Watson-Marlow 120 IP31 pumps: general information
12
1.14 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
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.
RGA number
Signature
Your position
Date
Please print out, sign and fax to Watson-Marlow Pumps at +44 1326 376009.
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 decontaminat-
ing the product(s) before return.