Temposonics
®
R-Series EtherNet/IP
TM
Operation Manual
I
36
I
10. Annex
Safety Declaration
Dear Customer,
If you return one or several sensors for verification or repair, we need you to sign a safety declaration. The purpose of this declaration is to
ensure that the returned items do not contain residues of harmful substances and / or that any danger to persons when handling these items
has been removed.
MTS order number:
___________________________________
Serial number(s):
___________________________________
Sensor type(s): _________________________________________
Sensor length: ___________________________________________
The sensor has been in contact with the following materials:
In the event of suspected penetration of substances into the sensor,
consult MTS to determine measures to be taken before shipment,
if necessary.
Don’t specify chemical formulas.
Please, include safety data sheets of the substances, if applicable.
Short description of malfunction:
Corporate information
Company: _______________________________________________
Address: _______________________________________________
_______________________________________________________
Contact partner
Name: _______________________________________________
Phone: _______________________________________________
E-Mail: _______________________________________________
We hereby certify that the measuring equipment has been cleaned and neutralized. Equipment handling is safe.
Personnel exposure to health risks during transport and repair has been removed.
Date
Signature
Stamp
JAPAN
MTS Sensors Technology Corp.
737 Aihara-machi,
Machida-shi,
Tokyo 194-0211, Japan
Tel. + 81- 42 - 775 - 3838
Fax + 81- 42 - 775 - 5512
www.mtssensors.com
GERMANY
MTS Sensor Technologie
GmbH & Co. KG
Auf dem Schüffel 9
58513 Lüdenscheid, Germany
Tel. + 49 - 23 51- 95 87 0
Fax + 49 - 23 51- 5 64 91
www.mtssensors.com
USA
MTS Systems Corporation
Sensors Division
3001 Sheldon Drive
Cary, N.C. 27513, USA
Tel. +1- 919 - 677- 0100
Fax +1- 919 - 677- 0200
