Calibration Service Assessment Form (Self Survey)

Vendor:      

Address:       City:      

State:       Zip Code:       Telephone:      

Surveyed by       Date:      

Key Personnel: Title:

           
           
           

Type of Metrology Service:

     
     
     

General Information:
Plant Size (Square Feet):      
Capacity Currently Utilized:      
Quality Manager Name:      
Title:      
Phone/Fax/Email:      
No. Of Inspection Personnel:      
No. Of Production Personnel:      
No. of Engineering Personnel:      
Name of contact for paperwork problems:      
 Audit Checklist

Audit Items Yes No Observations / Concerns

Measurement Standards

Is written Quality Assurance Specifications or Quality

Manual available?

Do you have any ISO or ANSI accreditations? If so,

please attach.

Is measurement uncertainty of each measurement

standard determined and documented?

Is collective measurement uncertainty determined in

cases where more than one calibration standard is
needed to perform a calibration?

Is both upward and downward traceability maintained by

the Calibration Control System?

Environmental Controls

Are all measurement standards calibrated within a

specified and controlled environment?

Is the controlled environment continuously monitored to

provide assurance to control limits?

Calibration Intervals

Are calibration intervals determined by an industry-

accepted standard (e.g. MIL-HDBK-52B)?
Are calibration intervals adjusted by Quality as needed
to reflect the confidence and calibration standard?
Is there a process for determining unacceptability of
measurement standards that are consistently found to
be out of tolerance, and is their use limited or
prohibited?
Are temporary extensions of calibration due dates
allowed, and if so are extensions approved and
documented by the Quality Manager or other
responsible manager?
Are certain measurement standards (e.g. ratio
measuring devices) calibrated prior to each use, and
labeled accordingly?

Is there a listing of equipment due for calibration, and is

it reviewed at the beginning of each month?
Audit Items Yes No Observations / Concerns
Calibration Procedures

Are the calibration procedures contained in the

manufacturers’ manuals utilized, and do they comply
with an industry-accepted standard (e.g. ANSI Z540-1
and/or ISO 10012-1)?

In instances where existing manuals do not contain

adequate procedures, have locally produced
comprehensive procedures been generated that
include:

 A discrete control number for each procedure?

 A list of required calibration equipment describing

the required parameters, ranges, and accuracies?

 Each characteristic to be calibrated and acceptable

limits for each characteristic?

 An acceptable test accuracy ratio for each

characteristic being calibrated?

 A concise calibration outline with reference to the

applicable manufacturers’ manual for detailed
instructions?

Out of Tolerance Conditions

Are all out of tolerance conditions found during

calibration of measurement standards or M&TE
reported to the Quality Manager or other responsible
manager?

Is there a documented process for assessing the impact

of out of tolerance conditions that is based upon:

 Use and application?

 Degree of out of tolerance condition?

 Effect on the parameter being or calibrated?

 Effect on the Universal’s Company’s product(s)?

 Maintenance of an acceptable test accuracy ratio

(4:1)?

 Safety considerations?
Is there a documented definition for “Significant Out Of
Tolerance” conditions (SOOT) that considers safety and
measurement integrity?

Is there a process for verification and/or re-calibration of

all finished goods impacted by a SOOT condition?

Audit Items Yes No Observations / Concerns

Is there a documented process for notifying all
customers who have received product that may have
been impacted by a SOOT condition?

Are all SOOT situations and associated corrective

actions reviewed and approved by the Quality Manager
or other responsible manager?

Calibration System Adequacy

Does the Quality Manager or other responsible

manager assure that calibrations performed by
subcontractors comply with all requirements in the same
manner as the originating calibration facility?

Are there adequate established processes for selecting,

training, & evaluating calibration personnel?
Is there an established auditing program that includes
random auditing for an established level for all ranges
and functions?

Do calibration labels include a control #, date of

calibration, next calibration due date, and the calibrating
technician?
Are there tamper-resistant seals affixed to all controls or
adjustments that could affect the calibration of any
measurement standard or M&TE?

Calibration Sources

Are all measurement standards that provide primary

traceability reference for the calibration system
calibrated by the National Institute of Science &
Technology (NIST); or a commercial laboratory meeting
the requirements of an industry accepted standard (e.g.
ANSI Z540-1 and/or ISO 10012-1; or determined by
radiometric calibration methods; and supported by
calibration reports?
Do calibration reports include:
 Identification of the measurement standard or
M&TE?
 Identification of the calibration source(s)?
 Date of calibration?
 Assigned calibration values?
 Environmental conditions?
 Any corrections required?
 If applicable, a statement indicating that the
measurement standards used are traceable?

Audit Items Yes No Observations / Concerns

Is Universal Company provided with a calibration report

that includes:
 Model number?
 Serial number?
 P.O. number?

 Date of calibration?

 Calibration environment (temperature & humidity)?

 If applicable, data reflecting any out-of-tolerance

condition prior to calibration?

 Calibration results?

 Reference standards NIST report numbers?

 Recommended re-calibration date?

 Calibration technician?

 Statement attesting to traceability and test accuracy

ratio?
 Authorized signature?

Is the calibration data for Universal Company

instruments retained for a minimum of three months
past the recommended re-calibration date?

Records

Are records supporting the requirements of an industry

accepted standard (e.g. ANSI Z540-1 and/or ISO
10012-1) provided by the Calibration Control System,
and do they include:
 Identification of each measurement standard &
M&TE assigned, upon their acquisition?
 Current calibration cycle?
 Date of last calibration?
 Calibration facility?
 Calibration procedure?
 Results of previous calibrations reflecting all
measurements or indications of calibrated
parameters and conditions of results?
 Any condition of limited use?
 Any adjustments, corrections, repair or part
replacement resulting from the calibration?
 Any comments relating to abnormal operation?
 If applicable, any calibration report number?

Audit Items Yes No Observations / Concerns

Are the records kept on file for a minimum period of two
years?
If calibration report data is maintained in electronic
format- are the electronic records backed-up at least
weekly, and stored at an off-site storage location?
Subcontractor Calibration Control

Is compliance assurance of subcontracted calibrations

evidenced by;
 A statement of compliance or;
 Results of recent government MIL STD 45662A
inspection audit or;
 Response to a survey relative to the provisions of
this checklist?

Storage and Handling

Are there environmental standards applied for
measurement standards & M&TE for such equipment
that are in immediate use?

Are items that require calibration by a subcontractor

packaged & shipped according to accepted commercial
practices?

Are all Universal Company instruments packaged &

shipped according to accepted commercial practices?
Are all items inspected upon receipt for evidence of
abuse or damage?
I hereby certify that the information supplied is accurate complete and current to
the best of my knowledge and that I am an official of the supplier who is
duly authorized to sign this certification.

Name:      

Title:      

Date:      

Note: This survey is required by Universal Avionics Systems Corporation (UASC).

This survey is in lieu of an on-site audit, up-date records, and/or as a
preliminary to another on-site audit at a future date if required.
Our customers and the FAA also have the right to enter your facility and
conduct audits. A UASC representative will accompany our customers on
these visits and will be responsible for problems identified. The authenticity
of all statements and responses are subjected to verification at that time.

Please return this completed form to the following address:

Universal Avionics Systems Corporation

3260 E. Universal Way
Tucson, AZ 85756
Attn: Quality Department