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CAUTION
Please fill in this form before servicing.
Hand over this form to the service engineer to keep for his and your safety.
Safety check sheet
1. Freezer contents : □Yes □No
Risk of infection: □Yes □No
Risk of toxicity: □Yes □No
Risk from radioactive sources: □Yes □No
(List all potentially hazardous materials that have been stored in this unit.)
Notes :
2.
Contamination of the unit:
Unit interior: □Yes □No
No contamination: □Yes □No
Decontaminated: □Yes □No
Contaminated: □Yes □No
Others:
3. Instructions for safe repair/maintenance of the unit
a) The unit is safe to work on □Yes □No
b) There is some danger (see below) □Yes □No
Procedure to be adhered to in order to reduce safety risk indicated in b) below.
Date :
Signature :
Address, Division :
Telephone :
Product name: Model: Serial number: Date of installation:
Biomedical Freezer MDF-
Please decontaminate the unit yourself before calling the service engineer.
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