SAFE 2010/MaxiSAFE 2010
INSTRUCTION MANUAL
Page 35 of 35
81-09-IM.doc
13. Statement
Statement regarding personal safety for repair/inspection
Jouan Nordic is legally obliged to protect its employees from all dangers.
We therefore kindly ask you to complete this statement before work is commenced.
Subject: Service report no. ____________ Service agreement no. ____________
The undersigned hereby declares that the above repair/inspection will not expose the service
technician to hazardous biological, chemical or radioactive agents. Reservations, if any, may be
indicated here (e.g. use of gloves, respiratory gear, etc.).
Date Name in block letters Signature
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