6100-XX5 Annual Reporting Form Licensed Certifying Body

Annual Certified Product Summary Report

ANNUAL CERTIFIED PRODUCT SUMMARY REPORT
Please complete and submit by January 31 of every year the following information for all
products that you have certified to any WaterSense® Specifications for the previous calendar
year. If you prefer, you may attach a printout or file with this information as long as it contains
all of the fields described below.

General Information
Product Certification Body Name:
Contact Name (for questions from EPA WaterSense Team regarding this form)
Name:

Telephone:

Fax:

E-mail:

Product Certification Summary

List Type of
Product

Number of
Products
Tested

Number of
Products
Certified

Number of
Products
Failed

Number of
Products
Suspended

Number of
Products
Withdrawn

Number of
Products
Reinstated

HET
Lavatory Faucet

Label Misuse/Dispute Action Summary
As part of your responsibilities as a Licensed Certifying Body, EPA requests that you provide
summary level data related to common label misuse problems identified and common dispute
actions taken during the year. Please document the frequency of occurrence for all of the
applicable scenarios listed in the table below (attach additional sheets if necessary):

Version 1.0

1

December 2007

Annual Certified Product Summary Report
Problem

Frequency of
Occurrence

Common label
misuse
problems

Label used in conjunction with an uncertified product from by a
manufacturer that has other products certified
Label used in conjunction with an uncertified product from a
manufacturer that does not have products certified
Continued use of label on a product with suspended/withdrawn
certification
Label modified from original provided by product certification
body
Label not used in conjunction with a specific certified product
Label used to represent product endorsement by EPA or product
certification body
Label used on general water efficiency promotional material
Use of any other WaterSense logo to promote product1
Use of the WaterSense label prior to receiving certification
Other: (Describe below)

Common
dispute actions

Manufacturer does not have an active Partnership Agreement with
EPA
Product fails to meet WaterSense criteria during routine
surveillance
Manufacturer not adhering to requirements for product
certification
Failure to take corrective actions with specified timeframe
Breach of licensing agreement with product certification body
Other: (Describe below)

Mail this form to:
OR
EPA WaterSense Program
c/o ERG
2300 Wilson Boulevard
Suite 350
Arlington, VA 22201

Fax this form to:
OR
EPA WaterSense Program
c/o ERG
(703) 841-1440

Email this form to:
[email protected]

1

Corrective action for this type of label misuse is typically handled by EPA. If such a situation is
encountered during routine surveillance, EPA requests that you track these occurrences and notify EPA
immediately so that corrective actions may be taken.
Version 1.0

2

December 2007