MSE Kestrel, User Manual, Page: 29 / 31

DECONTAMINATION
NO. NO
9.1 Declaration of Decontamination Status
Make: MSE Model: Kestrel
Serial Number:
…………………………..
You MUST complete either Declaration A or Declaration B providing further information as
requested.
Declaration A
I declare that
no part of the equipment listed above has been in contact with blood, other body fluids,
pathological sample or any substance that is deemed hazardous to human health. It has been
cleaned by us in preparation for inspection and service or repair by MSE CENTRIFUGES Ltd.
Signed: …………………………………… Name: ………………………………….
Capacity:……………………………………Date: …….…………………………….
Company/Hospital: ………………………………………………..…………………
Declaration B
The equipment listed above has been exposed, internally and/or externally to hazardous material as
indicated below:
Tick and provide details here
Blood, body fluids, pathological samples………………..…….…………
Other biohazards…………………………………………………………….
Chemicals or substances hazardous to health…………………………..
Other hazard…………………………………………………………………
Has the equipment, listed above, been fully cleaned and decontaminated?
Provide details: ……………………………………………………………
Please state why:…………………………………………………………..
Signed: …………………………………… Name: ………………………………….
Capacity:…………………………………….Date: ………….………………………..
Company/Hospital:……………… ……………………………………………………
YES