Report form



Report form for late reported test results

Sample #20620 - 3 identical non-coated metal plates

|Determinations |Unit |Reference |Actual method used |’Unrounded’ |Rounded |

| | |method *) |*) |result *) |result cfr. used |

| | | | | |standard *) |

|Nickel release - plate 1 |µg/cm2/week | | | | |

|Nickel release - plate 2 |µg/cm2/week | | | | |

|Nickel release - plate 3 |µg/cm2/week | | | | |

|Nickel release - average |µg/cm2/week |EN1811 | | | |

|Surface area of the plates used for the |cm2 | | | | |

|calculation – average | | | | | |

*) Please see the letter of instructions before the start of the analysis at kpmd.co.uk/sgs-iis-cts/

Please answer the additional questions for sample #20620 on the next page.

The report form of sample #20621 is on the final page.

Report form for late reported test results

Additional Questions for sample #20620 - 3 identical non-coated metal plates

1 Is your laboratory accredited in accordance with ISO/IEC17025 for this test?

0 No

0 Yes

2 Did you pre-treat the test vessel(s)?

0 No, new/disposable test vessel(s) were used

0 No, the previously used test vessel(s) were not pre-treated

0 Yes, the previously used test vessel(s) were pre-treated

0 Other option, please describe: ___________________________________________________________________________

___________________________________________________________________________

3 If yes in question 2: please describe the pre-treatment procedure

___________________________________________________________________________

___________________________________________________________________________

4 What was the volume of test solution in mL added to the test vessel at the start of the test?

___________________________________________________________________________

5 Which ratio in mL/cm² was used for the test solution versus the sample surface area?

___________________________________________________________________________

Remarks on Additional Questions:

___________________________________________________________________________

The report form of sample #20621 is on the next (final) page.

Report form for late reported test results

Sample #20621 – one cufflink for surface determination only

|Determination |Unit |Test result |

|Total sample surface area |cm2 | |

*) Please see the letter of instructions before the start of the analysis at kpmd.co.uk/sgs-iis-cts/

Please, describe as detailed as possible how you have measured and calculated the total surface area

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

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Any remarks?

____________________________________________________________________________

____________________________________________________________________________

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