23 Decontamination certificate
In compliance with the
UK Health and Safety at Work Act
and the
Control of Substances
Hazardous to Health Regulations
, you are required to declare the substances which have
been in contact with product(s) you return to Watson-Marlow or its subsidiaries or
distributors. Failure to do so will cause delays. Please ensure that you fax us this form and
receive an RGA (Returned Goods Authorisation) before you despatch the product(s). A copy
of this form must be attached to the outside of the packaging containing the product(s).
Please complete a separate decontamination certificate for each product.
You are responsible for cleaning and decontaminating the product(s) before return.
Your name
Company
Address
Postcode/zip
Country
Telephone
Fax
Product type
Serial number
To speed the repair, please
describe all known faults
The product has ...
Been used
Not been used
If the product has been used, please complete all the following sections. If the product has
not been used, please just sign this form.
Names of chemicals handled
with product(s)
Precautions to be taken in
handling these chemicals
Action to be taken in the
event of human contact
I understand that the personal data collected will be kept confidentially in accordance with
the UK Data Protection Act 1998.
Signature
RGA number
Your position
Date
Please print out, sign and fax to Watson-Marlow Pumps at +44 1326 376009.
Page 47 of 47
Watson-Marlow Bredel E-Manuals
14/12/2009
file://M:\staging\pdfs-global\m-521-cc-gb-03.htm
