T-IM114b P59/62
T20
Series
OPERATION TABLE
APPENDIX 2
DECONTAMINATION CERTIFICATE
Make and description of equipment/item:
Catalogue number (REF)*:
Serial Number (SN)*:
This is to certify that the above equipment/item has been decontaminated in accordance with the
attached procedure and that this certificate has been issued by the authorized person detailed
below. The equipment/item has also been suitably marked to show it has been decontaminated in
accordance with the attached procedure and that this certificate has been issued.
Certificate issued by:
Title:
Position:
Hospital/unit address:
Date:
Additional information (optional)
Reason for return:
For the attention of:
* If applicable and known
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