47
Safety Check Sheet (for copy)
1. Used sample
：
Risk of infection:
No possibility Some possibility Possible
Risk of toxicity:
No possibility Some possibility Possible
Radioactive material:
Not
used
Used
(Nuclide:
)
Other
special
instruction:
2. Contamination of the unit
Interior:
No contamination Decontaminated Some possibility of contamination Contaminated
(if decontaminated, method: )
Other
contamination:
3. Instructions for safe service/maintenance/disposal of the unit
a) The unit is safe to work on
b) There is some danger. The precaution or decontamination method is as follows:
Date:
Name
&
Signature:
Division
or
department
Telephone:
Product name
Model number
Serial number
Date of installation
Pharmaceutical
MPR-
refrigerator
MPR-715F
<Request> Please fill in this form before servicing. Hand over this form to the service engineer
to keep for his and your safety.
Please decontaminate the unit yourself before calling the service engineer.
