Subordinate Protot Subordinate Prototype Records

Testing and Recordkeeping Requirements under the Standard for the Flammability (Open Flame) of Mattresses

1633qualproto

Testing and Recordkeeping Requirements under the Standard for the Flammability (Open Flame) of Mattresses

OMB: 3041-0133

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QUALIFIED PROTOTYPE TEST RECORD* OMB 3041- 0133
16 CFR Part 1633 – Standard for the Flammability (Open Flame) of Mattress Sets
DATE: _____/_____/_____

TEST FACILITY:

Firm Name:______________________ PROTOTYPE ID: ________________________
Name

________________________________________________

Address

________________________________________________
Street

________________________________________________

City

TYPE OF TEST ROOM:

State

ZIP

_____ Configuration A – Open Calorimeter
_____ Configuration B – Room (10ft. x 12ft. x 8ft.)

TEST 1
Room Conditions
Temperature
_____
% Relative Humidity _____

TEST 3

TEST 2
Room Conditions
Temperature
_____
% Relative Humidity _____

°C / °F

°C / °F

Room Conditions
Temperature
_____
% Relative Humidity _____

°C / °F

Time Out of Conditioning Room
___:____ a.m. / p.m.

Time Out of Conditioning Room
___:____ a.m. / p.m.

Time Out of Conditioning Room
___:____ a.m. / p.m.

Test Start Time
___:____ a.m. / p.m.

Test Start Time
___:____ a.m. / p.m.

Test Start Time
___:____ a.m. / p.m.

Total Heat Release

Total Heat Release

Total Heat Release

(within first 10 minutes)

(within first 10 minutes)

(within first 10 minutes)

_______ MJ

_______ MJ

_______ MJ

Peak Heat Release Rate

Peak Heat Release Rate

(within first 30 minutes)

(within first 30 minutes)

_______ kW

Peak Heat Release Rate
(within first 30 minutes)

_______ kW

_______ kW

Date of Test

Date of Test

Date of Test

____/____/____

____/____/____

____/____/___

TEST RESULTS:

Accept ______

Reject ______

I certify that this test was carried out in full accordance with the provisions of the Standard for
the Flammability (Open Flame) of Mattress Sets – 16 C.F.R. Part 1633.
TESTED BY:

Name

Print

Signature

CERTIFIED BY:

________________________________

Name

________________________________

________________________________
Print

Signature

________________________________

*To complete test record requirements under § 1633.11(a) for qualified prototypes, the information contained herein
must be accompanied by:
(1) a graphic depiction of the peak rate of heat release and the calculated total heat release over time; and
(2) a video or photographs of the testing of the mattress set.
This data sheet may be used in combination with a third-party laboratory test report


File Typeapplication/pdf
File TitleQualified Prototype Test Record
Subjectmattress flammable qualified prototype test record CFR standard
Authorhpepin
File Modified2006-07-17
File Created2006-06-20

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