APPLICATION FORM N°:

INTERNAL PRODUCTION CONTROL PLUS SUPERVISED PRESSURE EQUIPMENT

CHECKS AT RANDOM INTERVALS
(Module A2 of European Directive 2014/68/EU)

PART 1 - REQUEST FOR SUPERVISED CHECKS (to be filled in by the applicant)

APPLICANT: Manufacturer: Authorized Representative established within the Community:

MANUFACTURER (to be filled even if he is not the applicant)

Company Name:
Address:

AUTHORIZED REPRESENTATIVE established within the Community (if any):

Name:
Address:

MANUFACTURING WORKS Address:

Tél: e-mail:

ADDRESS OF SITE FOR SUPERVISED CHECKS (if different from manufacturing works address):

Tél: e-mail:

EQUIPMENT:
Vessel □ Fired or otherwise heated pressure equipment□ Piping □ Safety device □
Pressure accessories □ Assembly □
BRANDING NAME: if different from manufacturer’s name.
DESCRIPTION of EQUIPEMENT :

Designation: Type / version:

Quantity:
Period(s) for supervised checks:

We, undersigned, having completed the information in attached Annex 1, hereby request Bureau Veritas to
carry-out the supervised checks for the described equipment at random intervals, according to the applicable
requirements of directive 2014/68/EU transposed into French law by the Code de l’environnement, articles
R557-1 and followings.
We hereby confirm that no application for supervised checks for the described equipment at random intervals
under Module A2 of directive 2014/68/EU has been made to another notified body.
We hereby warrant that we shall abide by all provisions contained in and implied by the Directive 2014/68/EU as
transposed in the applicable law(s) and that we shall indemnify Bureau Veritas against the consequences of any
failure to do so.
We agree to give Bureau Veritas surveyors every access to the facility needed to carry out their duties.
The latest published Bureau Veritas General Conditions of Service, a copy of which has been submitted to us,
are applicable.
The present application engages both parties upon receipt of acknowledgement by Bureau Veritas.

At : on : by : (name and position, signature)

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 PART 2 – PROCESS of SUPERVISED CHECKS AT RANDOM INTERVALS

Upon receipt of the application, Bureau Veritas will examine the content and give all necessary information
to the applicant:

- Additional documentation relative to the equipment, to be sent/put at disposal to Bureau Veritas.

- Additional information relative to the conditions for the visits and for testing.
- Information relating to the acceptance sampling procedure (4 th paragraph of §4 module A2)

Bureau Veritas will send an agreement to be signed by the applicant covering the monitoring of the final
assessment with the performance supervised checks during unexpected visits.
During such visits, Bureau Veritas will take samples of pressure equipment at the manufacturing or storage
premises in order to conduct checks.

Each intervention will be the subject of a report/record issued by Bureau Veritas.

When the results of checks performed during first unexpected visit, are satisfactory, Bureau Veritas issues to the
applicant, a letter of authorization to affix notified body identification number of Bureau Veritas (0062), for the
batch of products and/or a period of validity.

For the purpose of the monitoring of the final assessment, the following documentation shall be kept available
to Bureau Veritas (ref. §2 of module A2)

TECHNICAL DOCUMENTATION (to be put at disposal)

- Analysis and assessment of the risk(s)

- A general description of the pressure equipment
- Conceptual design and manufacturing drawings and diagrams of components, sub-assemblies, circuits..
- Descriptions and explanations necessary for the understanding of those drawings and diagrams and the
operation of the pressure equipment
- A list of the harmonised, applied in full or in part, and descriptions of the solutions adopted to meet the
essential safety requirements. In the event of partly applied harmonised standards, the technical
documentation shall specify the parts which have been applied
- Results of design calculations made, examinations carried out
- Test reports
- Instruction notice and safety information

MANUFACTURING DOCUMENTATION (to be put at disposal)

- Certificates for the materials, products and components;

- Documentation concerning the traceability requirements for manufacture;
- Records for heat treatment;
- A list of the qualifications of permanent joining operating procedures, and justifications thereof,
- A list of the qualifications of the personnel undertaking the permanent joining of parts, and justifications thereof;
- A list of the personnel in charge of non-destructive testing, and documentation in support of the qualification of
such personnel;
- Inspection reports;
- Reports on destructive testing;
- Reports on non-destructive testing;
- The report on the proof test.

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FOR THE ASSEMBLY, TECHNICAL DOCUMENTATION (to be put at disposal)
- The list of pressure equipment making the assembly (a template can be sent on request)
- EC or EU Declaration of conformity for pressure equipment making the assembly
- Instructions notice of pressure equipment already assessed
- Technical documentation relating to the integration of the pressure equipment concerned
- Technical documentation relating to the protection against exceeding the limits for the whole assembly

PART 3 - OBLIGATIONS AND RESPONSIBILITIES

The applicant shall permanently keep Bureau Veritas informed of the updated production schedule for
the equipment covered by the supervised checks.

The applicant shall keep Bureau Veritas informed of any evolution to the scope of the initial application for
supervised checks.
In such case, Bureau Veritas will assess the impact of such modifications on the process of the supervised
checks and/or the frequency of unexpected visits, and decide on subsequent actions.
Bureau Veritas will give due consideration to:

- the results of the previous unexpected visits which were conducted;

- the knowledge of the means implemented for the final assessment

In case of disagreement on the conclusions issued by Bureau Veritas, the applicant can present an appeal on
a formal manner according to the procedure AQUAP 2012/02.

The applicant shall put at disposal to Bureau Veritas:

- The draft of EU Declaration of Conformity
- The full list (including, if needed, the number of items per model /version) of pressure equipment which
are marked with the BV Notified Body number under the contractual agreement signed by the applicant
and Bureau Veritas.

The applicant must keep and put at disposal of the national authorities:
- The EU Declarations of Conformity
- The relating technical documentation
During a period of ten years after the last pressure equipment has been placed on the market.

The applicant accepts that the relevant information concerning non-conforming equipment and subsequent
actions, be communicated to the Notifying Authority of Bureau Veritas.

Except otherwise agreed upon, all documentation issued by Bureau Veritas will be written in English language.

Bureau Veritas staff will act according to the Bureau Veritas General Conditions of Service.

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 Annex 1 to the application form (Module A2)
(to be filled in by the applicant)

Identification of the equipment covered by the application

SUPPLIES (type) SUPPLIER (Name, address)

SUB-CONTRACTED EQUIPMENT or SUB-CONTRACTOR (Name, address)

PART OF EQUIPMENT

LABORATORIES * IN CHARGE OF NAME AND ADDRESS (for external Laboratory)

PRODUCTION TESTING

* Laboratory in charge of the type testing / production testing (give details on an attached sheet where
necessary: name and address, accreditation, recognition, scope of activities...).

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