OSHA Form 5-30-8 NRTL Application, Expansion Company Profile Worksheet

NRTL Company Profile Worksheet (Form III)

NRTL Application, Expansion Company Profile Worksheet			OMB Control Number:1218-0147 Expires: 01/31/2025
Form III Company Profile (for initial applications only)
1. Legal Name of Applicant:
2. Applicant Owner(s) and Key Officers
a. Name		b. Title
3. Explanation of Impartiality (independence):
4. Primary Field of Testing:
5. Brief profile and history of company – include principle line(s) of business:
Paperwork Reduction Act Statement		OMB Control Number: 1218-0147
According to the Paperwork Reduction Act of 1995, no person is required to respond to a collection of information unless such collection displays a valid OMB control number. Public reporting burden for this collection of information is estimated to average 1 hour. This burden includes locating and assembling information required to complete the application and is included in the burden calculated for initial applications. The obligation to respond to this collection is voluntary. Information obtained from this form will be used to determine if the application and supporting information meets the requirements of the NRTL Program as outlined in 29 CFR 1910.7. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: U.S. Department of Labor, OSHA, Office of Technical Programs and Coordination Activities, Directorate of Technical Support and Emergency Management, 200 Constitution Avenue, NW, Room N3655, Washington, DC 20210.
Form III Completion Directions – General Guidance
OSHA safety standards require that specified equipment and materials (products) be tested and certified for safety by an OSHA-recognized organization. OSHA’s Nationally Recognized Testing Laboratory (NRTL) Program fulfills this responsibility by recognizing the capabilities of mainly private sector testing organizations to test and certify such products for manufacturers. To be recognized, an organization must meet OSHA’s requirements. Initial recognition is granted if the application and an on-site audit of the organization demonstrate the applicant is completely has the capability to test and certify products for safety. An organization must have the necessary capability both as a testing laboratory and as a product certification body to receive OSHA recognition as a NRTL. Once recognized, OSHA reviews each NRTL’s activities to assure it continues to comply. The NRTL can also request an expansion of its recognition. This form, and its attachments, asks the NRTL to verify its general information as well as provide specific information related to its facilities and capabilities to meet NRTL Program requirements. Completing this form is entirely voluntary. Each applicant is free to submit an application for initial recognition using any form it chooses. However, OSHA will consider applications that do not contain the information requested in this form to be deficient and may delay or deny the request. An applicant that chooses to use this form for initial recognition must send: (1) this completed form; (2) any additional information it wishes to submit to demonstrate capabilities to meet NRTL Program requirements; and (3) payment to: Director Office of Technical Programs and Coordination Activities Directorate of Technical Support and Emergency Management Occupational Safety and Health Administration US Department of Labor 200 Constitution Avenue NW, Room N3655 Washington, DC 20210 USA Completed and signed forms and any accompanying documentation may also be scanned and emailed to nrtlprogram@dol.gov. For questions, contact the Office of Technical Programs and Coordination Activities at +1.202.693.1911

Form III Company Profile
The company profile provides an overview of the ownership structure of the applicant. It is used to assist in determining an applicant’s impartiality in conducting product safety testing and certification. It is also used to develop a profile for the applicant’s business and identify the leadership for the applicant.
Block 1:	Enter the legal business name of the applicant as currently recognized or requested. Note: If the applicant wishes to use a name that is different from the name listed on OSHA’s NRTL page (see http://www.osha.gov/dts/otpca/nrtl/nrtllist.html), the applicant must submit a request for name change to OSHA’s NRTL Program office using the contact information listed above.
Block 2:	Block 2a. Enter the name of the organization officer or official. Block 2b. Enter the title of the organization officer or official
Block 3:	Provide an explanation of how the applicant will ensure impartiality on product safety testing and certification. Provide any documentation such as agreements or independent validation associated with the explanation. Note: Accreditation in ISO/IEC 17065 by a recognized third-party accreditation body will meet independent validation requirements of impartiality. Inclusion of the applicant’s ISO/IEC 17065 accreditation certificate and accreditation worksheets will meet documentation requirements for proof of impartiality.
Block 4:	Provide a description of the testing laboratory / certification body’s primary field of testing and certification.
Block 5:	Provide a brief profile and history of the company to include the company’s principle line of business. Use additional pages as required.