Sigma 2-5, Operating Instruction

Page: 53 / 55

Operating Manual SIGMA 2-5, page 53 of 55
03/06
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Declaration of Decontamination of Centrifuges, Accessories and Spare Parts
This declaration may only be filled in and signed by authorised staff.
Repair Order dtd. :
Order No. :
Type of unit : Serial No. :
Type of unit : Serial No. :
Type of unit : Serial No. :
Type of unit : Serial No. :
Accessories :
Is the equipment free from harmful substances ? YES
Ο
NO
Ο
If not, which substances have come into contact with the equipment?
Name of the substances : _________________________________________________________________
_________________________________________________________________
Remarks (e.g to be touched _________________________________________________________________
with gloves only) ; _________________________________________________________________
General characteristics of the substances :
Corrosive
Ο
Explosive
Ο
Biologically hazardous
Ο
Radioactive
Ο
Toxic
Ο
In combination with which substances may hazardous mixtures develop?
Name of the substances :
Has the equipment been cleaned before shipment? YES
Ο
NO
Ο
Is the equipment decontaminated and not harmful to health? YES
Ο
NO
Ο
Prior to repair, radioactively contaminated components must be decontaminated according to the valid
regulations for radiation protection.
Legally Binding Declaration
I / we hereby declare that the information on this declaration are correct and complete.
Company / Institute :
Street :
Postcode, City :
Tel. : FAX :
Name :
Date : Stamp :
Signature :
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