Midwest Metrology, LLC    341 Smith Drive    Clayton, OH   45315

                                                                                   TEL:  937-832-0965          FAX: 937-832-0966

 

 

Customer Information/QA Requirement Form

 

The following form allows you to define the services you require from Midwest Metrology. The information presented is from current or previous descriptive purchasing documents (P.O. or equivalent). Please review the information and make the appropriate changes and fax back to Midwest Metrology within 24 hours. If this form is correct, you do not need to fax this form back to Midwest Metrology. If the documentation we have on file for your company does not completely describe all requirements, then the options will indicate default services by Midwest Metrology. If corrections have been made, please sign and fax to the attention of Bill Sierschula, Quality Manager at (937) 832-0966.

Company

Sales/P.O./Quote #

Contact

Phone #

Fax #

     

     

     

     

     

Ship to:     

Bill to:     

                  

                

                  

                

Name on Calibration Report:

     

QA Requirements

 ISO/IEC 17025 accredited calibration  See note 1,3

 ANSI/NCSL Z540-1-1994  See note 1

 MIL-STD 45662A See note 2

 ISO 9000 See note 2        

 ISO 10012-1 See note 2

 No QA specifications apply

 Other QA specifications (please define)

     

 

Notes:

1.        As received and as left data is included

2.        Midwest Metrology Standard Service

3.        Applicable measurement uncertainties will be reported for TUR’s of less than 2:1. Additional costs are associated with ISO/IEC 17025 accredited calibrations. Please contact Midwest Metrology for information.

Shipping Requirements

 Prepaid

 Collect

 COD

 3rd Party - Account #      

UPS Service  

      Standard     Red      Blue

Fed-X Service

 Standard    Next Day-AM

 Customer Pick-up

     

 Other 

Packing 

 Midwest Metrology             Customer Supplied

Special Shipping Instructions

     

Technical Requirements

 As Received Data  *

 As Left Data  *                                                          

 Use customer ID number for serial number

 4:1 test accuracy ratio required

 Apply calibration label(s) to instrument(s)

 Apply Calibration Void Seals (if applicable)

 When test accuracy ratio (TAR) is not 4:1, provide actual ratio report *

    * additional costs may apply 

Calibration Intervals:

 

Customer assigns calibration interval. Interval must be provided prior to or at time of equipment

receipt. Work will not commence until information is received.

 

A calibration interval of 12 months will be used unless notified by the customer.

 Midwest Metrology selected calibration procedure. (NAVAIR, ANSI, internally generated, or other industry accepted method

      based on appropriate standards used by Midwest Metrology  to perform required tests. Identified on Calibration Certificate.

  Customer supplied calibration procedure. Must be reviewed and approved prior to use.

Statement of Compliance, where applicable, is based on test results falling within specified limits with no reduction by the uncertainty of the measurement.

 

Should information on this form be used for all future services performed by Midwest Metrology?       Yes          No

 

 Note:     If work is currently being performed by Midwest Metrology this form must be returned (faxed) within 24 hours for any

                changes to affect this work.

 

 

Form Completed by: _______________________________________    Date: _________________________