CO
2
MPACT ENDOSCOPIC INSUFFLATOR
®
SYSTEM Operator’s Manual
Page 27
Section 12.0 CERTIFICATE OF NON-CONTAMINATION
Customer Name:
Address:
City:
State:
Zip Code:
Contact Name:
Authorized Signature:
Telephone # and E-mail:
Product Model No.: 710300
Description: CO
2
MPACT ENDOSCOPIC INSUFFLATOR
®
SYSTEM
SERIAL No.: #
RA. No.:
The above person hereby certifies that the above described product being returned to US Endoscopy has
been inspected and contains no foreign material or fluids and is not contaminated with any bio-hazardous
matter or any other material that may cause or contribute to any illness or personal injury of any kind.
Prior to disinfecting the CO2MPACT ENDOSCOPIC INSUFFLATOR
®
SYSTEM, ensure the power is
turned off and the electrical cord is unplugged. To disinfect the CO2MPACT ENDOSCOPIC
INSUFFLATOR
®
SYSTEM wipe down with an intermediate-level disinfectant (corrosive disinfectants,
such as bleach, are not recommended since they may damage the equipment) in accordance with the
manufacturer’s directions. Do not use abrasive or sharp-edged devices when disinfecting the
CO2MPACT ENDOSCOPIC INSUFFLATOR
®
SYSTEM. Do not spray fluids directly onto the unit or
allow fluids to enter the unit. Dry all components thoroughly. Do not sterilize or autoclave this unit.
Prior to returning any product to US Endoscopy complete this Certificate of Non-Contamination Form,
and send/fax to US Endoscopy Quality department at 1-800-769-8226.
