消防电子产品质量检验申请表.doc

消 防 电 子 产 品 质 量 检 验 申 请 表APPLICATION FORM FOR THE QUALITY APPROVAL TEST OF FIRE ELECTRONIC PRODUCT 申请企业名称 Applicant Firms Name 企业法人代表Firms Legal Representative （ 签字 ） （Signature） （加盖申请企业公章）（Official Seal of the Applicant）填报日期： 年 月 日Date:中国国家消防电子产品质量监督检验中心印制Printed and Distributed by China National Supervision and Test Center for Fire Electronic Product Quality注 意 事 项Notice to Matters Concerned 1请用正楷字填写检验申请表。 Please fill in the Application Form by the regular script2封面填报日期应在抽封样品日期之前。 The filling date should be before the sampling date3企业联系人应是企业法人授权的、具有全权处理有关检验事宜资格的人员。必要时，企业法人应在检验申请表中注明检验报告领取人。 The linkman should be the personnel，authorized by the artificial person，deal with matters about the test of your productsIf it is necessary，the artificial person should designate the person who will take away the test report in the Application Form申请企业承诺我代表申请企业郑重承诺：1. 承诺所有送检产品采用的元器件和设计的安全性均符合相关的标准、法律法规、市场准入制度，否则承担由此引起的一切法律责任。2. 本企业同意按国家消防电子产品监督检测中心的要求提供产品评价所需文件和资料，所提供的信息均真实有效，否则承担由此引起的一切法律责任。3. 遵守国家有关法律法规和国家消防电子产品监督检测中心制定的消防电子产品检验规则的所有要求及程序。4承诺本企业生产、销售的产品与送检样品的主要元器件、结构参数、生产工艺、安全性设计保持一致。5. 按有关法律法规、规章的要求，正确使用检测报告，不损害国家消防电子产品监督检测中心的声誉，不对社会产生误导，不未经许可发表声明，在传播媒体中对产品检测报告内容的引用，严格遵守国家的相关要求。6. 安排具有操作能力的人员配合国家消防电子产品监督检测中心的检测人员，按检验中心的安全工作管理制度，服从安排，否则由企业承担后果。7承诺配合国家消防电子产品监督检测中心共同完成产品检验工作，如因应企业原因影响检验进度，由企业承担后果。申请企业法定代表人签字：(加盖公章)年 月 日概 况1 申请企业/Applicant Firm1.1名称/Name:1.2法定代表人/Authorized Person of Applicant firm：1.3地址及邮编/Address and Postcode:1.4 联系人/Representative to be contacted: 1.5 电话/Tel: 1.6移动电话/Mobile：1.7 传真/Fax: 1.8电子邮件/E-mail: 2 代理机构或中国办事处(代表处)/Agency or Office PRC (Representative office)2.1名称/Name:2.2联系人/Representative to be contacted：2.3地址及邮编/Address and Postcode：2.4电话及传真/Tel and Fax：2.5移动电话/Mobile2.6电子邮件/E-mail:3 制造商/Manufacturer:3.1名称/Name:3.2地址及邮编/Address and Postcode:3.3 联系人/Representative to be contacted: 3.4 电话/Tel:3.5 移动电话/Mobile3.6 传真/Fax: 3.7 电子邮件/E-mail:4 生产厂/Factory:4.1名称/Name:4.2地址及邮编/ Address and Postcode:4.3 联系人/ Representative to be contacted: 4.4 电话/ Tel: 4.5移动电话/Mobile4.6 传真/Fax: 4.7 电子邮件/E-mail:5 付款单位/ Payment Organization:5.1名称/ Name:5.2地址及邮编/ Address and Postcode:5.3联系人/ Representative to be contacted: 5.4电话/ Tel: 5.5移动电话/Mobile5.6 传真/Fax: 5.7 电子邮件/E-mail:6.企业产品质量检验能力/ Capability for the quality approval of the firm：7.产品生产日期及出厂检验情况/ Manufacturing date and summary about the product test in manufacturer：申 请 检 验 产 品 情 况Description of the Product Applied for Test序 号Serial No.产品名称Name of Product型号规格Model and specification执行标准Implemented standard商 标Trademard主型产品Major Model Product分型产品Sub-model Product申请检验产品名称、型号及照片Name, Model and Photograph due to be Applied for Test主型产品Major Model Product贴 照 片 处Photograph of the product stickup here名 称 型 号Name Model分型产品Sub-Model Product贴 照 片 处Photograph of the product stickup here名 称 型 号Name Model分型产品Sub-Model Product 贴 照 片 处Photograph of the product stickup here名 称 型 号Name Model分型产品Sub-Model Product 贴 照 片 处Photograph of the product stickup here名 称 型 号Name Model 表1（可附页）送检产品的信息（火灾报警控制器）Information on the Products（Fire Alarm Control Units）Submitted for Test注：请认真填写如下信息（在选择的信息前划）Note: Please carefully fill in the following information(scratch “”in front of the information selected)1.请选择控制器的分类方式： 独立型 区域型 集中型 集中区域兼容型1 Select classification of control unit： Independent Local Central Combined Independent and Central2. 控制器是否具有接收来自同一探测器（区）两个或两个以上火灾报警信号才能确定发出火灾报警信号的功能： 是 否2. Whether the control unit has a function by which it may defines to initiate a fire alarm signal only when it receives two or more fire alarm signals from the same detector : Yes No3.控制器是否具有接收到不同部位两只火灾探测器的火灾报警信号才能确定发出火灾报警信号的功能： 是 否3. Whether the control unit has a function of defining to issue a fire alarm signal only when it receives the fire alarm signal form two detectors in the different locations: Yes No4.控制器是否具有历史事件记录功能：是 否4. Whether the control unit has a logging function of historical events: Yes No5.是否能通过控制器改变与其连接的火灾探测器的响应阈值：是 否5. Whether the response threshold value of a fire detector can be changed by the control unit connected with it: Yes No6.控制器是否设置少于6组的控制输出：是 否6. Whether the control unit has less than six groups control outputs: Yes No7.控制器是否具有传输火灾报警信息的功能：是 否7. Whether the control unit has a function of transmitting fire alarm information: Yes No8. 是否为火灾报警控制器(联动型)(如果是联动型,请同时填写消防联动控制设备信息表):是 否8. Is it an integrated fire alarm control unit （If so, full in a questionnaire of control for fire protection equipment at the same time）: Yes No9. 请选择控制器具有的功能： 屏蔽功能监管功能 部位或探测器的自检功能软件控制功能 续表1（可附页）9. Select functions of the control unit:disabled supervisoryself-test of location or a detector software-controlled 10如控制器具有屏蔽功能，请选择能屏蔽的设备种类：每个部位或探测区、回路 消防联动控制设备 故障警告设备 火灾声和/或光警报器 火灾报警传输设备10. If the control unit has disabled function, please select the type of equipment which can disable: each location or detector， loop，zone integrated fire control equipment fault warning equipments audible and/or visual signaling appliances for fire alert fire alarm routing equipment11.请填写控制器的如下信息：11：Fill in the following information on the control unit：a外观尺寸（长宽高）： mm mm mm；aDimension（lengthwidthheight）： mm mm mm； b容量：回路数量： ；每回路地址点数： ；bcapacity：number of loops： ；address locations per loop： ； c.显示器：数码管 液晶（显示器型号： ）； c.display：LED LCD（model of display： ）； d.备用电池：型号： ，数量： ；d.stand-by battery：model： ，quantity： ；e.是否采用总线通讯方式：是 否e. Whether is a bus communication mode isused： Yes No12. 请列出所配接的火灾探测器、手动火灾报警按钮、声和/或光警报器、显示盘（制造商和型号）。12. Please list manufacture name and model of fire detectors , manual fire alarm pionts,audible and/or visual signaling appliances for fire alert ,fire indicating panels that control unit connect.13需要说明的其他信息。13. Other information needs to explain. 表2（可附页）送检产品的信息（消防联动控制设备）Information on the Products（Control for fire protection equipment）Submitted for Test注：请认真填写如下信息（在选择的信息前划）Note: Please carefully fill in the following information(scratch “”in front of the information selected)1.是否为火灾报警控制器(联动型) (如果是联动型,请同时填写火灾报警控制器信息表): 是 否1. Is it an integrated fire alarm control unit （If so, full in a questionnaire of fire alarm control units at the same time）: Yes No2.是否具有气体灭火功能: 是 否2. Whether the product has gas extinguishing function: Yes No3.请列出所配接的控制器（制造商和型号）。3.Please list manufacturer and model of the fire alarm control unit connected with product.4.请填写控制器的如下信息：4：Please fill in information of the control unit：a外观尺寸（长宽高）： mm mm mm；aDimension（lengthwidthheight）： mm mm mm； b容量：回路数量： ；每回路地址点数： ；bcapacity：number of loops： ；address locations per loop： ； c.显示器：数码管 液晶（显示器型号： ）； c.display：LED LCD（model of display： ）； d.备用电池：型号： ，数量： ；d.stand-by battery：model： ，quantity： ；e.是否采用总线通讯方式：是 否e. Whether is a bus communication mode isused： Yes No 5.请列出所配接的输入/输出模块(制造商和型号)。5.Please list manufacture name and model of I/O modules connected with the product.6需要说明的其他信息。6. Other information needs to explain. 送检产品的信息（消防电气控制装置）Information on the Equipments（Fire electricity control equipments）submitted for Test注：请认真填写如下信息（在选择的信息前划）Note: Please carefully fill in the following information(scratch “”in front of the information selected)1.请列出消防电气控制装置类型： 消防泵控制设备 防排烟风机控制设备 双电源控制设备 消防泵自动巡检控制设备 消防电动开窗机控制设备1.Please list the model of fire electricity control equipments: Fire pump control equipments Fire blower control equipments Fire dual-power control equipments Fire pump automation checks control equipments Fire electrically operated window opener control equipments2.是否配接启动零件: 是 否2.Whether the equipments connects with the initiating parts: Yes No3.是否设置延时功能：是 否3.Whether the equipments have deferred function: Yes No4是否采用三相交流电源供电：是 否4.Whether adopt the three-phase alternating current power source to supply electricity or not: Yes No5是否具有自动纠相功能：是 否5.Whether the equipments have auto-rectifing the appearance function: Yes No6配接的受控设备是否为一用、一备相互切换设备：是 否6.Whether the equipments connected with is one-used and one-prepared equipments exchanging each other: Yes No7是否具有故障报警功能：是 否7.Whether the equipments have fault alarm function: Yes No 8外形尺寸（长宽高）： mm mm mm8. External form dimension（lengthwidthheight）： mm mm mm 9. 其它需要说明的信息：9.Other information needs to explain：表 （可附页） 送检产品的信息（消防设备应急电源）Information on the Equipments（Fire equipments emergency power source）submitted for Test注：请认真填写如下信息（在选择的信息前划）Note: Please carefully fill in the following information(scratch “”in front of the information selected)1输入类型：交流单相 交流三相Entering voltage: Alternating current single phase Alternating current three-phase2应急工作时输出类型： 直流 交流单相 交流三相Emergency export voltage: Direct-current Alternating current single phase Alternating current three-phase3.额定输出功率（kVA）： Fixed output power（kVA）：4.额定应急工作时间（min）： Fixed emergency time (min): 5.是否配接消防水泵、喷淋泵等灭火设备：是 否Whether match the equipment cutting out an engine such as receiving the fire control water pump , gushing to drench a pump: Yes No6是否能接收联动信号：是 否Whether being able to receive the gear signal : Yes No7是否仅配接三相负载：是 否Whether only match three-phase loads: Yes No8是否具有手动控制电源输出功能：是 否Whether having the manual-control power source output function or not: Yes No9是否具有自动控制电源输出功能：是 否Whether having the auto-control power source output function or not: Yes No 10外形尺寸（长宽高）： mm mm mmExternal form dimension（lengthwidthheight）： mm mm mm 11使用电池的制造商（含注册证明）、生产厂、型号、类型The manufacture name , factory ,model and type of the battery used in emergency power supply for fire emergency luminaries12. 其它需要说明的信息：Other information needs to explain：表 （可附页）表 （可附页） 送检产品的信息（消防电动装置）Information on the Equipments（Fire electricity equipments）submitted for Test注：请认真填写如下信息（在选择的信息前划）Note: Please carefully fill in the following information(scratch “”in front of the information selected)1.请列出消防电气控制装置类型： 消防电磁门吸 消防电动开窗机 消防电动防火阀1.Please list the model of fire electricity control equipments: Fire electromagnetic door holders Fire electrically operated window openers Fire electrically fireproof valve 2.是否具有机械操作部件: 是 否2. Whether having the mechanism component or not: Yes No3.是否设置延时功能：是 否3.Whether the equipments have deferred function: Yes No4是否同时具有手动和自动控制功能：是 否4. Whether having hand movement and the auto control function at the same time or not: Yes No5外形尺寸（长宽高）： mm mm mm5. External form dimension（lengthwidthheight）： mm mm mm 6. 其它需要说明的信息：6.Other information needs to explain： 表3（可附页）送检产品的信息（点型感烟火灾探测器）Information on the Products（Point Smoke Detectors）Submitted for test注：请认真填写如下信息Notes:Please carefully fill in the following information1：报警确认灯工作方式（正常监视、故障、报警状态）。1：The condition of the alarm indicator (quiescent、fault、alarm).2：探测器响应阈值是否可调及可调范围。2：Whether the detectors response threshold value can be adjusted and What is its adjustable limit3：探测器是否具有漂移补偿功能，如果具有，请提供相关资料。3：Whether the detector has a function of drift compensation, if so,please provide the related technical data.4：是否为依靠软件控制而符合本标准要求。4: Whether the detector depends on software control in order to fulfil the requirements of this standard.5：制造商规定的供电参数的上、下限值。5：the upper and lower limits of the power supply parameters (e.g. voltage) range specified by the manufacturer.6：请列出所配接的控制器（制造商和型号）。6：Please list manufacture name and model of fire alarm control units that the product connect.7：探测器的外形尺寸。7：the dimension of the detector.8需要说明的其他信息。8. Other information needs to explain. 表4（可附页）送检产品的信息（点型感温火灾探测器）Information on the Products（Point Type Heat Fire Detectors）Submitted for test注：请认真填写如下信息Notes:Please carefully fill in the following information1：报警确认灯工作方式（正常监视、故障、报警状态）。1：The condition of the alarm indicator (quiescent、fault、alarm).2：分类(A1, A2, B, C, D, E, F ,G,以及S,R)。2：Classification (A1, A2, B, C, D, E, F ,G and S,R).3：是否为依靠软件控制而符合本标准要求。3: Whether the detector depends on software control in order to fulfil the requirements of this standard.4：制造商规定的供电参数的上、下限值。4：the upper and lower limits of the power supply parameters (e.g. voltage) range specified by the manufacturer.5：请列出所配接的控制器（制造商和型号）。5：Please list manufacture name and model of fire alarm control units that the product connect.6：探测器的外形尺寸。6：the dimension of the detector.7：需要说明的其他信息。7：Other information needs to explain. 表5（可附页）送检产品的信息（手动火灾报警按钮）Information on the Products（Manual Fire Call Point）Submitted for Test注：请认真填写如下信息（在选择的信息前划）Notes:Please carefully fill in the following information (scratch “”in front of the information selected)1.请选择手动火灾报警按钮的分类方式： 户内型 户外型1. Type of the manual fire call point： indoor outdoor2.请选择手动火灾报警按钮如何进入报警状态: 击碎启动零件 使启动零件移位2. How does the manual fire call point enters into the alarm condition: broken initiating parts displaced initiating parts3：报警确认灯工作方式（正常监视、故障、报警状态）。3：The condition of the alarm indicator (quiescent、fault、alarm).4：手动火灾报警按钮的外形尺寸。4：the dimension of the manual fire call point.5.请列出所配接的控制器（制造商和型号）。5. Please list manufacture name and model of fire alarm control units that the product connect.6：需要说明的其他信息。6：Other information needs to explain. 表6（可附页）送检产品的信息（独立式感烟火灾探测报警器）Information on the Products（Smoke alarm devices）Submitted for test注：请认真填写如下信息Notes:Please carefully fill in the following information1：报警确认灯工作方式（正常监视、故障、报警状态）。1：The condition of the alarm indicator (quiescent、fault、alarm).2：报警器响应阈值是否可调及可调范围。2：Whether the alarm response threshold value can be adjusted and What is its adjustable limit.3：报警器是否为互联式，最大互联量是多少。3：Whether the alarms have the interconnection function? if so, Maximal interconnection amounts is? .4：是否为依靠软件控制而符合本标准要求。4: Whether the alarm depends on software control in order to fulfil the requirements of this standard.5：制造商规定的供电参数的上、下限值。5：the upper and lower limits of the power supply parameters (e.g. voltage) range specified by the manufacturer.6：探测器的外形尺寸。6：the dimension of the alarm.7需要说明的其他信息。7. Other information needs to explain. 附页提交中心送检产品技术资料明细表（需标明资料名称、页数及份数）The List of Technical Document to be Submitted（including Name、 Number of Copies and Pages）每种分型产品与主型产品的区别Difference between Major Model and Sub-model Product 企业负责人： Person in Charge of Quality：企业对产品检验的要求或其他需说明的事项Some Necessary Requirements of the Firm for the Product Test 企业负责人： Person in Charge of Quality：注：Notes：1. 请按要求填写检验申请表一式一份，并附产品照片三张（125mm88mm）Please fill in the test application form in one copy according to the requirements, and enclose 3 sheets of the perfuct photos （125mm88mm） 2. 提交企业注册证明复印件Submit the certificate of your commercial registration.3. 提交技术资料：a) 产品安装使用说明书一式两份(中文)；b) 产品技术说明书一式一份；c) 产品机械设计图纸一式一份；d) 产品电路设计图纸及元器件明细表（包括印刷线路板图、程序框图）一式一份；3. Submit the following technical data:a. Instruction of the product use and installation(in chinese),2 copies;b. Instruction of the product techniques , 1 copy;c. Mechanical drawing of the product, 1 copy;d. Circuit diagrams and parts list of the product（including the PC