UL DQS Inc.

UKAS Accredited Industry Auditor Competency Form

Name:

Regional Office:

Industry/Service Area of Competency Requested:

IAF Code:

SIC Code:

Class Risk:

(Note: If Class 1 Low Risk, then complete only Section 1 General Experience and Education Required. If Class 2 Medium Risk, then complete all sections of form. If Class 3 High Risk, then complete all sections and additionally an interview is required to determine competency of key characteristics for industry/service.)

1.  Education or related coursework:

2.  Key Characteristics for Industry/Service (i.e. regulations, terminology, industry needs, and industry objectives):

a.

b.

c.

d.

e.

3.  Key Characteristics for Processes or Core Tools (i.e. control plans, controlled environment, APQP):

a.

b.

c.

d.

e.

4.  Justification (please check all applicable):

Direct Experience [see para. 5.2.2.2 of Q-1807-4]

Related Experience [see para. 5.2.2.2 of Q-1807-4]

Audit Experience [see para. 5.2.2.3 of Q-1807-4] (Can not qualify by Audit Experience only)

Regulatory Experience [see para. 5.2.2.5 of Q-1807-4]

5.  Qualification Experience:

Industry/Service Area / Company/Org where experience was obtained /

Position (Title/Function)

/ Length of time in position / Time spent in the position relative to the SIC’S requested
a.
b.
c.
d.
e.

6.  Process Experience:

In order to qualify for a certain industry/service, the auditor must be knowledgeable of the processes (e.g. product, service, etc.) industry jargon, equipment, applicable standards, typical practices, and quality tools in the requested industry/service. Please provide a detailed account of the process(es) in which you have demonstrated competence. Please include company or organization’s name, job function, years in position, and why you feel that this would be applicable. (Please include any applicable interview documentation to support this area as necessary.)

7.  Regulatory Experience: (If applicable)

Regulatory experience in the category:

If the requested industry/service is highly regulated, or if there are significant regulatory requirements, which apply to the industry/service, please describe the applicable regulatory requirements. Include the source of your knowledge of these requirements (e.g. industry experience, education):

8.  Qualification supported by Audit Experience: (Can not qualify by Audit Experience only)

A. Number of audits performed / Number audit days:

With UL:

With another organization:

B. Industries/services related to audits conducted:

(please list related industries/service areas, along with an associated description; attach an additional sheet if more space is necessary)

a.

b.

c.

d.

e.

C.  Please add any comments relevant to the audit experiences listed above. Various forms of validation of competency (i.e. interview) should be considered depending on the level of complexity and regulations:

MANAGEMENT DECISION

1.  Comments / Additional Information Required (document interview if applicable):

2.  Based upon the information presented within this document and the competency evaluation completed, list all approved IAF and/or SIC codes:

3. MSS Audit Management

Check one:

Approved Not Approved Pending (provide comments above)

Signed:

Date:

4. MSS Certification Management: Defined as a VP of Certification, Director of Audit Management, or designee. (For Class Risk 3 only)

Check one:

Approved Not Approved Pending (provide comments above)

Signed:

Date:

QF-1807-1 Issued: 12/4/08