FORM QA-50-60-03

To: NIPPON KAIJI KYOKAI

Date:

APPLICATION FOR MANAGEMENT SYSTEM AUDITI, the undersigned applicant, request the NIPPON KAIJI KYOKAI, to provide the certification services as
described below in accordance with the “Rules for Certification of the Management Systems”.
Kind of Audit

Applicable Standards□ Initial □ Annual □ Renewal □ Occasional (due to:□ Transfer of Management System Certification(Name of Existing Certification Body:□ISO 9001:2015□ISO 14001:2015□ISO 45001:2018□JIS Q 9001:2015 □JIS Q 14001:2015 □JIS Q 45001:2018□ISO 39001:2012))□ISO 50001:2018□JIS Q 50001:2019(If you apply for different kinds of audits for multiple applicable standards, please apply for the audits for each applicable standard.)

Certification No.

(No entry for Initial Audit)

Organization Name
Address* Details of sites shall be entered to the attachment 1.

Name
Top Management:
Position
Details of Organization

Management
Representative*Name(*When appointed)

Position
Name
Position

Person in ChargeTel.
E-Mail(When available, fill telephone number and e-mail address for the department.)

Scope of Certification□ No change (※)(Refer to description of existing certificate)Number of Personnel* No. of People(including part-time worker, temporary worker, cooperative company worker etc.)(involved in the scope ofcertification)

Application of Shift Work□: No□: Yes(Please fill out the attachment 1 with details.)

Expected Date of Audit
Contract with Consultant □: No
Outsourced processes
Information forManagement System
Documents□: YesName of Consultant:□: Yes (□ Attached the identified outsourced processes)□: No*Required to fill for initial audit.

(Please fill in the title, document number, revision number and or revised date, etc.)

Remarks※ When there is no changes after the previous audit, please tick “No change” (It is unnecessary to enter details into the column).

ApplicantSignature

Billingaddress□: as stated above□: as stated below

Organization
Tel. & Fax. No.

E-Mail:Name & Position

Note: Please use the latest version downloaded from ClassNK website (http://www.classnk.or.jp/),then fill out completely and file with ClassNK.

Attachment 1

Sites included in the scope of certification (Please fill out all sites.)
No.
Name of Site:

Details of Each Site (☑：check the appropriate box.)
Address
Scope ofCertification

1

Number of people in the site:() Persons
Approx. number ofcooperative company worker
among mentioned above:() Persons
Name of Site:

Shift Work :□ Not applied□ Applied(Please fill out
the right columnwith details)

Type of shift: □ 2-shift □ 3-shift□ Others (*Number of shift worker: ()) Persons

Kind of shift work: (Kind of work of each shift :)□ Same □ Different

Level of control of each shift: □ Same □ Different

Address
Scope ofCertification

2

Number of people in the site:() Persons
Approx. number ofcooperative company worker
among mentioned above:() Persons
Name of Site:

Shift Work :□ Not applied□ Applied(Please fill outthe right columnwith details)

Type of shift: □ 2-shift □ 3-shift□ Others (*Number of shift worker: ()) Persons

Kind of shift work: (Kind of work of each shift :)□ Same □ Different

Level of control of each shift: □ Same □ Different

Address
Scope ofCertification

3

Number of people in the site:() Persons
Approx. number ofcooperative company worker
among mentioned above:() Persons
Name of Site:

Shift Work :□ Not applied□ Applied(Please fill out
the right columnwith details)

Type of shift: □ 2-shift □ 3-shift□ Others (*Number of shift worker: ()) Persons

Kind of shift work: (Kind of work of each shift :)□ Same □ Different

Level of control of each shift: □ Same □ Different

Address
Scope ofCertification

4

Number of people in the site:() Persons
Approx. number ofcooperative company worker
among mentioned above:() Persons

Shift Work :□ Not applied□ Applied(Please fill out
the right columnwith details)

Type of shift: □ 2-shift □ 3-shift□ Others (*Number of shift worker: ()) Persons

Kind of shift work: (Kind of work of each shift :)□ Same □ Different

Level of control of each shift: □ Same □ Different*Example: In case of 2-shift with 15 persons each, please fill out 30 persons in this column.

Note: Please use the latest version downloaded from ClassNK website (http://www.classnk.or.jp/),then fill out completely and file with ClassNK.

Attachment 2

This attachment can be used only for the following cases and submitted to the NIPPON KAIJI KYOKAI (ClassNK)
together with the application form.
1) Initial Audit.
2) Transfer of Certification
3) Change of the “kind of certificate” or “description of the certificate”.
* Certificates with the symbol or mark of accreditation bodies (JAB and RvA) are issued only for the accredited scopes of ClassNK.

Kind ofCertificate(Please select thecertificate to beissued)

ISO 9001□ Certificate with NK Registration Mark□ Certificate with NK Registration Mark and JAB Accreditation Symbol*□ Certificate with NK Registration Mark and RvA Accreditation Mark*ISO 14001□ Certificate with NK Registration Mark□ Certificate with NK Registration Mark and JAB Accreditation Symbol*

ISO 45001, ISO39001,ISO 50001□ Certificate with NK Registration MarkOrganization
NameAddress
Description
in English
Scope of Certification

Documents
attached(Please tick thedocuments
attached to theapplication form)

Common□ Manual of management system (MS)□ List of procedures, instructions and others relating to MS□ Organization’s outline (general features of organization, significant aspects of its process andoperations, and any relevant legal obligations;)□ Business and Service activities (general information, relevant for the field of certification applied for,concerning the applicant organization, such as its activities, human and technical resources, functions
and relationship in a large corporation, if any;)□ Other referenced document (This document shall include the identification of the outsourced
processes. When the MS documents include it, the corresponded part of MS can be attached. )Transfer of Certification□ Copy of latest management system certificate
ISO 9001□ List of products/services applied to the QMS□ List of Ships applied to the QMS (only Ship management organization)
ISO 14001□ Documents relating to evaluation of Environment Aspects□ Documents relating to Environmental Management Program(s)□ Documents relating to Legal and other requirements applied
ISO 45001□ Documents relating to hazards, occupational health and safety risks and hazardous materials□ Documents relating to OHS management program(s)□ Documents relating to Legal and other requirements applied
ISO 39001□ Documents for performance factors, and for risks and opportunities to be addressed□ Documents relating to Road Traffic Safety Management Program(s)□ Documents relating to Legal and other requirements applied
ISO 50001□ Documents for energy performance□ Documents relating to energy management program(s)□ Documents relating to Legal and other requirements applied
Note: Please use the latest version downloaded from ClassNK website (http://www.classnk.or.jp/),then fill out completely and file with ClassNK.

Attachment 3 (For the integrated audit only)This sheet is for evaluating the information of integrated level of management systems, and for the confirmation ofcompliance with the conditions of integrated audit*.
Please enter the information into the column and submit to the ClassNK together with the application form.
* Integrated audit: An integrated audit is when an organization has integrated the application of requirements of
two or more management systems standards into a single management system and is being
audited against more than one standard.

No.

Conditions

Confirmation columnfor organization

1 The scope of management systems (activities, products or services, organization) is thesame.

Yes

No

2 The audit cycle of management systems is the same (or the organization agree with tobe the same).

Yes

No

3 The integrated management system in single system documentation set, including work
instructions to a good level of development, has been established.

Yes

No

4 Management reviews are conducted with considering the overall business strategy andplan (or the organization is being planned to conduct).

Yes

No

5 Internal audits are conducted according to the integrated approach (or the organization
is being planned to conduct).

Yes

No

6 Activities related policies and objectives are conducted and managed according to theintegrated approach.

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

7 Systems and processes are controlled according to the integrated approach.

8 Improvement mechanisms (risk management, corrective action, measurement andcontinual Improvement) are controlled according to the integrated approach.
9 Management support and responsibilities are integrated.

10 As the auditee, the ability to respond to multi-aspect questions from audit teams isensured.

Note: Please use the latest version downloaded from ClassNK website (http://www.classnk.or.jp/),then fill out completely and file with ClassNK.