Two Park Avenue tel 1.212.591.

8500

Survey Team Size Questionnaire New York, NY

10016-5990 U.S.A.
fax 1.212.591.8501
www.asme.org

Company Name: Company ID:

Division Name (If Applicable):

Address of Location Being Surveyed:

Facility Information
Provide a response to 1, 2, and 3 below for
each location for which this application is being
submitted.

1. Provide the acreage and number of

buildings.

2. Indicate the activities performed and the

number of employees performing activities
which control/affect quality.

3. Provide distances with units between

buildings from the main facility. Indicate best
mode of transportation and length of time to
reach buildings/locations, i.e., walking, car,
airplane, train.

Facility Limitations
4. Are there any limitations on the entry to your Yes No
facilities that could obstruct the progress of
the survey activities or prevent non-nationals If Yes, please provide explanation:
entry to certain buildings or areas in the
facility?
5. Is there a shortened work week schedule or Yes No
multiple shifts?
If Yes, please provide explanation:

Facility Restrictions
6. Are there restrictions on the use of personal Yes No
computer, cell phones, flash drives or other
electronic equipment in your facilities? If Yes, please provide explanation:

Facility Services
7. Are copying, computer, phone, and Internet Use of copying machines? Yes No
services available to the survey team within
your facilities? Use of computers? Yes No
Internet service available? Yes No
Use of a phone? Yes No
Code Work
8. Code work performed since the last ASME Has there been any certification or application of the Certification Mark under the ASME Certificate since
Survey the last ASME survey?
Yes No
Language
9. Proficiency In English Are employees that are involved with the Quality Program or have an impact on quality proficient in
speaking English?
Yes No
Are the procedures, process sheets, and/or drawings written in the English language?
Yes No

NUC-FRM-02 8/10/2020 Page 1 of 3

 Two Park Avenue tel 1.212.591.8500
Supplemental Application Form for the New York, NY fax 1.212.591.8501

Nuclear Material Organization Certification Program 10016-5990 U.S.A. www.asme.org

FORM C
Company Name: Company ID:

Division Name (If Applicable):

Address of Location Being Surveyed:

Select Certificate Being Requested1:

Quality System Certificate Material Organization Scope on N-Type Certificate of Authorization
Quality System Certificate (Corporate) Material Organization Scope on N-Type Certificate of Authorization (Corporate)
Quality System Certificate (Corporate Extension) Material Organization Scope on N-Type Certificate of Authorization (Corporate Extension)

Check Certificate Being Requested: New Renewal - If Renewal, Enter Current Certificate Number:

NCA-3800 Quality System Program:

Check the type of operations to be listed in the certificate scope2.
Manufacturing Supplying Providing Services (See Form S)

Utilization of Unqualified Source Material Approval and Control of Suppliers

Qualification of Noncertified Material Organizations Shipment of Material from Qualified Material Organizations to Other Parties

Information for the ASME Survey Team:

Enter “P” (Perform Activity) or “S” (Subcontract Activity) or both in the spaces below for each activity:
Material Testing Product Form Conversion Nondestructive Examination Heat Treatment
Affecting Mechanical Properties Melting & Heat Analysis Repair Welding Receipt, Identification, Verification,
Handling, Storage, Shipment of Material

Product Forms:
Identify your product forms by indicating in the spaces provided the type of material from which the product is made.
Enter “F” for Ferrous, “NF” for Nonferrous, or both in the spaces below.
Welding Material:
Bars Fittings Made From NPT Stamped Tubular Product Bare Electrodes Strip Electrodes
Threaded Fasteners Seamless Tubular Products Covered Electrodes Bare Wire
Castings Tubular Products Welded w/out Filler Metal Flux Cored Electrodes Consumable Inserts
Forgings Tubular Products Welded w/ Filler Metal (NPT Stamped) Metal Cored Electrodes Powdered Filler Metal
Plates Structural Shapes
Prestressing Systems (Div. 2):
Clad Plates Sheet Strands Couplings
Seamless Fittings Strip Wires Coupling Components
Flanges Brazing Material Bars Non Load Carrying Materials
Hot Rolled Rod Fittings Welded w/out Filler Metal Anchorages Prestressing Systems
Anchorage Components
Semi-Finished Product Forms:
Concrete Reinforcing Systems (Div.2):
Rounds Billets Reinforcing Bars
Hollows Ingots Reinforcing Systems
Hot Rolled Wire Semi-Finished Strip Mechanical Splice Products
Hot Rolled Rod Slabs
Blooms

NUC-FRM-02 8/10/2020 Page 2 of 3

 Two Park Avenue tel 1.212.591.8500
Supplemental Application Form for the New York, NY fax 1.212.591.8501

Nuclear Material Organization Certification Program 10016-5990 U.S.A. www.asme.org

FORM C
Company Name: Company ID:

Division Name (If Applicable):

Address of Location Being Surveyed:

NCA-3900 Quality System Program:

Check the type of operation(s) and material(s) to be listed in certificate scope:
Non-Metallic Material Manufacturer Non-Metallic Material Constituent Supplier
Plastic Concrete Admixtures (Air Entraining, Chemical, Mineral, Grout Fluidifier)
Plastic Grout Aggregates
Cement
Cement Grout
Ice & Water
Polyethylene Material Manufacturer Polyethylene Source Material Manufacturer
Polyethylene Material Supplier Natural Compound
Pigment Concentrate Compound
Polyethylene Compound

Activities performed at another location3:

Address:

Code Activities Performed:

For a Material Organization scope addition to an N-type Certificate, a copy of the application including this form should be provided to the
AIA when the application is sent to ASME.

Footnotes:

1 For N-type Certificates of Authorization, a program demonstration/implementation of the Material Organization activities is required.

2 These operations are already included among the activities that may be performed under an N-type certificate (N, NA, NPT, & NS). The N-type
Certificate Holder is to indicate which additional operations will be performed under the program. Listing of these operations in the N-type certificate scope
is not required but must be addressed in the N-type Certificate Holder’s Quality Assurance Manual and be included in the program demonstration/
implementation presented to the ASME Survey Team.

3 Specific address and activities such as quality assurance, design, purchasing, forming, storage, etc., performed at another location that supports the main
location as identified at the top of the form, which will appear in the certificate scope.

NUC-FRM-02 8/10/2020 Page 3 of 3