SPE # ???
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Manufacturer/Client (Dropdown)
Date:(Calendar)
Model Evaluated: (Open Field)
-Listed (check box)
-Applied / Not Listed (Check box)
Model Description: (Open text box)
Other Models in Series: (Open text box)
Evaluated by: (Dropdown Staff)
Date representative model last evaluated: (Calendar)
Instructions:
Evaluate for each of the following requirements.
(A=acceptable; X=not acceptable (see narrative); N=not applicable)
Key:
QM = GCT’s NSF/ANSI Quality Manual
QP = GCT’s Quality Procedures
((Just text for above instructions))
NSF Standard: (Check boxes - like you have on the Evaluation Plan tab)
-(Check box) -NSF/ANSI Standard 40
-(Check box) -NSF/ANSI Standard 46
-(Check box) -NSF/ANSI Standard 50
-(Check box) -NSF/ANSI Standard 245
-(Check box) -NSF/ANSI Standard 350
-Other (open field)
GENERAL (GULF COAST TESTING POLICIES):
(Drop downs next to all of the below numbers (A=acceptable; X=not acceptable; N=not applicable)
1_____ Model # (QP03, QP04, QP06, QP07, QP11, QM 7.0)
2_____ GCT® Mark (QP15, PM 4.4, 4.7, 4.9. 9.2, 16.1)
3_____ Documentation and Literature (QP07)
4_____ Records on File (QP 11, PM 7, PM 22)
5_____ Reevaluation/Periodic Monitoring (QP11, PM 5, QM 7.9)
6_____ General Format of Listing (PM 17)
7_____ Verified Corrective Action (QP10)
8_____ Inspections and Distributors (QP04)
9_____ Additional Models (QP05)
10_____ Distribution of Test Data (QP17)
MATERIALS:
11_____ Interior Surfaces (NSF 4.1)
12_____ Exterior Surfaces (NSF 4.2)
13_____ Welding (NSF 4.3)
14_____ Dissimilar Metals (NSF 4.4)
DESIGN AND CONSTRUCTION:
15_____ Exposed Surfaces (NSF 5.1)
16_____ Structural Integrity (NSF 5.2)
17_____ Infiltration and Exfiltration Resistance (NSF 5.3)
18_____ Mechanical Components (NSF 5.5)
19_____ Electrical Components (NSF 5.6)
20_____ Access Ports (NSF 5.7)
21_____ Failure Sensing and Signaling Equipment (NSF 5.8)
22_____ Flow Design (NSF 5.9)
MANUALS:
24_____ Owner’s Manual (NSF 6.1)
25____ Instruction Manual (NSF 6.2.1)
26____ Operation and Maintenance Manual (NSF 6.2.2)
27____ Troubleshooting and Repair Manual (NSF 6.2.3)
28____ Documentation and Literature (NSF 7.0)
OPERATION AND MAINTENANCE:
29____ Limited Warranty (NSF Annex A.1)
30____ Initial Service Policy (NSF Annex A.2.1)
31____ Six-month service calls (NSF Annex A.2.1.1)
32____ Notification (NSF Annex A.2.1.3)
33____ Extended Service Policy (NSF Annex A.2.2)
34____ Standby Parts (NSF Annex A.2.3)
35____ Availability of Services (NSF Annex A.2.4)
INSPECTION:
Conditions of evaluation: (Open text box)
Production – Inventory – Incomplete – Prototype (Open text box)
No production at time of this visit. (Open text box)
Repeated items from last evaluation (Open text box)
Gulf Coast Testing’s contract and policy prohibit the use of the Gulf Coast Testing® mark on products not in full compliance with the applicable standard and policies. Completion of this report does not constitute acceptance for Certification/Listing.
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Inspector: ______________________________ Signature: _________________________________________ Date: _________________________________________
Manufacturer: ___________________________ Signature: _________________________________________ Date: _________________________________________
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