TP350 User’s Manual
Servicing Request and Safety Check
Attention: Distributor of Takara Bio Inc.
Product Name
：
TaKaRa PCR Thermal Cycler Dice
TM
Touch
Model : TP350
Serial No
Date of request
：
Requested by
Name
Contacts
：
（
Telephone
、
）
Company/Institute Name
Address
Details of request
：
（
Current status
）
Customers are requested to provide the following information on the type of the function
and any safety considerations. Safety check covers all personnel involved in using the
system, as well as safety of the location in which the system was operated. If contaminated,
the customer is requested to decontaminate the system prior to servicing.
◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆
1.
Material in use
（
）
・
Pathogenicity
：《
□
none
,
□
possibly,
□
yes
》
・
Toxicity
《
□
none,
□
possibly,
□
yes
》
・
Radioactive substances
：《
□
not used,
□
used
：
nuclide
（
）》
2.
System contamination status
□
no contamination,
□
decontamination,
□
possibly contaminated
○
This is to confirm that the system is free of contamination
○
This is to confirm that there is risk of contamination and the specific safety measures
and decontamination procedures were implemented.
Date (year/month/day)
/
/
Company/Institution
Witness by
（
signature
）
◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆◆
The Safety Confirmation Form shall be presented as statement of the safety of the
equipment to be serviced by customers requesting servicing and maintenance
work. We request your cooperation as it is designed to ensure the safety of all
those who come into contact with the system.
＊
Note that we may decline to perform servicing and maintenance work if we do
receive the Safety Confirmation Form.
！
Caution
ｖ
2.01
