SAFETY
Applicant Information * Denotes Required Data
*Applicant Name:
Date:
Applicant Address:
Requester Name:
*Phone #:
*Email:
Reports/Products Affected by Amendments/Modifications
Listing/File #:
CB or EN Report #:
US/CAN Report #:
ATEX or IECEx Report #:
Other Information:
Description of Product Amendments/Modifications
Please fill in this section with a detailed description of the amendments/modifications. Please explicitly indicate in the body of this PAR whether this PAR covers both the ordinary location and the hazardous location elements of the certification, if applicable.
Amendments/Modifications to Critical Components List or Critical Drawings List
Please complete the below tables listing component changes and/or changes to drawings controlled within the MET Report.
Details of New or Alternate Critical Components
Figure/item No.
Object/ Parts No.
Manufacturer/ Trademark
Type/Model
Technical Data
Mark(s) of Conformity
Certification file # (if known)
Details of Revisions to Critical Drawings Please list ALL revision level changes to the respective drawing, up to and including the latest revision level, in successive order.
Drawing Number
Previous Revision
New Revision
Description of Revision
Justification for Acceptance (if known)
Example 1:
SCHEMATIC123
A
B
Removed resistor, R1
Not an intrinsically safe critical component.
Example 2:
ASSEMBLY123
Material change from stainless steel 304 to 316
Similar metals. Physical and mechanical properties remain the same.
Additional Information
Please provide any additional information or references to documents included with the submittal in this section.
If this is a medical product for the US market, are the above changes considered significate changes in accordance with the guidance provided by the FDA?
YesNoN/A