17
Leica HI1220 Flattening Table
8. Decontamination Certificate (Master)
Leica Biosystems Nussloch GmbH
Heidelberger Str. 17-19
69226 Nussloch, Germany
Phone: ++49 (0) 6224 143 0
Fax: ++49 (0) 6224 143 268
www.LeicaBiosystems.com
Tick Box A if applicable. Otherwise please complete all parts of B, providing further
information as requested or appropriate.
Decontamination Certificate
Nameplate information
Model (see nameplate)*
SN (see nameplate)*
REF (see nameplate)*
This equipment has not been in contact with unfixed biological samples.
A
B
This equipment has been exposed internally or externally to hazardous materials as indicated
below:
Yes
No
Blood, body fluids, pathological samples
Other biohazards
Chemicals/substances hazardous to health
Other hazards
Yes
This equipment has been cleaned and decontaminated:
Yes
No
If yes, give details of the method:
If no**, please indicate why not:
Please provide further detail here:
Please provide further detail here:
**
Such equipment must not be returned without the written agreement of Leica Biosystems.
The equipment has been prepared to ensure safe handling/transportation.
Whenever possible, please use the original transportation case/box.
Yes
No
1
3
2
Signature/Date
*
Name
*
Position
*
Institute
*
Department
*
Address
*
Phone
*
Fa
x
Important - to avoid refusal of shipment:
Place one copy in the unit prior to packaging, or hand it over to the service engineer. Customer assumes all responsibility for the
immediate return shipment of articles sent to Leica without proper decontamination documentation.
If you have any further questions, please call your local Leica organization.
Leica Internal Use:
If applicable, note corresponding Job and RAN-/RGA-Number:
Job Sheet No.: _______________ BU
R
eturn
A
uthorization
N
umber: ______________ SU
R
eturn
G
oods
A
uthorization: ______________
Version 3.5 - 01/2013, Order-No. 14 0700 83101
Dear Customer,
Any product that is to be returned to Leica Biosystems or serviced on site, must be cleaned and decontaminated in the appropriate manner. Since it is not possible to
decontaminate for prion diseases, such as CJD, BSE, CWD etc., equipment exposed to specimens containing prion diseases cannot be returned to Leica Biosystems
for repair. On-site repair of prion contaminated equipment will only be conducted after the Field Service Engineer has been educated in the risks, instructed in the
policies and procedures of the institution, and provided with personal protective equipment. Please fill out this confirmation carefully and enclose a copy with the
instrument. Attach the confirmation to the outside of the flight case or hand it directly to the service technician.
Packages will not be opened, nor servicing commenced until the Company or service engineer have received a satisfactory certificate. Should returned
goods be considered a hazard by the Company, they will be returned immediately to the customer at his/her expense.
Note:
Microtome knives must be in boxes.
Mandatory information:
Fields marked with * are mandatory. Depending on whether the instrument is contaminated, please also complete either section A
or section B.
Radioactivity
