we have comprehended that： 1、贵方的认可业务范围可以覆盖我们申请认证的领域; The accreditation scope of CCCI could cover the certification scope that we have applied； 2、“咨询认证一条龙”的做法属违规行为; The combination of consultant services and certification activitie

34、s violates regulations； 3、认证收费国家有相应的收费标准； There are relevant national fee standards regarding the certification charges; 4、其他 Others 特此确认. Authorized Signature: Date: （Official Stamp of Applicant） (Please return this sheet together with Certification Contract to CCCI) 华夏认证中心 China Certification Center Inc. 8/ 8