QMS Application Form 2014 Quality in Microbiology Scheme Please complete all sections below and return to LGC Standards Proficiency Testing by email, fax or post. Returning customer Lab ID: Purchase order no.: (compulsory) MC _ _ _ _ Samples and Matrix Round Despatch Reporting Date Deadline MC213 06 Jan 31 Jan MC214 03 Feb 28 Feb MC215 03 Mar 28 Mar MC216 07 Apr 02 May MC217 12 May 06 Jun MC218 09 Jun 03 Jul MC219 07 Jul 01 Aug MC220 04 Aug 29 Aug MC221 01 Sep 26 Sep MC222 13 Oct 07 Nov MC223 10 Nov 05 Dec 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 20 21 22 23 24 25 26 D D F D F D F D F D F D F D F D F F D F D F D F D F D F D D F D F D F D F F D 27 28 29 30 31 32 * 09 Jan 2015 *Please note that sample 32 is not currently within the scope of LGC Standards’ UKAS accreditation. MC224 08 Dec 1 Not available F Food matrix (oatmeal) Please indicate the number of samples required in the relevant boxes above D Dairy matrix (skimmed milk powder) LGC Standards Proficiency Testing, 1 Chamberhall Business Park, Chamberhall Green, Bury, Lancashire, BL9 0AP, UK. Telephone: + 44 (0) 161 762 2500, Fax: + 44 (0) 161 762 2501 E-mail: [email protected], Website: www.lgcpt.com Page 1 of 3 V1 QMS Application Form 2014 Quality in Microbiology Scheme Sample Target Organism(s) Test Wt 03 Salmonella species Enumeration 10g 04 Cronobacter species Presence/Absence 25g 05 Osmophilic yeast Enumeration 10g Osmophilic mould Enumeration Salmonella species Presence/Absence 25g 25g 06 07 08 09 10 11 Listeria species Presence/Absence Listeria monocytogenes Presence/Absence Sample Target Organism(s) 18 Escherichia coli Low-level Coliforms Test Wt Presence/Absence 10g Presence/Absence Enterobacteriaceae Presence/Absence Escherichia coli (low-level) Enumeration Coliforms (low-level) Enumeration Enterobacteriaceae (low-level) Enumeration 20 Escherichia coli Enumeration ONLY 10g Thermotolerant coliforms Enumeration 21 Campylobacter species Presence/Absence Vial Listeria species Enumeration Listeria monocytogenes Enumeration Enterococci (faecal streptococci) Enumeration 10g 22 Escherichia coli O157 (non-toxigenic strain) Presence/Absence 25g 10g 23 Yeast Enumeration 10g Mould Enumeration Clostridium species Presence/Absence Clostridium perfringens Enumeration 10g Mesophilic aerobic bacterial spores Enumeration Thermophilic aerobic bacterial spores Enumeration 12 Shigella species Presence/Absence 25g 13 Vibrio species Presence/Absence 25g 10g Yeast and Mould Enumeration Lactic acid bacteria Enumeration 10g 25 Aerobic psychrotrophic organisms Enumeration 10g 26 Pseudomonas species Enumeration 10g 27 Bifidobacterium species 24 Vibrio parahaemolyticus Presence/Absence Enumeration Vial 14 Yersinia enterocolitica Presence/Absence 25g 28 Tea Salmonella species Presence/Absence Vial + 25g tea matrix 15 Total anaerobic mesophilic count Enumeration 10g 29 Tea Total aerobic mesophilic count Enumeration Anaerobic sulphite-reducing bacteria Enumeration Coliforms Enumeration Vial + 10g tea matrix Mesophilic anaerobic spores Enumeration Coagulase positive staphylococci Enumeration Total aerobic mesophilic count Enumeration Yeast and Mould Enumeration Escherichia coli Enumeration 16 17 Coliforms Enumeration Enterobacteriaceae Enumeration Coagulase positive staphylococci Enumeration Bacillus cereus Enumeration 10g 30 Herb Salmonella species Presence/Absence Vial + 25g herb matrix 31 Spice Salmonella species Presence/Absence Vial + 25g spice matrix Enumeration Vial 10g 32 Campylobacter species For details on the full technical specification of the scheme, please refer to the QMS Scheme Description. Please fill in your address details below: Send Test Materials to: Contact name: Department: Company: Address: Send Invoices to: Contact name: Department: Company: Address: Town/City: Post/Zip Code: Country: Tel: Fax: E-mail: Town/City: Post/Zip Code: Country: Tel: Fax: E-mail: VAT no: Send Report Notifications to: Contact name: E-mail*: *An email will be sent to this address to notify when the report is available to download from PORTAL, the online reporting system LGC Standards Proficiency Testing, 1 Chamberhall Business Park, Chamberhall Green, Bury, Lancashire, BL9 0AP, UK. Telephone: + 44 (0) 161 762 2500, Fax: + 44 (0) 161 762 2501 Page 2 of 3 E-mail: [email protected], Website: www.lgcpt.com V1 QMS Application Form 2014 Quality in Microbiology Scheme For additional information and costs, please contact Customer Services by email: [email protected] or by telephone: +44 (0) 161 762 2500. Please note: Please contact LGC Standards for prices. VAT (charged at the prevailing rate) is payable by all participants based in the UK and by those in the rest of the European Union if a VAT Registration Number is not provided. UK participants will pay carriage at a rate of £14 per round. Participants outside the UK will pay an additional fee to cover courier charges. If you would like a guide as to these charges, please contact LGC Standards Proficiency Testing. All courier charges set by LGC Standards Proficiency Testing do not include local import charges, taxes (etc.), which will be covered by the participant. Do not send remittance with this form, you will be invoiced subsequently after the despatch of each round. No refunds will be given for failure to take part in any round of the PT scheme. LGC Standards Proficiency Testing reserves the right to not send samples or the report for previous samples to any participant that has not paid their subscriptions within the terms stated on the invoice. LGC Standards Proficiency Testing cannot guarantee the number of participants that will return results for any particular parameter in each round. The prices stated are for reporting results and receiving reports electronically via PORTAL (internet reporting). If alternative data entry or reporting methods are required, further charges apply. Please contact LGC Standards Proficiency Testing for the current charges. By signing this application form, you are agreeing to comply by LGC Standards' Standard Terms and Conditions for the Supply of Laboratory Quality Products and Services. Furthermore, for test samples containing microorganisms with a bio safety level (BSL) of 1 or 2, you are confirming that you are complying with applicable laws and regulations when using such materials. LGC Standards would like to be able to contact you from time to time with information about the LGC Group, its activities, products and services. By completing and returning this form to us, you agree to your personal information being used by LGC Standards and other members of the LGC Group for the administration and provision of our products and services and for related marketing activities. You can change your marketing preferences at any time by emailing [email protected] Signature ……………………………………… Date ………………………… LGC Standards Proficiency Testing, 1 Chamberhall Business Park, Chamberhall Green, Bury, Lancashire, BL9 0AP, UK. Telephone: + 44 (0) 161 762 2500, Fax: + 44 (0) 161 762 2501 Page 3 of 3 E-mail: [email protected], Website: www.lgcpt.com V1
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