APPLICATION FORM
Recognition as a Queensland Government Self-Assessed
Quality Assured Supplier - AS/NZS ISO 9001:2008
This application is for suppliers to the Queensland Government who wish to gain recognition of their
quality management system based on self-assessment.
A Self-Assessed quality management system is defined as a fully implemented quality management
system of all applicable elements of a quality management system standard and verified by the
supplier as conforming to all requirements.
Your application will be reviewed by Queensland Government Chief Procurement Office (QGCPO). If
successful, your organisation will be listed in the Queensland Government Register of Quality Assured
Suppliers and issued with a Letter of Recognition - Self Assessed Quality Assured Supplier.
PART 1: SUPPLIER QUALITY MANAGEMENT SYSTEM DETAILS
COMPANY/BUSINESS NAME:
TRADING NAME:
ACN/ABN :
BUSINESS ADDRESS:
(List all offices to be included in
this application)
P/CODE:
POSTAL ADDRESS:
P/CODE:
E-MAIL ADDRESS:
WEBSITE:
PHONE NO:
FAX NO:
CONTACT OFFICER:
(Dr, Mr, Mrs, Ms etc.)
POSITION:
(Please Print)
AUTHORISED:
DATE :
(Signature)

Does your quality management system address the requirements of AS/NZS ISO 9001:2008?

YES
 NO
(Tick relevant box as applicable)
How long has your quality management system been in operation?
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.
QGCPO use only
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: 18/02/2010
SA Application Form
NOT / APPROVED
/
/
Assessor Signature
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PART 2: SELF ASSESSMENT REQUIREMENTS
Please tick () the relevant box below
1.
This organisation has a documented and maintained quality
management system consisting of a quality manual which includes or
makes reference to quality systems procedures.
Do not send a copy.
 
2.
This organisation has a documented Quality Policy statement in
accordance with Element 5.3 (Quality Policy) of AS/NZS ISO 9001:2008.
 

Please enclose a copy.
 

3.
1.
YES
 NO
Date/Issue/Revision
of current
quality manual __________________
YES
NO
**Is a copy enclosed as requested?
YES
NO
This organisation has completed planned internal audits in accordance
with Element 8.2.2 (Internal Audit) of AS/NZS ISO 9001:2008 to ensure
compliance with the selected Australian Standard and operating
procedures.
 
Please enclose copies of internal audit records for the last 12 months,
viz:
**Are copies enclosed as requested?
(a) evidence of audit planning (e.g. schedule of audit)
(b) audit checklist or similar document
(c) audit report or summary of audit result
(d) non-conformance records* raised as a result of the internal audit
process
YES










YES




YES

YES
YES
YES
NO
NO
NO
NO
NO
* Please note that the copies of the non-conformance records
required are for the non-conformances found during the actual
internal audit process and not those found during the normal course
of the work.
4.
This organisation has conducted a Management Review in accordance
with Element 5.6 of AS/NZS ISO 9001: 2008 to ensure the continuing
suitability and effectiveness in satisfying the requirements of the
Standard and our quality policy and objectives.
Please enclose a copy of your most recent (in the last 12 months)
Management Review minutes and/or records.
 


NO
**Is a copy enclosed as requested?
 
YES

NO
Before submitting this application, please ensure that all details are completed.
**Please note that any box above that is ticked “No” may result in the application being delayed or rejected.
I declare that the information provided on this form, and its enclosures comply with the requirements of AS/NZS ISO
9001:2008, are true and correct and acknowledge that any of the information may be subject to a review by the
Queensland Government.
AUTHORISED:
DATE:
(Senior Management Signature)
If you have any questions regarding the Queensland Government QA Policy requirements, please call the
QA Hotline on 1800 628 901.
Please return this application form with the requested enclosures to:
QUEENSLAND GOVERNMENT CHIEF PROCUREMENT OFFICE
Level 15, Mineral House, 41 George Street, Brisbane Qld 4000
GPO Box 123, Brisbane Qld 4001
Tel: 07 3235 4333
Fax: 07 3224 7921
QGCPO Use Only:
All sections of this form are verified as complete and application is accepted for Self Assessed Registration.
IDENTIFICATION CODE:
RECORDED:
DATE:
(Signature)
Issue Date: 18/02/2010
SA Application Form
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