Electrothermal MH8517, Инструкция

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Page 16 of 20 M6847 issue 1.1
APPENDIX ‘A’. DECONTAMINATION CERTIFICATE.
Bibby Scientific Limited
.
Beacon Road, Stone, Staffordshire ST15 0SA. Great Britain
Tel: +44(0)1785 812121. Fax: +44(0)1785 810405
E-mail:
electrothermalhelp@bibby-scientific.com
DECONTAMINATION CLEARANCE CERTIFICATE
For the Inspection, Repair or Return of Medical, Laboratory or Industrial Equipment.
Prior to a Service Engineer working on equipment that has been in an environment where substances hazardous to health may have been
used, you are requested to provide the following information:
CUSTOMER DETAILS
Company:-
Address:-
Department:-
Contact Name:-
Tel No:-
Fax No:- Post Code:-
Product Description
Model No:-
Serial No:-
Has the equipment been exposed to any of the following, Please answer all questions by deleting YES/NO as applicable and by providing
details in section 2 below.
A. Blood, body fluids, Pathological
specimens YES/NO Provide details if YES
B. Biodegradable material that could
become a hazard YES/NO Provide details if YES
C. Other biohazard YES/NO Provide details if YES
D. Chemical or substances hazardous to
health YES/NO Provide details if YES
E. Radioactive substances State name(s)
and quantities of isotopes and checks
made for residual activity YES/NO Provide details if YES
F. Other hazards YES/NO Provide details if YES
2. Please provide details of any hazard present as indicated above. Include details of names and quantities of
agents as appropriate:-
3. Your method of decontamination (please describe):-
4. Are there likely to be any areas of residual contamination (please specify)
I declare that the above information is true and complete to the best of my knowledge and belief.
Authorised signature:- Name (please print):-
Title/Position:-
For and behalf of:- Date:-