A
Decontamination - sample copy
This "Certi
fi
cate of Decontamination" is intended to protect the occupational health and
safety of our employees pursuant to the German Protection against Infection Act and trade
association accident prevention regulations.
Please understand that we can only initiate work operations when this Certi
fi
cate is
submitted.
Before sending the unit back to us for inspection/repair, the unit and accessories must
be cleaned pursuant to current laws and regulations and, if necessary, must also be
disinfected with a surface disinfection agent listed by the VAH.
Device type:
Serial number:
Accessories:
Device / accessories ...
are not contaminated:
were cleaned before shipping?
are free from toxic matter?
have been decontaminated and/or disinfected and no longer pose a health
risk?
With what type of toxic materials did the device / accessories come into contact?
Corrosive
Biologically hazardous (e.g. microorganisms)
Toxic
Radioactive
None
Certi
fi
cate of decontamination
! ! ! CAUTION!
This form must be visibly af
fi
xed to the outside of the package!
