To: NIPPON KAIJI KYOKAI Date: APPLICATION FOR MANAGEMENT SYSTEM AUDIT I, 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 □ Initial □ Annual □ Renewal □ Occasional (due to: ) □ Transfer of Management System Certification (Name of Existing Certification Body: ) Applicable Standards □ ISO 9001:2015 □ JIS Q 9001:2015 □ ISO 14001:2015 □ JIS Q 14001:2015 □ ISO 45001:2018 □ JIS Q 45001:2018 □ ISO 50001:2015 □ JIS Q 50001:2015 □ OHSAS 18001:2007 (If you apply for different kinds of audits for multiple applicable standards, please apply for the audits for each applicable standard.) Name and Address Certification No.: (No entry for Initial Audit) Organization Name: Address : (*) Top Management: Name Position Management Representative for Management System: (when available) Name Position Person in Charge: Name Position Tel. Fax. E-Mail (Please fill in an appropriate organization or departmental e-mail address.) Scope of Certification (Refer to description of existing certificate) Number of Personnel (involved in the scope of certification) * No. of People (including part-time worker, temporary worker, cooperative company worker etc.) Application of Shift Work □: No □: Yes (Please fill out the attachment 1 with details.) Expected Date of Audit Contract with Consultant □: No □: Yes Name of Consultant: Information for Management System Documents (Please fill in the title, document number, revision number and or revised date, etc.) Remarks *; Please fill out the attachment 1 about details of each site. (Name & address of sites, scope, number of people etc.) Applicant & Billing address □: as stated below □: as stated above - Organization - Tel. No. Fax. No. - Name & Position - Signature
To: NIPPON KAIJI KYOKAI Date: Sites included in the scope of certification (Please fill out about all sites.) No. Details of Each Site (☑：check the appropriate box.) 1 Name of Site: Address Scope of Certification Number of people in the site: ( ) Persons Shift Work : □ Not applied □ Applied (Please fill out the right column with details) Type of shift: □ 2-shift □ 3-shift □ Others ( ) *Number of shift worker: ( ) Persons Approx. number of cooperative company worker among mentioned above: ( ) Persons Kind of shift work: ( ) Kind of work of each shift : □ Same □ Different Level of control of each shift: □ Same □ Different 2 Name of Site: Address Scope of Certification Number of people in the site: ( ) Persons Shift Work : □ Not applied □ Applied (Please fill out the right column with details) Type of shift: □ 2-shift □ 3-shift □ Others ( ) *Number of shift worker: ( ) Persons Approx. number of cooperative company worker among mentioned above: ( ) Persons Kind of shift work: ( ) Kind of work of each shift : □ Same □ Different Level of control of each shift: □ Same □ Different 3 Name of Site: Address Scope of Certification Number of people in the site: ( ) Persons Shift Work : □ Not applied □ Applied (Please fill out the right column with details) Type of shift: □ 2-shift □ 3-shift □ Others ( ) *Number of shift worker: ( ) Persons Approx. number of cooperative company worker among mentioned above: ( ) Persons Kind of shift work: ( ) Kind of work of each shift : □ Same □ Different Level of control of each shift: □ Same □ Different 4 Name of Site: Address Scope of Certification Number of people in the site: ( ) Persons Shift Work : □ Not applied □ Applied (Please fill out the right column with details) Type of shift: □ 2-shift □ 3-shift □ Others ( ) *Number of shift worker: ( ) Persons Approx. number of cooperative company worker among mentioned above: ( ) 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.