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Required Telarc Services

Reason For Request

Are You An Existing Telarc Client? *

Yes

Required Telarc Services

Column 1

Health & Safety

Q-Safe

ISO 45001

Asbestos Class A Audit Requirement

ACC Accredited Employer Programme

Totika Pre Qualification Scheme

Environmental Management

ISO 14001

Quality Management

ISO 9001

Column 2

Food Safety

ISO 22000

FSSC 22000 (GFSI)

BRCGS (GFSI)

MPI Food Act 2014

WSE (Woolworths Supplier Excellence Programme)

WSMP (Wine Standards Management Plan)

McD SQMS (McDonalds Supplier Quality Management System)

Asset Management

ISO 55001

Column 3

Public Safety

NZS 7901

Information Security

ISO 27001

Medical

ISO 13485

NZS 8156

Aeromedical and Air Rescue

Integrated System

Do you have one management system for all your standards? *

Yes

Please tick which ones apply *

Management Reviews that consider the overall business strategy and plan?

An integrated approach to internal audits?

An integrated approach to policy and objectives?

An integrated approach to systems processes?

An integrated documentation set including work instructions, to a good level of development as appropriate?

An integrated approach to improvement mechanisms, (Corrective and Preventive Action; measurements and Continual Improvement)?

An integrated approach to planning, with good use of business wide risk management approaches?

Unified management support and responsibilities?

Is this company well organised?

Scope of Business

Products/services you offer Please list the products/services that you offer. Identify seasonal products/services you wish to be included in the scope of certification. *

Do you currently hold Certification with another Certification Body? If yes please specify which body and for what standard. *

Special Compliance/Customer Requirements/Legal Requirements Please specify any special Compliance, Legal or Customer requirements, and any previous compliance actions or infringements. *

Are you using a consultant to develop your system or undertake internal audits? *

Yes

Certification Required by: Please specify preferred audit timing. *

BRCGS (GFSI)

BRCGS (GFSI) *

Food

(Manufacturing of) Packaging

Storage and Distribution (non-manufacturing sites)

Existing Certification (FSSC or ISO 22000)

Do you have an existing certification (FSSC or ISO 22000)? *

Yes

Certification Type (FSSC or ISO 22000) *

Certificate Issued by (Certification Body) *

Certificate Issue Date *

Certificate Expiry Date *

Type of Food Act Risk Based Measure

Type of Food Act Risk Based Measure: (Verification Services only) *

Custom Food Control Plan

National Programme 3

Templated Food Control Plan (MPI template)

National Programme 2

Templated Food Control Plan (Industry Template)

National Programme 1

FCP Custom Type *

Aseptic processing and packaging

Low acid “canned” food processing

Dairy

Additional Information Required for Food Control Plan (FCP)

Do you have an existing MPI registration number *

Yes

Your exisiting MPI number *

Registered with: *

MPI

A Local Authority

If not currently registered who do you intend to register your food control plan/National Programme with? *

MPI

A Local Authority

Are you operating in *

a single local authority

in more than one local authority

You are *

An Existing Business

New Business

Planned Start Date *

NZS 7901 Safety Management System Facility Questionnaire

Please specify your industry sector/s *

Electricity Generation

Electricity Transmission

Electricity Distribution

Gas Transmission

Gas Distribution

Please specify any other certifications currently held by the organisation. *

AS/NZS ISO 9001

AS/NZS ISO 14001

AS/NZS 4801/OHSAS 18001

ACC Partnership Programme/WSMP accreditation

NZS 7901

Other

Other (please specify) *

Have any previous NZS 7901 assessments, certifications or reviews been undertaken? *

Yes

Date *

Please describe findings, (or attach report) *

Has a consultant been used to develop or audit your SMS system? *

Yes

Please provide consultant name and contact details *

Audit Type Required? *

Gap Analysis/Pre Assessment

Stage 1 Manual Review

Stage 2 Certification Audit

Re-Certification Audit

Where can a copy of your asset register be accessed? Please provide web link if available. *

Summary of main types and quantity of assets relevant to Public Safety.

(Electricity Substations, Poles, Transformers, Power line lengths etc.) (Gas network entry points, district pressure regulating stations, strategic network isolation valves, cathodic protection, odorisation monitoring points, and gas measuring systems etc.)

Asset Type *

Asset Quantity *

Add additional Asset

nzs-7901-additional

When do you plan to be ready for an audit?

Please attach appropriate documents to assist Telarc to determine the organisation boundaries and the scope of your certification needs. If there are multiple documents please zip them and upload the zipped file.
If required use multiple copies of this form or attach a suitable list or matrix to indicate different sites, asset types and quantity.
The applicant warrants that the information provided in this application form is correct.

attach appropriate documents *

Approx number of staff (FTE), including contractors, whose duties impact on the public, by job type:

Senior Management *

Administration Staff *

System Design Staff *

Control Room Staff (supply control) *

Line Technicians *

External Plant Maintenance Staff *

Labourers *

Traffic Controllers *

Vegetation Control *

Substation and Transformer Site Maintenance *

Gas Transmission Station and Valve Maintenance *

Gas Distribution Pressure Regulating System *

Other (Please Specify)

Environmental Management Systems

Please detail the previous uses of the site(s) seeking certification. *

FOR CERTIFICATION TO ISO 14001 PLEASE INDICATE THE TYPES OF ASPECTS AND IMPACTS RELEVANT TO YOUR SITES AND OPERATIONS. *

Discharge of contaminants to Air

Discharge of contaminants to Land

Discharge of contaminants to Water

Significant quantities of waste created/stored/disposed of by sites.

Sites emit significant quantities of heat, light or radiation.

Onsite storage/use of hazardous substances and goods (includes asbestos).

Sites have Resource Consents

Sites have Trade waste consents of Air discharge permits

Required for WSE

Please download fill out and attach this additional form. Please label it with your company name

WSE Quote request form

Health and Safety Management Systems

This is required for BS OHSAS 18001, Asbestos or ISO 45001

For certification of Safety Management Systems please indicate the types of hazards relevant to your sites and operations. *

Dangerous Goods.

Vehicle/Pedestrian interaction (including fork-lifts).

Powered plant (including building plant rooms)

Other plant (including scaffolding) or mechanical hazards.

Manual handling (includes occupational overuse Syndrome).

Hazardous substances (includes asbestos).

Atmospheric contaminants other than hazardous substances

Use of ionising or non-ionising radiation.

Confined Spaces.

Slips, trips and falls.

Noise

Thermal environment

Below ground work environment

Storage and/or use of explosives

Electrical hazards

Pressurised environment

Threats of bullying, violence or occupational assault.

Sites classed as major hazard facilities.

Other significant OHS risks:

Please list main hazardous substances used in your processes *

Please specify OHS risks *

ISMS Related Information

Please confirm that any ISMS related information including confidential and or sensitive information (such as ISMS records of information about design and effectiveness of controls) shall be made available for review by the audit team.

NB. An audit cannot proceed unless appropriate access to ISMS related information has been granted.

Factors Related to Business and Organisation (Other Than IT)

Please select the appropriate grades for each category that best represents your business and regulatory requirements

Type(s) Of Business And Regulatory Requirements

Organisation works in non-critical business sectors and non-regulated sectors

Organisation has customers in critical business sectors

Organisation works in critical business sectors

Process And Tasks

Standard processes with standard and repetitive tasks; lots of persons doing work under the organisation’s control carrying out the same tasks; few products or services

Standard but non-repetitive processes, with high number of products or services

Complex processes, high number of products and services, many business units included in the scope of certification (ISMS covers highly complex processes or relatively high number or unique activities)

Level Of Establishment Of The MS

ISMS is already well established and/or other management systems are in place

Some elements of other management systems are implemented, others not

No other management system implemented at all, the ISMS is new and not established

NB: Critical business sectors are sectors that may affect critical public services that will cause risk to health, security, economy, image and government ability to function that may have a very large negative impact to the country

Factors Related to IT Environment

Please select the appropriate grades for each category that best represents your IT environment

IT Infrastructure Complexity

Few or highly standardized IT platforms, servers, operating systems, databases, networks, etc.

Several different IT platforms, servers, operating systems, databases, networks

Many different IT platforms, servers, operating systems, databases, networks

Dependency On Outsourcing And Suppliers, Including Cloud Services

Little or no dependency on outsourcing or suppliers

Some dependency on outsourcing or suppliers, related to some but not all-important business activities

High dependency on outsourcing or suppliers, large impact on important business

Information System Development

None or a very limited in-house system/application development

Some in-house or outsourced system/application development for some important business purposes

Extensive in-house or outsourced system/application development for important

Asset Register

Please upload your asset register, or provide a link to your asset register

Reason For Request

Reason for Request

Reason for Request *

New Certification

Transfer of Certification

Scope Extension

Additional Site(s) Certification

Transfer

Transition

Upload your current certificate(s)

Address Details

Physical Address

Postal Address

Your postal address is different from your physical address

Management/Contact Person

Management / Contact Person

First Name *

Last Name *

Title *

Email *

Mobile Number *

Employees

Full Time Employees *

Part Time Employees *

Contractors *

Full Time Employees Role Breakdown - eg; 2x management, 4x labourers 2x sales etc

Sites

For each office and worksite that you with to include in this application we will require some additional information.

For each site please provide; Physical address, Core Processes, Number of FTE's at the site, Number of Shifts at the site.
If you are interested in BRC or FSSC please also provide Facility area (m2) and Number of HACCP plans onsite.
If you are interested in ISO27001 please provide details of site staff that are involved in Information Security for each site.

Does your business have multiple sites? *

Yes

Upload your site information documents, OR enter site information below

Site Information

Physical Address

Total number of FTEs on site

Site Core Scope

Information Systems Staff (FTEs)

Maximum number of employees in main shift (FTE’s)

No. of shifts at site

Facility Area (in M2)

No. of HACCP Plans On Site

Number of Production Lines At Site

List Off-Site Storage And/or Activities

Add Additional Site

Declarations

Our terms of business can be found here

The information provided above accurately describes the business*

I confirm that I have read and accept the Telarc terms of business*

How did you hear about Telarc

Request A Quote

Are You An Existing Telarc Client? *

Required Telarc Services

Integrated System

Scope of Business

BRCGS (GFSI)

Existing Certification (FSSC or ISO 22000)

Type of Food Act Risk Based Measure

Additional Information Required for Food Control Plan (FCP)

NZS 7901 Safety Management System Facility Questionnaire

Summary of main types and quantity of assets relevant to Public Safety.

Approx number of staff (FTE), including contractors, whose duties impact on the public, by job type:

Environmental Management Systems

Required for WSE

Health and Safety Management Systems

Asset Register

Reason for Request

Upload your current certificate(s)

Company Information

Address Details

Management / Contact Person

Employees

Site Information

Declarations