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RFQ – Hazloc

Applicants Information
Company Name
Website
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Contact Name
Title
Email
Phone
Manufacturing Information
If different than Applicant Information
Company
Website
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Contact Name
Title
Email
Phone
Product Information
Product’s description and intended use/application
Type of Equipment
Model
Brief Description (electrical or not)
Overall Dimensions: Width
Overall Dimensions: Length
Overall Dimensions: Height
Uncrated Weight (kg)
Marks Requested
Approval Process
- IECEx
- ATEX
- Canada & USA (cLCus Mark)
- Canada (cLC Mark)
- USA (LCus Mark)
- Other Mark
Other Mark - Please Describe
Electrical Ratings
Voltage
Phases
Current
Frequency
Hazardous Location Rating
Equipment Group
- Group I (mining)
- Group II (non-mining)
Hazardous Zone Ratings (Zone Markings)
Zones for Gas
- Zone 0
- Zone 1
- Zone 2
Gas Protection Method
- ia
- ib
- ic
- nA
- nC
- nR
- ma
- mb
- mc
- da
- db
- dc
- e
- o
- Other
Please specify other
Gas Group
- I
- IIA
- IIB
- IIC
- IIB+H2
Zones for Dust
- Zone 20
- Zone 21
- Zone 22
Dust Protection Method
- iaD
- ibD
- ta
- tb
- tD
- ma
- mb
- mc
- Other
Please specify other
Dust Group
- IIIA
- IIIB
- IIIC
Temperature Classification
- T1
- T2
- T3
- T4
- T5
- T6
Ambient Temperature
Hazardous Zone Ratings (Division Markings)
North American Hazardous Ratings
- Class I
- (Group A
- Group B
- Group C
- Group D)
- Class II
- (Group E
- Group F
- Group G)
- Division 1
- Division 2
Objective – Indicate applicable standards, if known
Quality System
ISO 9001 Certified
Please upload a copy of your certificate
QAR Currently Held
Please provide your QAR Report Number
List of Certified Products
Describe subcontract work
Requirement
- Initial Application
- Re-Certification
- Transfer
Quality Module certificates are subject to periodic surveillance audits. According to IECEx rules, the surveillance audit frequency is every 12 months for Non-ISO 9001 registered companies and every 18 months for ISO 9001 registered companies. The QAR certificate is valid for 3 years. LabTest reserves the right to carry out audits at any time without notice.
Name
Date
To help us provide you with an accurate and quick proposal, provide as many of the following as possible
Product schematics • Product brochure • Operating manual • Wiring diagram • Previous test data & reports • Target completion date • Block diagram • Electrical rating • Operating frequency • Test budget • Installation manual • Product photograph(s)
File
File
File
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