Thermo Scientific Sarasota FD910, User Manual

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12320 Cardinal Meadow Dr. Suite 150
Sugar Land, TX 77478 USA
Tel:
800-437-7979
Form No.: QF_COSHH ECO: 5424 REV: B Date 12-08-06
HEALTH AND SAFETY (COSHH) CLEARANCE FORM
Failure to comply with this procedure will result in equipment service delays.
This form must be completed for all equipment returned to Thermo Fisher Scientific (Thermo Fisher) –
Franklin, MA
Depot
Repair. Depot repair personnel are unable to handle any equipment that has been in contact with a process fluid or hazardous
material if it is not accompanied by this correctly completed Health and Safety Clearance Form.
All sections of this form must be completed, and the form must arrive at Thermo Fisher prior to the arrival of the equipment. A
copy of this form must also accompany the equipment.
Prior to returning any equipment for service, authorization must be obtained from customer service. A Return Material
Authorization (RMA) number will be issued and must be entered in Section 1 of this form.
Section 1: Reference Details
RMA #:
Equipment type:
Serial #:
Section 2: Process Fluid Information
All substances in contact with the equipment must be
declared.
Chemical names (list all):
Precautions to be taken when handling these substances (list
all):
Action to be taken in the event of human contact or
spillage:
Additional information you consider relevant:
Section 3: Shipping Information
Carrier details:
Tel:
/ Fax:
Scheduled delivery date to Thermo Fisher:
Section 4: Declaration
Must be authorized ONLY if non-toxic or non-
hazardous substances apply.
I hereby confirm that the equipment specified above has not
come into contact with any toxic or hazardous substances.
Signed:
Name:
Position:
For/on behalf of:
Date:
Must be authorized if toxic or hazardous substances
apply.
I hereby confirm that the only toxic or hazardous
substances that the equipment specified has been in contact
with are named in Section 2, that the information given is
correct, and that the following actions have been taken:
1. The equipment has been drained and flushed.
2. The inlet/outlet ports have been sealed, and the
equipment has been securely packed and labeled.
3. The carrier has been informed of the hazardous nature
of the consignment and has received a copy of this
completed form.
Signed:
Name:
Position:
For/on behalf of:
Date:
A copy of this completed form MUST BE HANDED TO THE CARRIER to accompany the equipment.