(Form HS2)
Return A uthorisation Number:
You must:
.Know about all of the substances which have been used and produced in the equipment before you complete this
Declaration
.Read the Procedure (HS1) on the previous page before you attempt to complete this Declaration
.Contact your supplier to obtain a Return Authorisation Number and to obtain advice if you have any questions
.Send this form to your supplier before you return your equipment
Are any of the substances used or produced in the equipment
.Radioactive yes O no O
.Biologically active yes O no a
.Dangerous to human health and safety? yes O no O
If you have answered 'no' to all of these questions, go to Section 4.
Action required after spillage
or human contact
Chemical
symbol
Substance name
Pr~autionsrequired
(for example, use protective gloves, etc.)
1
2
I "
4
5
6
Reason for return and symptoms of malfunction
If you have a warranty claim:
.who did you buy the equipment from ?
0
;
"'
~
.I
~
~
give the supplier's invoice number
Print your job title:
Print your name:
Print your organisation:
Print your address:
Date of equipment deliveryTelephone number:
I have made reasonable enquiry and I have supplied accurate information in this Declaration. I have not withheld any
information. I have followed the Return of Edwards Equipment Procedure (HSl) on the previous page.
Signed
Date
To Next Page
Loading...
Need help?
General
