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7.2
Health and Safety Declaration Form
On site service
Serv
To ma
clean a
equipm
not su
additio
Yes
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expla
for an
answ
Equip
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area
Nam
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job ti
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vice Ticket #
ke the mutual
and free of any
ment, please c
fficiently clean
onal charges.
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r
w
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i
p
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anation
ny “No”
wers here:
pment type /
eby confirm th
has been mad
e:
tion or
itle:
ed:
#:
protection an
y hazardous c
complete this c
ned, accessible
Please review
Provide expla
Instrument ha
Please rinse tu
residue. Ensur
wipe test or ot
Adequate spa
installation. In
prior to GE arr
Consumables
any area that
All buffer / wa
Excess contai
Product No:
hat the equipm
de safe and ac
nd safety of GE
contaminants b
checklist and p
e and safe for
w the actions b
nation for any
as been clean
ubing or piping
e the area aro
ther suitable s
ce and cleara
some cases t
rival.
s, such as colu
t may impede
aste vessels a
ners have bee
ment specified
ccessible.
E service perso
before a Servic
present it to the
an engineer m
below and ans
y “No” answe
ed of hazardo
g, wipe down s
ound the instru
urvey.
nce is provide
his may requir
umns or gels, h
access to the
re labeled.
en removed fr
above has bee
onnel and our c
ce Engineer st
e Service Engi
may lead to de
swer “Yes” or
ers in box belo
ous substance
scanner surfac
ument is clean
ed to allow saf
re customer to
have been rem
e instrument .
from the area
Seria
en cleaned to
Comp
Date
GE and GE
GE Healthc
NJ 08855-1
© 2010-14
On Site
Safety
customers, all
arts a repair. T
neer upon arr
lays in servicin
“No”.
ow.
es
.
ces, or otherw
. If radioactivit
e access for in
o move equipm
moved or isola
to provide ac
l No:
remove any h
pany or institu
(YYYY/MM/DD
monogram are trade
are Bio-Sciences Co
1327
General Electric Com
e Servic
y Declar
equipment an
To avoid delays
ival. Equipmen
ng the equipm
wise ensure rem
ty has been us
nstrument serv
ment from nor
ated from the
ccess.
hazardous sub
ution:
D):
emarks of General E
rp, 800 Centennial A
mpany—All rights res
D
ce Hea
ration F
nd work areas
s in the servici
nt and/or work
ent and could
moval of any d
sed, please pe
vice, repair or
rmal operating
e instrument a
bstances and t
Electric Company.
Avenue, P.O. Box 132
served. First publishe
DOC1149542/
28-980
lth &
Form
must be
ng of your
k areas
be subject to
angerous
rform a
g location
and from
hat the
7, Piscataway,
ed April 2010.
00-26 AC 05/2014
52
Frac-920 and Frac-950 Operating Instructions 28-9622-09 AC
7 Reference information
7.2 Health and Safety Declaration Form