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QPL Evaluation Form - Incontinent Adult Briefs
QPL Application and Test Report Deadline: April 2, 2009
Completion of this form is required for each product submitted for evaluation to the QPL. Complete the information requested to prevent disqualification of this product.Manufacturer:
Product Type: / BriefsProtective Underwear Other
Product Model #:
Product Part Number or Designation: / Complete a new form for each product submitted, except for size.
Product Sizes Available: / Medium Large Extra Large
Category Submitted: / Super Performance High Performance Standard Performance
Product Type Submitted: / Type 1Type 2
General Construction Requirements – Adult Briefs
Provide a response or test data, as applicable to the following statements.
1. Briefs are provided with breathable side panels that are constructed of apertured film or nonwoven fabric that allow air and water vapor to pass through the material. / YESNO
2. Briefs are provided with only polymer hook type fasteners for the securement of the brief. / YESNO
3. Briefs are provided with tape tab type fasteners for the securement of the brief. / YESNO
4. The briefs are "hourglass" shaped (leg cut-outs in topsheet, backsheet, and core). / YESNO
5. The absorbent core consists of cellulose fiber and/or absorbent polymer, and are contoured (shaped in the crotch area) for good leg fit. / YESNO
6. The backsheet is moisture impervious. / YESNO
7. The topsheet resist the return of moisture to the skin and is constructed of polyethylene, polypropylene or polyester, either in aperture film form or nonwoven fabric form. / YESNO
8. The briefs have elastic leg gathers, each of which consists of at least three (3) strands. / YESNO
9. The briefs are secured by a minimum of four (4) refastenable adhesive tapes or polymer hook type fasteners and are readily unfastened without damage to the brief or to the fastener. / YESNO
10. The briefs are color coded and the product packaging is provided with other affixed coding for convenient identification of size. / YESNO
11. The briefs have a readily visible wetness indicator. / YESNO
12. The briefs contain an odor counteractant or will encapsulate a void to significantly reduce odor. / YESNO
13. Adhesives and glues used in constructing the briefs are water-insoluble, and will form continuous seals at the ends of the absorbent core to minimize leakage. / YESNO
14. The absorbent material does not migrate, compact, clump into a hard mass or separate upon encapsulating a fluid in the brief. / YESNO
15. All materials used in the briefs are safe for clients' skin, and are harmless if ingested in small quantities. / YESNO
16. A minimum of three (3) sizes are offered for this Performance and Type brief (Medium, Large & Extra Large). / YESNO
17. The briefs conform to the requirements of Federal Regulation 16CFR Parts 1609 and 1611 (CS-192-53, CS-191-53) for flammable materials. / YESNO
18. Six samples of each size are provided with this evaluation form. / YESNO
19. The test reports for the Total Absorbent Capacity, Rewet, and ROA tests have been conducted on the current product, model designation, and identical construction to the product submitted. / YES NO
Evaluation Form Continued to Next Page
Form Date: March 5, 2009 /Page 2 of 2
QPL Evaluation Form - Incontinent Adult Briefs20. Indicate the value obtained for the Rewet Test for Briefs in accordance with the test method as described in the Appendix A of the NC Specifications for Adult Incontinent Briefs, #6532- 1L, dated February 24, 2009. / Medium size grams
Large size grams
Extra Large size grams
21. Indicate the value obtained for the Rate of Acquisition Test (ROA) Test for Briefs in accordance with the test method as described in the Appendix A of the NC Specifications for Adult Incontinent Briefs, #6532- 1L, dated February 24, 2009. / Medium size seconds
Large size seconds
Extra Large seconds
22. Indicate the value obtained for the Total Absorbent Capacity in accordance with the test method as described in the ISO Test Method 11948-1:1996. / Medium size grams
Large size grams
Extra Large size grams
23. A copy of the complete test report for the above results is attached to this evaluation form. / YES NO
24.Briefs that utilize reusable one piece tape tab fasteners are certified by the manufacturer to be identical in performance to products tested in compliance with the Shuster Test Method TM-299, Tab Refastenability Test for Briefs with a maximum failure rate of 12.5% for a batch of eight (8) random samples tested. / Manufacturer certifies tape tabs are acceptable based upon testing.
25. Briefs submitted which are made by a manufacturer to be distributed under different brand names (“private label” products) may not need to be retested under for each brand name if an officer of the company (the original manufacturer), lists all such products by name and product code, signs and attests that the products are identical in manufacture, construction and performance. Any differences between the original and the rebranded product shall be identified and explained. Acceptance of the original test reports or request for supplemental testing will be determined based upon a review of the products and the information supplied. Authorization shall also be provided by a signature of an officer of the company (the original manufacturer), that the company providing the rebranded product is authorized to use any data acquired on the product by the original manufacturer. / No, this is not a rebranded product.
Yes, the product submitted is a rebranded product. Compliance of rebranded products with this requirement will be determined by review of the documentation and certification by the original manufacturer is provided with this QPL submittal.
26. All briefs offered are tested by an independent third party laboratory, and are compliant with all the product requirements in accordance with the NC Specification No. 6532-1L, dated February 24, 2009. / YES NO
As an officer of this company, I affirm that the information and data provided in the above statements are accurate, truthful, and consistent with internal test data obtained from the current production of the product submitted for the QPL evaluation, to the best of my knowledge.
Signature of an Officer of Manufacturer:
Print Name from the above signature:
Title of Signer:
Date:
All submittals may be subject to review by an advisory committee of experienced professionals working with patients having various levels of incontinence. The committee, at its discretion, may recommend rejection of any product that is deemed not acceptable.