Sakura Tissue-Tek Polar DM, Руководство по эксплуатации

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Decontamination Statement
Before you return the instrument that has been used in your institute to the authorized Sakura distributor or
representative for any reason,
please kindly complete this document and place it visibly on the outside
of or include in the transport container of the instrument to be returned.
This statement aims to protect service personnel, transport workers, ambient environment and other
instruments from any contamination.
We would appreciate it if you could provide us with the information as detailed as possible.
Thank you very much for your kind cooperation in advance.
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Name of Your Institute
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Description of Instrument
Product Name Model Serial Number
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Usage Status
Remarks
1. Has the instrument been used in a hospital where provides medical
services for infectious diseases designated by law?
Yes No
2. Has the instrument been used in a ward where provides medical care
to patients of infectious diseases designated by law?
Yes No
3. Has the instrument been used in a room where is in charge of
pathology of infectious diseases?
Yes No
4. Has the instrument been used in a pathology laboratory for infectious
diseases?
Yes No
5. Has the instrument been used in a room where is in charge of
disposal of goods used for infectious diseases?
Yes No
6. Has the instrument been used in a room where special bacteria are
studied?
Yes No
7. Has the instrument been used in a room where is in charge of
disposal of goods exposed to special bacteria?
Yes No
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Decontamination
Customer is kindly requested to return the instrument after cleaning and decontaminating the areas of the
instrument where have contacted or were likely to contact infectious materials as thoroughly as possible using
a general disinfectant such as ethyl alcohol, chlorhexidine-alcohol, benzalkonium chloride and chlorhexidine.
1. Date when decontamination was done
2. Method of Decontamination
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Statement
I certify that the instrument described above has been thoroughly cleaned as described above,
decontaminated of all chemical and biological contaminants and is safe for unprotected human contact.
Department
Telephone number
Name Date
Signature