U/QS/18 DATE-15/03/2021

Company Name & Address (For Invoicing) PO No.

Certificate in the (Name & Address) GST No.

MOB NO / PHONE NO.

Contact Person Name : + X X
9 1
Date : / / 2023 Request NO: Email ID.

(A) Whether Conformity Statement Required ? Yes No

Error is found within the limit of specified accuracy - if Error ≤ User Specified Accuracy & Out Of Limit - If Error > User Specified Accuracy.
(B) Whether Decision Rule Required ? Yes No
If Error + Measurement Uncertainty ≤ User Specified Accuracy , then Statement of Decision Rule will be PASS.
&If Error + Measurement Uncertainty > User Specified Accuracy , then Statement of Decision Rule will be FAIL.
Method used UCSPL :- Yes No Laboratory has the capability and resources :- Yes No
Customer requested Method :- Yes No NABL scope with CMC given to customer :- Yes No

Before filling instruments deatis please read instruction in Note given at end of this form
SR.NO. INSTRUMENT NAME ID.NO. Manufacture's SR.NO. MAKE RANGE LEAST COUNT ACCURACY CALIBRATION POINTS for LOCATION Calibration Frequency
Thermometers, Temp.sensors & IR (Periodicity)
(Non contact) Gun & RH Indicator

10

11

12

13

14

15

NOTE :
1 If equipments are more ,please attach separate sheet for details covering above information
2 Give CALIBRATION POINTS- for Thermometers,Temp.sensors & IR (Non contact) Gun and RH e.g. PT-100 RANGE 0- 100 Calibration points will be 20,50,90 & this will be as per customer use
This may also usefull for other instruments also
3 Give CALIBRATION POINTS-for stop wach,timer & hour meter AND Test voltage for Insulation /Megger tester
4 If frequency (periodicity) of Calibration is more than 1 year, we will keep calibration due on as blank

Customer Representative Name & Signature : UCSPL Representative Name & Signature :
CALIBRATION POINTS INPUT OF OUTPUT OF
for INSTRUMENT INSTRUMENT
Thermometers,Temp.sensors
& IR (Non contact) Gun and
RH
SR.NO. INSTRUMEN ID.NO. Manufactur MAKE RANGE LEAST ACCURACY CALIBRATION POINTS for Thermometers, Temp.senso
T NAME e's SR.NO. COUNT IR (Non contact) Gun & RH Indicator

10

11

12

13

14

15
N POINTS for Thermometers, Temp.sensors & LOCATION
(Non contact) Gun & RH Indicator
Calibration Frequency (Periodicity)