Type of Audit (please tick)
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COMPANY/BUSINESS NAME:
TRADING NAME:
ACN/ABN :
BUSINESS ADDRESS:
(Please List all offices to be included in this application)
POSTAL ADDRESS:
E-MAIL ADDRESS:
PHONE NO:
CONTACT OFFICER:
(Dr, Mr, Mrs, Ms etc.)
AUTHORISED:
P/CODE:
P/CODE:
(Please Print)
WEBSITE:
FAX NO:
POSITION:
DATE :
(Signature)
Does your quality management system address the requirements of
AS/NZS ISO 9001:2008?
Is your quality management system currently certified or has certification been planned?
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YES
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NO
(Tick relevant box as applicable)
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YES
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NO
(Tick relevant box as applicable)
If yes, by whom and when? (Please include Certificate No., if applicable).
How long has your quality management system been in operation?
Have internal quality audits been conducted on all elements of your QMS?
(It is essential that internal quality audits have been carried out on the whole system at least once prior to the audit by a Queensland Government Auditor).
If yes, when was the last internal audit conducted?
When was the last Management Review performed?
What is the size of the organisation (i.e. number of staff/employees)?
State the scope of services and/or products provided by your organisation.
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YES
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NO
(Tick relevant box as applicable)
Upon completion of Section 1, the Supplier should forward this form (2 pages) to a Queensland Government customer Department/Agency to complete Section 2. On completion of Section 2 the form will be returned to the Supplier for their information. The Supplier should then forward the completed form to:
Queensland Government Chief Procurement Office, GPO Box 123, Brisbane Qld 4001
Ph: 07 3235 4333 / Fax: 07 3224 7921
If the goods or services have been assessed as High Risk or Moderate Risk, arrangements will be made for a QMS audit. If the goods or services are assessed as Low Risk, the supplier may apply for registration under the
heading of Self Assessed.
Issue Date: 03/02/2012 Request for Quality Management System Audit - General Page 1 of 2

DEPARTMENT/AGENCY:
BRANCH:
POSTAL ADDRESS:
E-MAIL ADDRESS:
P/CODE
CONTACT OFFICER: PHONE: FAX:
(Dr, Mr, Mrs, Ms etc.) (Please Print)
The Department/Agency has conducted a risk analysis on the goods and/or services to be supplied to the Queensland
Government. The goods and/or services to be supplied are: (Tick relevant box as applicable)
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HIGH RISK *
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MODERATE RISK *
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LOW RISK
(Quality system audit required) (Evaluation of selected elements required) (Quality system audit not required)
* The cost of the quality management system audit is borne by the requesting Department/Agency.
The fee charged for a standard audit is $1320 (inc GST), plus travel and accommodation at cost, where incurred.
Is the audit necessary for contract award/tender consideration? (Tick relevant box)
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YES
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NO
Results of audit will be required by ……………………………………………………………………… (ASAP is not acceptable)
(For URGENT audits allow approximately 15 working days upon receipt of this form by Queensland Government Chief Procurement Office).
I authorise the Department/Agency to pay the cost of the audit. The fee charged for a standard audit is $1200 plus travel and accommodation at cost, if incurred.
DATE:
AUTHORISED:
(Print Name & Sign)
Before returning this form to the supplier, please ensure that all questions in Sections 1 and 2 are completed.
Incomplete or unauthorised applications will delay the audit process.
If you have any questions regarding the QA Policy requirements, please call the QA Hotline on 1800 628 901.
All sections of this form are verified as complete and application is accepted for audit.
AUTHORISED: DATE:
(Manager, Procurement Services)
RECORDED ON DATA BASE:
(Project Officer)
FILE NUMBER:
IDENTIFICATION CODE:
DATE:
REGIONAL NETWORK COORDINATOR:
ALLOCATED AUDITOR:
Privacy Statement
The Principal is collecting Personal Information on this form from the applicant for the purpose of responding to your request for Quality Management System audit. This Personal Information may be disclosed on the Queensland
Government Register of Quality Assured Suppliers which is publicly available at: http://www.qgm.qld.gov.au
Aside from the Queensland Government Register of Quality Assured Suppliers, your personal information will not be disclosed to any other third parties without your consent unless authorised or required by law.
Issue Date: 03/02/2012 Request for Quality Management System Audit - General Page 2 of 2