申请书401CH正文改

安全生产检测检验机构资质申请书/r/n/r/n/r/n/r/nAQJY401/r/nCH/r/n:20/r/n12/r/n/r/n/r/n20/r/n12/r/n年/r/n5/r/n月/r/n1/r/n日/r/n施行/r/n/r/n/r/n/r/n第/r/nPAGE/r/n7/r/n页共/r/nNUMPAGES/r/n7/r/n页/r/n/r/n安全生产检测检验机构资质申请/r/n书/r/n/r/n/r/n/r/n/r/n/r/n/r/n/r/nAQJY401/r/nCH/r/n:20/r/n12/r/n/r/n/r/n20/r/n12/r/n年/r/n5/r/n月/r/n1/r/n日/r/n施行/r/n/r/n第/r/n/r/nPAGE/r/n1/r/n/r/n页共/r/n/r/nNUMPAGES/r/n7/r/n/r/n页/r/n/r/n安全生产检测检验机构资质/r/n申请书/r/n（初次换证）/r/n申请机构：/r/n/r/n申请级别：/r/n/r/n/r/n/r/n□/r/n甲级/r/n/r/n/r/n□/r/n乙级/r/n/r/n/r/n/r/n填表/r/n日期：/r/n/r/n国家安全生产监督管理总局制/r/n说/r/n/r/n明/r/n1./r/n本申/r/n/r/n2/r/n./r/n本申请书/r/n纸质文本/r/n一式/r/n三/r/n份，签名之处由签名人签字/r/n，要字迹清楚/r/n。/r/n3/r/n./r/n本申请书须经申请机构法定代表人签名、申请机构盖章/r/n方为/r/n有效。/r/n4/r/n./r/n技术/r/n服务机构/r/n通讯信息：/r/n名称：/r/n国家/r/n安全生产检测技术/r/n中心/r/n联系地址：北京市朝阳区/r/n北苑路32号甲1/r/n号/r/n楼/r/n安全大厦/r/n邮政编码：/r/n1000/r/n1/r/n2/r/n电话：010-/r/n84911714/r/n、/r/n84911340、84911021、84911847/r/n传真r/n电子信箱：/r/ngjajzx/r/n@/r/ngmail/r/n.c/r/nom/r/n

/r/n一、申请机构概况/r/n名称/r/n地址/r/n邮政编码/r/n传真电话/r/n电子信箱/r/n网址/r/n联系人/r/n职务/r/n固定电话/r/n移动电话/r/n主持工作负责人/r/n职务/r/n固定电话/r/n移动电话/r/n法定代表人/r/n职务/r/n固定电话/r/n移动电话/r/n主管单位/r/n（部门）/r/n名称/r/n法人单位名称/r/n及地址/r/n法人/r/n营业/r/n执照(证书)/r/n/r/n编号/r/n注册资金/r/n（万元）/r/n初次获得安全生产检测检验机构资质证书号及获得日期/r/n二、申请类型及证书状况/r/n£/r/n初次/r/n£/r/n换证（原证书号：/r/n /r/n有效期至：/r/n/r/n）/r/n/r/n合并：/r/n£/r/n增项/r/n£/r/n变更/r/n三、申请机构基本信息/r/n设备设施特点：/r/n£/r/n固定/r/n£/r/n离开固定设施的现场/r/n£/r/n临时/r/n£/r/n可移动/r/n参加/r/n检测/r/n能力/r/n考核/r/n活动/r/n情况：/r/n最近3/r/n年内参加/r/n检测/r/n能力/r/n考核/r/n项目/r/n共/r/n/r/n项/r/n。/r/n人员及设备设施：/r/n申请机构/r/n始建于/r/n/r/n年，现有在编人员/r/n/r/n名，其中专业技术人员/r/n/r/n名（高级职称/r/n/r/n名，中级职称/r/n/r/n名）/r/n，注册安全工程师/r/n/r/n名/r/n，/r/n仪器设备/r/n/r/n台（套）/r/n，设施/r/n/r/n台（套）/r/n，/r/n仪器设备设施原值/r/n/r/n万元。/r/n业务用房面积/r/n/r/n平方米，固定资产总额/r/n/r/n万元。/r/n从事与安全生产相关的检测检验工作经历/r/n（仅初次申请时）/r/n：/r/n管理体系初始运行时间/r/n及最新版本管理体系实施日期/r/n的说明/r/n：/r/n本次/r/n申请的/r/n技术能力：/r/n申请的检测检验领域/r/n：/r/n£/r/n防爆设备/r/n£/r/n电动机/r/n£/r/n变压器/r/n£/r/n电器/r/n£/r/n仪器仪表/r/n£/r/n监控系统/r/n£/r/n通风设备/r/n£/r/n提升设备/r/n£/r/n防坠器/r/n£/r/n钢丝绳/r/n£/r/n排水设备/r/n£/r/n压风设备/r/n£/r/n运输设备/r/n£/r/n勘探/r/n开发/r/n设备/r/n£/r/n储运设施/r/n£/r/n井巷设备/r/n£/r/n支护设备/r/n£/r/n采掘设备/r/n£/r/n非金属制品/r/n£/r/n金属制品/r/n£/r/n电缆/r/n£/r/n救护器材/r/n£/r/n煤尘爆炸性/r/n£/r/n煤自/r/n燃/r/n倾向性/r/n£/r/n煤与瓦斯突出危险性/r/n£/r/n危险品鉴定/r/n£/r/n常压储罐/r/n£/r/n民爆器材/r/n£/r/n烟花爆竹/r/n/r/n£/r/n特种劳动防护用品/r/n/r/n/r/n£/r/n其他（/r/n请说明/r/n）：/r/n/r/n申请的/r/n检测检验/r/n能力范围：被检对象/r/n/r/n项/r/n申请的授权签字人：/r/n/r/n/r/n/r/n名/r/n四、申请机构特殊信息/r/n对/r/n分包项目的说明/r/n（/r/n若有请填写/r/n）/r/n：/r/n对/r/n租用设备/r/n、设施、场所/r/n的说明/r/n（/r/n若有请填写/r/n）/r/n：/r/n已取得国家重点实验室或其他检测/r/n资质情况/r/n说明/r/n（若有/r/n请/r/n填写）/r/n：/r/n对/r/n多场所情况的说明/r/n（若有/r/n请/r/n填写）/r/n：/r/n五、申请书附表/r/n附表1：申请的检测检验能力范围/r/n/r/n/r/n/r/n共页/r/n附表/r/n1.1/r/n：仪器设备配置表/r/n共页/r/n附表/r/n1.2/r/n：/r/n检测检验/r/n标准/r/n自/r/n查表/r/n/r/n/r/n共页/r/n附表1/r/n./r/n3：检测检验能力变更申请表共页/r/n附表2/r/n：申请/r/n的授权签字人一览表/r/n/r/n共页/r/n附表2.1：/r/n授权签字人申请表共/r/n份/r/n附表/r/n3/r/n：/r/n管理体系/r/n自/r/n查表/r/n/r/n/r/n共/r/n份/r/n附表/r/n4/r/n：在编人员一览表/r/n/r/n共页/r/n附表/r/n5/r/n：仪器设备设施一览表共页/r/n附表/r/n6/r/n：参加/r/n检测/r/n能力/r/n考核/r/n活动/r/n表/r/n/r/n/r/n共页/r/n六、随申请书提交的有关资料/r/n1/r/n．/r/n法人/r/n营业/r/n执照/r/n（证书）/r/n2/r/n．/r/n组织机构框图/r/n3．/r/n平面图/r/n4/r/n．/r/n现行有效的/r/n管理/r/n手册和程序文件/r/n（/r/n初次申请时，并提供最近一次内审和管理评审/r/n资料/r/n）/r/n5．/r/n典型项目的检测检验报告/r/n6/r/n．/r/n计量认证合格证书/r/n（/r/n含附/r/n表/r/n）/r/n7．/r/n从事与安全生产相关的检测检验工作经历/r/n的客观证据/r/n（仅初次申请时）/r/n8．/r/n在编人员法定劳动关系证明材料、/r/n专业技术/r/n人/r/n9．/r/n技术负责人/r/n从事与安全生产相关的检测检验工作经历/r/n的客观证据/r/n10．/r/n其他资料（/r/n如/r/n固定资产评估证明材料、/r/n分包单位资质证明/r/n、/r/n设备等/r/n租用协议、/r/n已取得国家重点实验室或其他检测/r/n资质/r/n证明/r/n、/r/n开展新项目/r/n和变更/r/n的评审材料/r/n目录/r/n、/r/n参加/r/n检测/r/n能力/r/n考核/r/n活动的相关资料、/r/n非标准方法的相关资料/r/n等）/r/n（若有请提供/r/n）/r/n/r/n/r/n£/r/n有/r/n（共/r/n/r/n份）/r/n/r/n/r/n£/r/n无/r/n七、申请/r/n机构/r/n声明/r/n1/r/n．/r/n本/r/n机构/r/n自愿申请安全生产检测检验机构资质/r/n。/r/n2/r/n．/r/n本/r/n机构/r/n同意遵守国家相关法律、法规和国家安全生产监督管理总局对安全生产检测检验机构管理/r/n的/r/n规定/r/n，依法从事/r/n安全生产检测检验/r/n活动/r/n，并对/r/n检测检验/r/n结果承担法律责任/r/n。/r/n3/r/n．/r/n本机构保证本申请书所填写/r/n的/r/n信息均