Biometra TProfessional Basic - 12 Equipment Decontamination Certificate

68 Instruction Manual TProfessional Basic 06/2011
12 Equipment Decontamination Certificate
To enable us to comply with german law (i.e. §71 StrlSchV, §17 GefStoffV and §19 ChemG)
and to avoid exposure to hazardous materials during handling or repair, please complete this
form, prior to the equipment leaving your laboratory.
COMPANY / INSTITUTE __________________________________________________
ADDRESS ______________________________________________________________
PHONE NO _________________________ FAX NO_________________________
E-MAIL ______________________________________________________________
EQUIPMENT Model Serial No
______________ ______________
______________ ______________
______________ ______________
______________ ______________
If on loan / evaluation Start Date: __________________ Finish Date __________________
Hazardous materials used with this equipment:
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
Method of cleaning / decontamination:
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
The equipment has been cleaned and decontaminated:
NAME __________________________________ POSITION _______________________
(HEAD OF DIV./ DEP./ INSTITUTE / COMPANY)
SIGNED ________________________________ DATE ____________________________
PLEASE RETURN THIS FORM TO BIOMETRA GMBH OR YOUR LOCAL BIOMETRA
DISTRIBUTOR TOGETHER WITH THE EQUIPMENT.
PLEASE ATTACH THIS CERTIFICATE OUTSIDE THE PACKAGING. INSTRUMENTS
WITHOUT THIS CERTIFICATE ATTACHED WILL BE RETURNED TO SENDER.