Return of BOC Edwards Equipment - Declaration
(Form HS2)
You must:
•
Know about all of the substances which have been used and produced in the equipment before you complete this
Declaration
•
Read the Procedure (HS1) on the previous page before you attempt to complete this Declaration
•
Contact your supplier to obtain a Return Authorisation Number and to obtain advice if you have any questions
•
Send this form to your supplier before you return your equipment
Equipment model _______________________________________
Serial Number ___________________________________________
Has the equipment been used, tested or operated?
yes
❏
Go to Section 2
no
❏
Go to Section 4
Are any of the substances used or produced in the equipment
•
Radioactive
yes
❏
no
❏
•
Biologically active
yes
❏
no
❏
•
Dangerous to human health and safety?
yes
❏
no
❏
If you have answered 'no' to all of these questions, go to Section 4.
Substance name
Chemical
symbol
Precautions required
(for example, use protective gloves, etc.)
Action required after spillage
or human contact
1
2
3
4
5
6
Reason for return and symptoms of malfunction:
___________________________________________________________________
________________________________________________________________________________________________________________
If you have a warranty claim:
•
who did you buy the equipment from ? ________________________________________________________________________
•
give the supplier's invoice number
_________________________________________________________________________
Print your name:
_____________________________
Print your job title: _____________________________________
Print your organisation:
________________________________________________________________________________________
Print your address:
_______________________________________________________________________________________
_______________________________________________________________________________________
Telephone number:
____________________________
Date of equipment delivery: ________________________________
I have made reasonable enquiry and I have supplied accurate information in this Declaration. I have not withheld any
information. I have followed the Return of BOC Edwards Equipment Procedure (HS1) on the previous page.
Signed: ___________________________________________________
Date ___________________________________________
Your supplier will not accept delivery of any
equipment that is contaminated with radioactive
substances, unless you:
•
Decontaminate the equipment
•
Provide proof of decontamination
YOU MUST CONTACT YOUR SUPPLIER FOR
ADVICE BEFORE YOU RETURN SUCH EQUIPMENT
P900-71-000
Issue
F
3A05-010
SECTION 1 : EQUIPMENT
SECTION 2 : SUBSTANCES IN CONTACT WITH THE EQUIPMENT
SECTION 3 : LIST OF SUBSTANCES IN CONTACT WITH THE EQUIPMENT
SECTION 4 : RETURN INFORMATION
SECTION 5 : DECLARATION
Return Authorisation Number:
FOR SEMICONDUCTOR APPLICATIONS ONLY :
Tool Reference Number ____________________________
Process _________________________________________
Failure Date _____________________________________
Serial Number of
Replacement Equipment ___________________________
