Certifi cate of decontamination
! ! ! CAUTION! ! !
This form must be visibly affi xed to the outside of the package!
C Decontamination - sample copy
This "Certifi cate of Decontamination" is intended to protect the occupational health and
safety of our employees pursuant to the German Protection against Infection Act and trade
association accident prevention regulations.
Please understand that we can only initiate work operations when this Certifi cate is submitted.
Before sending the unit back to us for inspection/repair, the unit and accessories must be
cleaned pursuant to current laws and regulations and, if necessary, must also be disinfected
with a surface disinfection agent listed by the VAH (Alliance for Applied Hygiene).
Device type:
Serial No.:
Accessories:
Device / accessories ...
are not contaminated:
were cleaned before shipping?
are free of toxic matter?
have been decontaminated and/or disinfected and no longer pose a health risk?
What type of toxic materials have the device / accessories been in contact with?
Corrosive
Biologically hazardous (e.g. microorganisms)
Toxic
Radioactive
None
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