Certificate # Pending
Proposed Scope of Accreditation
For
Laboratory Name
Laboratory Address
Laboratory Contact
Laboratory Phone
In recognition of a successful assessment to ISO/IEC 17025:2005 to the following Calibration and
Measurement Capabilities, accreditation has been granted to “Laboratory Name” for the following:
Accreditation Granted Through: “DATE”
When filling in the tables (applicable to you) below, please refer to
1. Instruction Guidelines for Proposed Scope of Accreditations – Testing (L-A-B Form 28.9)
2. Instruction Guidelines for Proposed Scope of Accreditations – Calibration (L-A-B Form 28.10)
3. Instruction Guidelines for Proposed Scope of Accreditations – Dimensional Measurement (L-A-B Form 28.11)
If one of the tables is NOT applicable to your services, either:
1. Leave all entry locations blank
2. Delete table from template
When filling in the table below, please refer to Instruction Guidelines for Proposed Scope of
Accreditations – Calibration (L-A-B Form 28.10). If you have any additional questions please contact the
L-A-B office.
Calibration
Acoustics, Ultrasound, and Vibration – Acceleration
Calibration
Range
Expanded Uncertainty of
Parameter/Equipment
Measurement (+/-)
Remarks
Acoustics, Ultrasound, and Vibration – Vibration
Calibration
Range
Expanded Uncertainty of
Parameter/Equipment
Measurement (+/-)
Remarks
Acoustics, Ultrasound, and Vibration – Acoustic Impedance
Calibration
Range
Expanded Uncertainty of
Parameter/Equipment
Measurement (+/-)
Remarks
Form 28.13 - Rev 6 – 3/1/14
Page 1 of 9
Certificate # Pending
Acoustics, Ultrasound, and Vibration – Sound Pressure Level
Calibration
Range
Expanded Uncertainty of
Parameter/Equipment
Measurement (+/-)
Remarks
Amount of Substance – Chemical
Calibration
Range
Parameter/Equipment
Expanded Uncertainty of
Measurement (+/-)
Remarks
Amount of Substance – Gas
Calibration
Parameter/Equipment
Expanded Uncertainty of
Measurement (+/-)
Remarks
Amount of Substance – Particulate
Calibration
Range
Parameter/Equipment
Expanded Uncertainty of
Measurement (+/-)
Remarks
Amount of Substance – pH/Conductivity
Calibration
Range
Parameter/Equipment
Expanded Uncertainty of
Measurement (+/-)
Remarks
Amount of Substance – Refractive Index
Calibration
Range
Parameter/Equipment
Expanded Uncertainty of
Measurement (+/-)
Remarks
Electrical – Capacitance
Calibration
Parameter/Equipment
Range
Expanded Uncertainty of
Measurement (+/-)
Remarks
Electrical – Current
Calibration
Parameter/Equipment
Range
Expanded Uncertainty of
Measurement (+/-)
Remarks
Form 28.13 - Rev 6 – 3/1/14
Range
Page 2 of 9
Certificate # Pending
Electrical – Impedance
Calibration
Parameter/Equipment
Range
Expanded Uncertainty of
Measurement (+/-)
Remarks
Electrical – Inductance
Calibration
Parameter/Equipment
Range
Expanded Uncertainty of
Measurement (+/-)
Remarks
Electrical – Magnetic Properties
Calibration
Range
Parameter/Equipment
Expanded Uncertainty of
Measurement (+/-)
Remarks
Electrical – Power
Calibration
Parameter/Equipment
Range
Expanded Uncertainty of
Measurement (+/-)
Remarks
Electrical – Resistance
Calibration
Parameter/Equipment
Range
Expanded Uncertainty of
Measurement (+/-)
Remarks
Electrical – RF Attenuation
Calibration
Parameter/Equipment
Range
Expanded Uncertainty of
Measurement (+/-)
Remarks
Electrical – RF Power
Calibration
Parameter/Equipment
Range
Expanded Uncertainty of
Measurement (+/-)
Remarks
Electrical – Voltage
Calibration
Parameter/Equipment
Range
Expanded Uncertainty of
Measurement (+/-)
Remarks
Form 28.13 - Rev 6 – 3/1/14
Page 3 of 9
Certificate # Pending
Ionizing Radiation – Dosimetry
Calibration
Range
Parameter/Equipment
Expanded Uncertainty of
Measurement (+/-)
Remarks
Ionizing Radiation – Radioactivity
Calibration
Range
Parameter/Equipment
Expanded Uncertainty of
Measurement (+/-)
Remarks
Ionizing Radiation – Neutron Measurements
Calibration
Range
Parameter/Equipment
Expanded Uncertainty of
Measurement (+/-)
Remarks
Length – Artifacts and Standards 1D
Calibration
Range
Parameter/Equipment
Expanded Uncertainty of
Measurement (+/-)
Remarks
Length – Artifacts and Standards 2D
Calibration
Range
Parameter/Equipment
Expanded Uncertainty of
Measurement (+/-)
Remarks
Length – Artifacts and Standards 3D
Calibration
Range
Parameter/Equipment
Expanded Uncertainty of
Measurement (+/-)
Remarks
Length – Hand Tools and Precision Gages 1D
Calibration
Range
Parameter/Equipment
Expanded Uncertainty of
Measurement (+/-)
Remarks
Length – Hand Tools and Precision Gages 2D
Calibration
Range
Parameter/Equipment
Expanded Uncertainty of
Measurement (+/-)
Remarks
Length – Hand Tools and Precision Gages 3D
Calibration
Range
Parameter/Equipment
Expanded Uncertainty of
Measurement (+/-)
Remarks
Form 28.13 - Rev 6 – 3/1/14
Page 4 of 9
Certificate # Pending
Length – Other
Calibration
Parameter/Equipment
Range
Expanded Uncertainty of
Measurement (+/-)
Remarks
Mass – Density
Calibration
Parameter/Equipment
Range
Expanded Uncertainty of
Measurement (+/-)
Remarks
Mass – Flow
Calibration
Parameter/Equipment
Range
Expanded Uncertainty of
Measurement (+/-)
Remarks
Mass – Force
Calibration
Parameter/Equipment
Range
Expanded Uncertainty of
Measurement (+/-)
Remarks
Mass – Hardness
Calibration
Parameter/Equipment
Range
Expanded Uncertainty of
Measurement (+/-)
Remarks
Mass – Mass Artifacts
Calibration
Parameter/Equipment
Range
Expanded Uncertainty of
Measurement (+/-)
Remarks
Mass – Pressure/Low Vacuum
Calibration
Range
Parameter/Equipment
Expanded Uncertainty of
Measurement (+/-)
Remarks
Mass – Medium/High Vacuum
Calibration
Range
Parameter/Equipment
Expanded Uncertainty of
Measurement (+/-)
Remarks
Form 28.13 - Rev 6 – 3/1/14
Page 5 of 9
Certificate # Pending
Mass – Scale and Balances
Calibration
Parameter/Equipment
Range
Expanded Uncertainty of
Measurement (+/-)
Remarks
Mass – Torque
Calibration
Parameter/Equipment
Range
Expanded Uncertainty of
Measurement (+/-)
Remarks
Mass – Viscosity
Calibration
Parameter/Equipment
Range
Expanded Uncertainty of
Measurement (+/-)
Remarks
Mass – Volume
Calibration
Parameter/Equipment
Range
Expanded Uncertainty of
Measurement (+/-)
Remarks
Photometry and Radiometry – Photometric Sources
Calibration
Range
Expanded Uncertainty of
Parameter/Equipment
Measurement (+/-)
Remarks
Photometry and Radiometry – Properties of Detectors
Calibration
Range
Expanded Uncertainty of
Parameter/Equipment
Measurement (+/-)
Remarks
Photometry and Radiometry - Spectral Emission Properties of Sources
Calibration
Range
Expanded Uncertainty of
Parameter/Equipment
Measurement (+/-)
Remarks
Photometry and Radiometry – Spectrally-Integrated Measurements for Sources and Detectors
Calibration
Range
Expanded Uncertainty of
Remarks
Parameter/Equipment
Measurement (+/-)
Photometry and Radiometry – Properties of Materials
Calibration
Range
Expanded Uncertainty of
Parameter/Equipment
Measurement (+/-)
Form 28.13 - Rev 6 – 3/1/14
Remarks
Page 6 of 9
Certificate # Pending
Photometry and Radiometry – Color and Spectrally-Integrated Measurements of Materials
Calibration
Range
Expanded Uncertainty of
Remarks
Parameter/Equipment
Measurement (+/-)
Thermodynamic – Infrared (IR) Temperature
Calibration
Range
Parameter/Equipment
Expanded Uncertainty of
Measurement (+/-)
Remarks
Thermodynamic – Humidity
Calibration
Parameter/Equipment
Expanded Uncertainty of
Measurement (+/-)
Remarks
Thermodynamic – Thermometers and Probes
Calibration
Range
Parameter/Equipment
Expanded Uncertainty of
Measurement (+/-)
Remarks
Thermodynamic – Thermodynamic Sources
Calibration
Range
Parameter/Equipment
Expanded Uncertainty of
Measurement (+/-)
Remarks
Time and Frequency – Time Scale Difference
Calibration
Range
Parameter/Equipment
Expanded Uncertainty of
Measurement (+/-)
Remarks
Time and Frequency – Frequency / Period
Calibration
Range
Parameter/Equipment
Expanded Uncertainty of
Measurement (+/-)
Remarks
Time and Frequency – Modulation
Calibration
Range
Parameter/Equipment
Expanded Uncertainty of
Measurement (+/-)
Remarks
Form 28.13 - Rev 6 – 3/1/14
Range
Page 7 of 9
Certificate # Pending
Time and Frequency – Oscilloscopes
Calibration
Range
Parameter/Equipment
Expanded Uncertainty of
Measurement (+/-)
Remarks
When filling in the table below, please refer to Instruction Guidelines Proposed Scope of Accreditation–
Testing (L-A-B Form 28.9). The text contained in the table must comply with L-A-B instructions 28.9. If
you have any additional questions please contact the L-A-B office.
Testing
Testing – Major Field
Technology
Range, when
necessary
Methods Used
Product Types
Remarks
When filling in the table, please refer to Instruction Guidelines for Proposed Scope of Accreditations –
Dimensional Measurement (L-A-B form 28.11). The text contained in the table must comply with L-A-B
instructions 28.11. If you have any additional questions please contact the L-A-B office.
Dimensional Measurement
Length - Dimensional Measurement 1D
Inspection
Range
Parameter
Expanded Uncertainty of
Measurement (+/-)
Remarks
Length - Dimensional Measurement 2D
Inspection
Range
Parameter
Expanded Uncertainty of
Measurement (+/-)
Remarks
Length - Dimensional Measurement 3D
Inspection
Range
Parameter
Expanded Uncertainty of
Measurement (+/-)
Remarks
Form 28.13 - Rev 6 – 3/1/14
Page 8 of 9
Certificate # Pending
Calibration and Measurement Capability (CMC) is expressed in terms of the measurement parameter, measurement range,
expanded uncertainty of measurement and remarks. The expanded uncertainty of measurement is expressed as the standard
uncertainty of the measurement multiplied by a coverage factor of 2 (k=2), corresponding to a confidence level of
approximately 95%.
Notes:
1) Laboratory offers calibration services at the laboratory's own facilities and at the client or other agreed upon facilities.
Client Approval___________________________________________
Date_____________
Assessor Approval_________________________________________
Date_____________
Form 28.13 - Rev 6 – 3/1/14
Page 9 of 9