Bruker SamplePro hr-MAS, User Manual, Page: 64 / 82

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Z31914_00_01
Dismantling and Disposal
Figure 12.1: Repair Declaration Form
Safety and Repair Declaration
Equipment Clearance Form for Service, Repair, Disposal or Transfer
Version: 03 / OBD Seite 1 / 1 ZFQS0083
Use this form, whenever a probe or another unit situated in a magnet room or an analytical instrument might be exposed to
hazardous substances by customers, when it is to be returned to Bruker.
Whenever a customer returns a system or its components to Bruker, e.g. for repair, upgrade, loan returns, exchange, etc.,
the customer accepts the following obligation:
It is the explicit responsibility of the customer to make sure that the returned products are absolutely free of any
hazardous substances. In case of omission to do so, Bruker will hold the customer liable for any resulting injuries
and/or damages, caused to employees of Bruker and/or to other persons exposed to the hazardous substances.
The customer is further liable for all damage caused to Bruker, e.g. decontamination, security measures, etc. The
customer is finally liable for all other direct and/or indirect damages caused to Bruker by the hazardous
substances.
I ACCEPT THIS OBLIGATION
The repair declaration, completed and signed by the safety representative , has to be attached to the returned product.
The declaration must be attached to the delivery note on the package exterior. Any returned product without a properly
completed and duly signed declaration cannot be repaired. If we think that there is a risk of damage because of a
contaminated returned product, we must dispose the hazardous material at the expense of the customer.
The safety & repair declaration form may be signed by a Bruker service engineer if the system was never operated by the customer (e.g.
prior to completion of the installation).
The customer/signatory confirms that the returned product is absolutely free of any hazardous substances (e.g. toxic,
corrosive, explosive, biologically dangerous or radioactive).
PRODUCT PART NO.:
SERIAL NO.
:
FAULT DESCRIPTION (reason for return) :
DATE FAILURE OCCURRED: SYSTEM ORDER NO./ DISPATCH NO.:
COMPANY/INSTITUTE:
NAME:
MAILING ADRESS:
CITY/POSTAL CODE/COUNTRY
:
EMAIL:
SIGNATURE:
……………………………..……..
DATE:
………………………..…………..