SPECS EBE-1 - Page 34

Health and Safety Declaration for used Vacuum
Equipment and Components
The repair and/or service of vacuum equipment/components can only be carried out if a correctly
completed declaration has been submitted for every component.
1.______________________________________________Description of components
Type: __________________________________________Serial No:_____________________
2. Reasons for return____________________________________________________________
3. Equipment condition
Has the equipment ever come into contact with the following (e.g. gases, liquids, evaporation
products, sputtering products ...)
Yes No
•
toxic substances?
 
•
corrosive substances?
 
•
microbiological substances (incl. sample material)?
 
•
radioactive substances (incl. sample material)?
 
• ionising particles/radiation (α, β, γ, neutrons, ...)?
 
Yes No
Is the equipment free from potentially harmful and hazardous
substances?
 
4. Decontamination Procedure
Please list all harmful substances, gases and by-products which have come into contact with the vacu-
um equipment/component during the decontamination methode used.
SUBSTANCE DECONTAMINATION METHODE
5. Legally Binding Declaration
Organisation:
Address:
Phone/Fax:
Name/Position:
I hereby declare that the information supplied on this form is complete and accurate.
Date:__________Signature:_____________Company stamp
Rev.: 0 1/1