Planer Kryo360-1.7, Руководство оператора

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71 Additional information
5.3.1.1 Declaration of Contamination Status
Prior to the Inspection, Servicing, Repair or Return of Medical and Laboratory Equipment
To:
Planer plc.
110 Windmill Rd., Sunbury, Middlesex, TW16 7HD Make and Description of Equipment:
Serial No:
Authority's Reference or Order Number: Planer's Service Order or Returns Authorisation
Reference.
Tick box A if applicable. Otherw ise complete all parts of B, providing further information as requested or appropriate.
A
This equipment/item has not been used in any invasive procedure or been in contact w ith blood,
other body fluids, respired gases, pathological samples or substances hazardous to health. It
has been cleaned in preparation for inspection, servicing, repair or transportation.
B
1. Has this equipment/item been exposed internally or externally to hazardous materials as
indicated below ?
Provide further details here:
YES/NO Blood, body fluids, respired gases, pathological samples.
YES/NO Other biohazards.
YES/NO Chemicals or substances hazardous to health.
YES/NO Other hazards.
2. Has this equipment/item been cleaned and decontaminated?
YES/NO Indicate the methods and materials used.
If the equipment/item could not be decontaminated, please indicate w hy. Such equipment must
not be returned/presented w ithout the prior agreement of the recipient w hose reference or
contact name must be given above.
3. Has the equipment/item been suitably prepared to ensure safe handling/transportation.
YES/NO
I declare that I have taken all reasonable steps to ensure the accuracy of the above information in accordance w ith HSG
(93)26.
Authorised signature: Unit:
Name (printed): Department:
Position: Tel. No.
Date: Fax No.