EN-34 Frontier
TM
Centrifuge FC5515/FC5515R
12.8 Table 8: Redemption form / Decontamination certificate
Enclose this form with all returns of equipment and assemblies!
The completed declaration about the decontamination is a prerequisite for the assumption and further processing of the return. If no
corresponding explanation is enclosed, we carry out decontamination with costs at your expense.
.
Surname; last name:
Organization / company:
Street:
ZIP CODE: Place:
Telephone: Fax:
E-Mail:
Pos.
Crowd
Decontaminated
object
Serial number
Description / Comment
1
2
3
4
Are the parts listed above in contact with the following substances?
Health endangering watery solutions, buffers, acids, alkalis:
Yes
No
Potentially infectious agents:
Yes
No
Organic reagents and solvent:
Yes
No
Radioactive substances:
α
..
β
..
γ
Yes
No
Health endangering proteins:
Yes
No
DNA:
Yes
No
These substances have reached the equipment/assembly?
Yes
No
Which one, if yes:
Description of the measures for the decontamination of the listed parts:
I confirm the proper decontamination:
Company/Dept. Place and Date:
Signature of the authorized person n:
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