Molecular Devices Corporation
1311 Orleans Drive
Sunnyvale, CA 94089 USA
SkanWasher 400 User Guide
D-1
Appendix D: Decontamination Form
In order to protect personnel involved in servicing instruments, parts, or
accessories, one must ensure that risk factors hazardous to health (infectious
material, radioactive isotopes) are removed from the item in question.
This form must be signed and acompany the SkanWasher 400 instrument,
parts, or accessories, when returning for service or return after used for dem-
onstration purposes. If not, the recipient has the right to reject the equipment.
Product Description: ____________________________________________
_____________________________________________________________
Catalog Number: ______________ Serial Number: ____________________
Method of Decontamination: ______________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
I confirm that the above item has undergone an appropriate procedure of
decontamination at this facility before being handed over, or transmitted, to
you for service or return of item after used for demonstration purposes.
Name: ________________________________________________________
Institution: ____________________________________________________
Address: ______________________________________________________
_____________________________________________________________
City/State/Zip: _________________________________________________
Country: ______________________________________________________
Date: ________________ Signed: __________________________________
