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Promega Corporation · 2800 Woods Hollow Road · Madison, WI 53711-5399 USA · Toll Free in USA 800-356-9526 · 608-274-4330 · Fax 608-277-2516
TM411 · Revised 4/15
www.promega.com
10. Certificate of Decontamination
Disinfection and decontamination are required prior to shipping the instrument and accessories for repair.
Returned Instruments must be accompanied by a signed and dated Certificate of Decontamination, which
must be attached to the accessories box inside the instrument packaging.
To disinfect and decontaminate: Wipe off the magnetic rod assembly, plunger bar, inside platform, and
inside and outside surfaces using a cloth dampened with 70% ethanol. Follow immediately with a cloth
dampened with deionized water. Repeat the procedure as many times as required to effectively disinfect and
decontaminate the instrument.
Failure to follow these decontamination guidelines, sign and return the Decontamination Form will
result in decontamination charges before the instrument will be serviced.
Select either (A) or (B):
A. I confirm that the returned items have not been contaminated by body fluids or by toxic,
carcinogenic, radioactive, or other hazardous materials.
B. I confirm that the returned items have been decontaminated and can be handled without exposing
personnel to health hazards.
Circle the type of material used in the instrument:
Chemical Biological
Radioactive**
Briefly describe the decontamination procedure performed:
Date:
Place:
Signature:
Name (block capital letters):
** The signature of a Radiation Safety Officer is also required if the instrument was used with radioactive
materials.
This instrument is certified by the undersigned to be free of radioactive contamination.
Date:
Place:
Signature:
Name (block capital letters):
Title: