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Conditions for Granting, Maintaining, Extending, Reducing, Suspending or Placing on Probation and Withdrawing Accreditation

PUBLIC PROCEDURE PCAC-PR-519 Issued: 2017-5-5, Revision: 2

References PCAC-PL-502: Operating Policy of the Personnel Certification Accreditation Committee (PCAC)
1.1Objective of this procedure is to document the process of granting of initial accreditation as well as maintaining, extending, reducing, suspending and withdrawing accreditation by Personnel Certification Accreditation Committee (herein, PCAC) for the certification body (herein, CB).
ETG: Evaluation Task Group NCR: nonconformity PCAC: The Personnel Certification Accreditation Committee
3The Initial Decision on Accreditation
3.1The PCAC Evaluation Task Group (herein, ETG) is a 2-3 -member group composed of the PCAC members. The ETG is responsible for reviewing the assessment report to ensure the assessors’ findings on nonconformities (herein, NCRs) are substantiated and consistent. If there is a concern with the findings, a consensus will be reached among the assessors and ETG. If a consensus cannot be reached, the issue will be presented to PCAC for its final decision. The ETG recommends the accreditation action to PCAC.
3.2Once all the requirements are met and the ETG supports a recommendation for accreditation, the ETG and the ANSI staff prepare recommendation for accreditation for PCAC in accordance with PCAC-PL-502. PCAC then votes on granting accreditation. PCAC may approve the assessment report with NCRs as well as corrective action plans for removing the NCRs. PCAC will request ANSI staff to inform the CB of the specific date for the completion of the corrective actions.
3.3Following the approval by PCAC, ANSI staff shall promptly notify the applicant in writing of the accreditation action. No verbal notification will occur.
3.4In cases where applicants have failed to address NCRs within the agreed-upon timeframes that are determined by the assessors and PCAC, the ETG may recommend denial of accreditation to PCAC. If PCAC agrees with the ETG that there is substantial evidence to support denial of accreditation, the Committee may vote to deny accreditation. ANSI staff shall promptly notify the applicant in writing and include the basis for the Committee's decision along with information on any additional steps to be taken by the applicant. Even when the decision is denial of accreditation, all fees associated with this review process must be paid. The applicant may appeal this PCAC decision in accordance with ANSI’s appeals procedures.
3.4.1The applicant may choose to re-apply for ANSI for accreditation at any time after accreditation has been denied. The applicant must begin the ANSI process from the beginning, including the preliminary application to enter the accreditation process and payment of all relevant fees.
4Maintenance of Accreditation During Surveillance and Reassessment
4.1Results of surveillance or reassessment, including reports, NCRs along with corrective actions, opportunities for improvement (herein, OFIs) and commendations, as well as recommendations of the ETG are reviewed by PCAC.
4.2PCAC shall either vote to grant continued accreditation, in those cases when there have been no NCRs identified or all have been closed, or to request further corrective actions, providing the CB with the due date. Depending on the severity of NCRs and the length of time taken by the CB to provide corrective actions, PCAC may vote to suspend or withdraw accreditation or place the CB on probation.
4.3If the accreditation certificate expires prior to PCAC decision on the renewal of accreditation and the reassessment process is in progress, the program director shall extent the validity by 90 days. ANSI staff shall issue a new certificate of accreditation reflecting the 90 day extension. Any further extension will require a vote by PCAC. Upon reaccreditation, the CB shall be issued a new certificate of accreditation based upon the original effective date of granting accreditation, regardless of any extension(s).
5Extension and Reduction of Scope of Accreditation
5.1Extension of scope
5.1.1Decisions on scope extension are reviewed by PCAC in a manner similar to the review of initial accreditation decisions. In many cases scope extension is sought by the accredited CB during their regular surveillance and reassessment cycle. In such case, the regular annual assessment shall include an assessment of the scopes (certificate additional programs) submitted for scope extension. However, ANSI shall also review stand-alone scope extension requests and shall conduct (as a minimum) a document review and, if necessary, an onsite assessment.
5.1.2Scope extension fee as documented in the fee schedule procedure is payable upon submission of the request by the accredited CB.
5.1.3NCRs identified during a scope extension assessment may apply to all accredited programs.
5.2Reduction of scope
5.2.1PCAC may decide to vote to reduce the scope of accreditation of a CB if some of its accredited programs have been found not to conform to the requirements. A vote to reduce the scope of accreditation does not signify suspension of the CB or withdrawal of accreditation.
5.2.2Accredited CB may choose to voluntarily request reduction in the scope of its accreditation at any time by submitting a written notice to ANSI.
6Probationary Accreditation, Suspension and Withdrawal of Accreditation
6.1If a CB has failed to correct one or more NCRs within a designated timeframe, PCAC may place it on probationary accreditation. Once placed on probationary accreditation, the CB shall be given a reasonable period of time to correct the NCRs with a warning that failure to do so may result in a PCAC vote to suspend or withdraw accreditation.
6.2PCAC shall hold a vote to withdraw ANSI accreditation from a CB if any of the following occurs:
a)filing of any voluntary or involuntary petition of bankruptcy;
b)liquidation of the business or the organization;
c)discontinuance of the accredited certification program;
d)CB’s failure to correct a NCR in its program that has been requested by ANSI;
e)misuse of the ANSI accreditation symbol;
f)it is revealed that the information contained in the original application or subsequent reports is fraudulent;
g)failure to comply with ANSI policies and procedures, including the failure to pay the accreditation fees.
6.3If at any time during the term of the Accreditation Agreement the CB defaults in any way on its obligations to ANSI, ANSI shall call this administrative infraction to the attention of the organization for immediate correction. ANSI communication to the CB shall include a notice that if the administrative matter is not corrected within a specified timeframe, it will be brought to the attention of PCAC, which may vote to place the organization on probationary accreditation. If the matter remains unresolved, PCAC shall be notified and may vote to withdraw accreditation of the CB.
6.4An accredited CB has the right to voluntarily withdraw its ANSI accreditation at any time for any reason. Request for withdrawal must be submitted in writing by an authorized representative of the organization.
6.5Based on the recommendation of the ETG, PCAC may vote to suspend accreditation of one or more accredited certification programs. Reasons of suspension may include lack of resolution of NCRs or violation of ANSI policies or procedures, including the terms of the Accreditation Agreement. Suspension decision must be accompanied by a defined timeframe during which the CB must address the underlying problems or face the further PCAC decision on withdrawal of accreditation.
6.6When ANSI accreditation is withdrawn (including voluntary withdrawal) or suspended, ANSI staff shall publish and otherwise publicize the action in any way that ANSI deems appropriate. Upon withdrawal or suspension of its accreditation, a CB must discontinue use of the ANSI accreditation symbol, all advertising material which references the Personnel Certification Accreditation Program and return any accreditation documents deemed appropriate including its accreditation certificate to ANSI.

How is accreditation like an onion?