Invoice recipient / Customer no.
Location
/ Forwarding address
address
Call type
Notification no.
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Notification date
Page
Region
ID of technician
Name of technician
Appointed date
Order date
by
Serial no.
Customer order no. / PO
Service contract no.
Customer cost center
Customer inventory no.
Device description (Type)
Material no. (order no.)
Service device no.
Date of last maintenance
Date of calibration
Date of delivery
Date of start-up
Equipment no. (Factory no.)
Safety Declaration
Dear customer,
When using biological and chemical agents within and ouside of devices, hazards to the health of the operating personnel
may be present and contamination of the surroundings of the device may occur when service or repair works are carried out.
Within the scope of national and international legal regulations, such as
• responsibility of a company for the protection of its employees,
• responsibility of the operator for the operational safety of devices,
all possible hazards must absolutely be prevented. Prior to any calibration, service, and repair works, prior to any
relocation of a device, and prior to the shut-down of a device, the device must be decontaminated, disinfected, and cleaned as
required by the work to be carried out.
Therefore, we ask you to fill in this certificate of decontamination before you start with the required work.
Yours sincerely,
Thermo Electron LED GmbH
Works to be carried out
(please mark where applicable)
Thermo Electron LED GmbH
Customer Center Germany
Robert-Bosch-Str. 1
D-63505 Langenselbold
Telephone 0 8001 112 110
Telefax
0 8001 112 114
www.thermofisher.com
Declaration
1/1
Prevented maintenance
Repair work
Calibration
Filter replacement
Transfer to new location
Transport
Declaration of possible contamination (
)
please mark where applicable
The device is clear of biological material
The device is clear of radioactivity
The device is clear of cytostatic agents
The device is clear of dangerous chemical substances
The device is clear of other dangerous substances
Certification
Prior to carrying out the required work, we have decontaminated, disinfected, and cleaned the device as described
in the operating instructions of the device and in accordance with nationally applicable regulations.
The device does not present any hazards.
Note
Date, legally binding signature, stamp
Summary of Contents for Heracell 150i
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