Source container FQG61, FQG62
Hauser
53
Pre-return inspection
Company
Name
Address
Name of inspector and role
Container
FQG6_-_____________
Radiation source
Isotope
137
Cs
60
Co
Source serial number
Nominal activity (MBq / GBq)
Date of manufacture
Checks
Enter yes or no
Wipe test report not older than 3 months is
enclosed with the return shipment documents
A copy of the manufacturer's certificate of the
source is enclosed with the return shipment
documents
No significant signs of corrosion on the container
which could put the safe storage of the source at
risk
No signs of serious damage on the container from
fire, falls or collisions
"EIN/ON" and "AUS/OFF" mechanism works
according to the Operating Instructions
The container is in the "AUS/OFF" position and
secured with a padlock/lock pin
The transport index has been determined
The container is labeled according to international
regulations concerning the transportation of
hazardous materials (ADR/RID, DGR/IATA)
Date
Signature
