Annex for Gates Gold or Gates Silver DHF TS 011 approval

Please complete and return this Annex with the Application Form

Annex for Gates Gold or Gates Silver
DHF TS 011 approval / Annex N
1Name of applicant company
2DHF membership
2.1Are you a member of the Door and Hardware Federation?
If yes, please state your membership number / SelectYesNo
3Scheme- Please select the scheme you are applying for / SelectGates SilverGates Gold
4Management
Please list the management responsible for powered gates and barrier systems
4.1Senior Qualifying Manager(s) / Experience (years)
4.2Qualifying Manager(s) / Experience (years)
Note:All managers listed in section 4.1 and 4.2 should complete a Personal Data (NSF 450) Form
4.3Nominated Designer(s) / Experience (years)
Note:Nominated Designers listed in section 4.3 should complete a Competency Form (GSF 452)
5Level of trading
5.1How many powered gates and barrier systems have you installed?
Please indicate how many of these systems you consider meet the requirements of DHF TS 011
Type of system / Total installed / Installed during last 12 months / On maintenance contracts / Compliant to DHF TS 011
5.1.1Sliding Gates
5.1.2Swing Gates
5.1.3Folding Gates
5.1.4Barriers
6Staff
6.1How does your training plan meet the training and competency requirements of DHF TS 011?
6.2Which processes do you subcontract out?
7Documentation
7.1Confirm that you have read and understood the current NSI Regulations and Approval Criteria. / SelectYesNo
7.2Do you have access to all necessary Standards and Codes of Practice relating to your approval and scope of activity? / SelectYesNoN/A
7.3Confirm the following documentation (where relevant) is retained and will be available to audit during application visits.
Please do not send specimen copies
Technical files / SelectYesNo
Site survey and site plans / SelectYesNo
Risk assessments / SelectYesNo
Design proposals / SelectYesNo
Commissioning sheets / SelectYesNo
Handover sheets / SelectYesNo
Preventive and reactive maintenance records / SelectYesNo
Modification records / SelectYesNo
Isolation records / SelectYesNo
Records of Safety Notices issued / SelectYesNo
Records of non-conforming equipment/corrective actions / SelectYesNo
Training Matrix / records / SelectYesNo
8Quality Management System documentation (Gates Gold) or Business Operating Manual and Procedures (Gates Silver)
8.1Gates Gold applicants only
Do you have a Quality Management System designed to comply with
BS EN ISO 9001 & NSI Quality Schedule GBQS301?
Note: Please ensure any QMS documentation has been issued and the QMS implemented prior to the initial certification audit. / SelectYesNoN/A
8.2Gates Silver applicants only
Have you read and understood the Management and Technical Requirements document?
Do you have a Business Operating Manual (“BOM”)? / SelectYesNoN/A
SelectYesNoN/A
8.3Please confirm that a copy will be available at your premises during the audit. / SelectYesNo
9Branches
Give details of all branches to be included in this application for approval (please do not list the head office quoted on the main application form)
Premises (see Guidelines -Gates Gold and Gates Silver Approval Criteria)
Address incl postcode
Telephone number / Fax number
Email address
Address incl postcode
Telephone number / Fax number
Email address
Address incl postcode
Telephone number / Fax number
Email address
Address incl postcode
Telephone number / Fax number
Email address
Address incl postcode
Telephone number / Fax number
Email address
Address incl postcode
Telephone number / Fax number
Email address
Address incl postcode
Telephone number / Fax number
Email address
If more branches, please provide a separate list.
DECLARATION
We agree that our application is for NSI approval for Gates Gold or Gates Silver.
We understand and accept that in the context of the NSI approval schemes, the term ‘Powered Gates and Barriers’ means gate and barrier systems in full compliance with the DHF TS 011 Code of Practice and NSI standards. An NSI Certificate of Compliance must be issued in respect of each installation coming into operation on or after the date on which NSI approval is awarded to us / SelectYesN/A
To be signed by the proprietor – or all partners in the partnership – or a director authorised to sign on behalf of the limited company.
Signature / Print name / Date
/ Click here to enter a date. /
/ Click here to enter a date. /
/ Click here to enter a date. /

Thank you for completing this form

Please use the checklist on the following page

Please submit this form by email to:

Gates Gold / Gates Silver application checklist
Please submit these documents with your application
Submitted
Completed Application Form or Short Application Form for existing NSI approved companies
Completed Annex Form N
Application Fee -Please ask NSI for a quotation
The following documents are required for new applications only (not normally required when extending the scope of an existing approval however NSI reserves the right to request additional data at any time)
Finance
Limited companies and Plc’s: NSI reserves the right to request up to date accounts during the application process.
If you are a Sole trader or partnership, please submit a full set of properly prepared accounts (to include Profit and Loss and Balance Sheet) for the last 3 years (which would cover a 4 year period by showing comparative figures). If you have traded for less than 4 years:
  • For Gold applications a minimum of 2 years accounts should be submitted.
  • For Silver applications a minimum of 1 years accounts and one year projected figures to include profit & loss and balance sheet or for new companies 2 year business plan to include profit & loss and balance sheet; a letter of comfort is optional.
Note: A model business plan, with notes is available through NSI Support Services Ltd upon request.
Personal Data Forms
For Directors, Partners, Sole Traders, Shareholders (with 10% or more of the shares), Senior Qualifying Managers, Qualifying Managers and Systems Performance Managers (see section 4).
Note: If your company is Stock Exchange listed (or is a subsidiary of a Stock Exchange listed company), ask the NSI office for details of which individuals need to fill in these forms.
Gates Competency Form (GSF 452)
For Nominated Designers
Quality Systems Documentation – Gates Gold applications only
Quality manual, procedures and engineering instructions complying with BSEN ISO 9001 and NSI Quality Schedule GBQS301.
Please ensure the following QMS Documentation is available at the time of audit:
  • Documented Quality Manual (for ISO 9001:2008)
  • Process Descriptions/flowcharts;
  • Mandatory and any additional procedures;
  • Any other relevant documentation such as; working instructions, example forms, quality records, engineer’s worksheets, document control records etc.

NSF 200.1 Annex N CONFIDENTIAL WHEN COMPLETEDPage 1 of 5

Sept 2016

© NSI 2016