Appendix A – Chapter 3 Mobile Patient Bed Maintenance
Page 276 of 314
Part Number: 0160-6411, Rev A, 02/2019
Software Release: cOS 5.00
Decontamination Certification
Under the provisions of Postal Law, Title 18, United States Code, Section 1716, and Department
of Transportation regulations contained in CFR 49, Part 173.386 and 173.387, “etiologic agents,
diagnostic specimens and biological products…are nonmailable…”
The undersigned therefore certifies that the
OPTIMEDICA
equipment being returned herein by
____________________________________________________________________________________________________________________________________________________________
Individual / Institution City, State/Province, Country
has undergone decontamination with a commercially available germicide cleared for use as a
Hospital Disinfectant and is clean and free from biohazards, including – but not limited – human
or animal blood, tissue or tissue fluids, or components thereof.
The undersigned also agrees to reimburse
OPTIMEDICA
for any costs incurred in
decontaminating the enclosed equipment, in the event said item is received by
OPTIMEDICA
in a
contaminated condition.
Model:Mobile Patient Bed
Name (Printed): ______________________________________________________________
Signature:___________________________________________________________________
Date (MM/DD/YY):____________________________________________________________
