TECHNICAL ASSESSOR/ EXPERT F-05/03

Issue date: 18/03/15

RECORD FORM
Rev No: 01

A About Yourself
Title Surname Forename(s) Date of birth

CNIC Number:

Address for contact

Tel No.(Office)
Tel No.(Res)
Fax
E-mail
Mobile

In the fields of work ticked:

Calibration Laboratory: Testing Laboratory: Medical Laboratory:

Certification Body: Halal Certification Body Inspection Body

Proficiency Testing Product Certification

B About Your experience

1. Qualifications Subject(s) / Awarding institution Date

Please provide copies of certificates awarded
where appropriate

Degrees

Technical qualifications

General

2. Current membership of professional institution

Institution Membership Date achieved

Grade

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 TECHNICAL ASSESSOR/ EXPERT F-05/03
Issue date: 18/03/15
RECORD FORM
Rev No: 01

3 Details of last five jobs (most recent first)

From To Name of employer and Position held

nature of business

4 Details of experience in

Performing laboratory
tests/calibrations/medical
OR Inspection

Quality assurance

Other relevant technical

areas

5. Details of assessment experience

CABs assessed Date

6. Details of assessor training received

Training / Courses Date

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 TECHNICAL ASSESSOR/ EXPERT F-05/03
Issue date: 18/03/15
RECORD FORM
Rev No: 01

7. Details of Technical Courses (e.g. Method Validation, Measurement Uncertainty, Traceability, PT

etc.)

Courses Date

8. List of Equipment used (e.g. GCMS,GC, HPLC, AAS, UV, pH meter, conductivity
meter, proximate analyzer etc)

Name of the equipment(s) Used when (Year)

9. Please identify your expertise in each specific sub-discipline, and fill in the relevant
rows:

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 TECHNICAL ASSESSOR/ EXPERT F-05/03
Issue date: 18/03/15
RECORD FORM
Rev No: 01

Code Sub-discipline Year Where worked

From ..…. to - ………
T1 Calibration
T1a mass
T1b temperature
T1c volume
T1d length
T1e dimensions
T1f time
T1g electrical
T1h frequency
T1i pressure
T1j viscosity
T1k conductivity
T1l pH
T1m Other please specify
T2 Physical testing
T2a textile
T2b leather
T2c steel
T2d paper
T2e sampling
T2f Other please specify
T3 Chemical testing
T3a textile,
T3b leather,
T3c pharmaceutical,
T3d metallurgy,
T3e mineral,
T3f glass & ceramics,
T3g applied chemistry
T3h sugar,
T3i fertilizers,
T3j cement,
T3k explosive,
T3l water,
T3m environmental,
T3n natural
herbs/medicines
T3o nuclear,
T3p pesticides
T3q geology,
T3r non destructive
testing
T3s mycotoxins 4 of 5
T3t Other please specify
T4 Environmental
 T4a water
T4b air
T4c soil
T4d microbiological F-05/03
testing TECHNICAL ASSESSOR/ EXPERT
Issue date: 18/03/15
T4e noise RECORD FORM
Rev No: 01
T4f Other please specify
T5 Microbiological
testing
Please complete Part C if you will be supplying assessment services through your employer
C
T5aCompany details
environmental
T5b food
Name
T5c of Organization / Business
marine products
T5d water
T6e Other please specify
Name
T6 of main contact for assessors (BLOCK CAPITAL, please)
Agriculture
T6a soil
T6b water,
Address
T6c for pesticide
contact (if different from address on page 1)
T6d Other please specify
T7 Geochemical
T7a inorganic
T7b organic
T7c Other please specify
T8 Sampling
Postcode
T8a liquids (rivers,
drums)
T8b powders
Tel. No Fax No. E-mail
T8c solids
T8d gases
T8e packing materials
T8f environmental
T8g Other please specify
D Endorsements – please ensure that both sections 1 and 2 are completed
T9 Petrochemical
T9a Oil Testing Signature of Applicant
T9b1 To be Gas Testing
completed by the applicant
T9c Other please
I confirm that thespecify
details given in this Form
T10 Electrical Testing
and attachments are correct
T10a2 ThisTransformers
section must be completed by either
T10b (a)Cablesa senior manager if services are supplied through your employer, or
T10c (b)Fans a referee if services are to be supplied independently
T10d To the best
Lights of my
(LED, knowledge, the information given in this form and
CFL,
attachments
Tubular) is true and correct
T10e Energy Meter
T10fSignature of professionally
Solar Panel qualified referee/senior manager Name (BLOCK CAPITAL, please)
T10g Battery Chargers
T10h Refrigerators
T10i Electrical Ballast
T10j Air Conditioners
T10k Motors
T10l Microwave Oven
T10m TV, LCD and LED
Panels
T10n PCB
T10m Other please specify 5 of 5