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Documents are only to be used and distributed completely and unchanged. It is strictly the users´ responsibility to check carefully
the validity of this document with respect to his product. 25/11/2013 // 999281
Description of the decontamination method:
Outside: ...............................................................................................................................................
Inside(e.g.bottle,screwcap,coupling,lter,hoses,handle): ............................................................
.............................................................................................................................................................
.............................................................................................................................................................
Interior(vacuumpump,vacuumsensor): ............................................................................................
.............................................................................................................................................................
.............................................................................................................................................................
10. Risk level 2 and higher: The device may only send for repair if it is ensured that also the
vacuum pump is not contaminated.
The vacuum pump has been checked for internal contamination and is not contaminated:
☐ yes ☐ no
11. All parts of the device are free of hazardous, harmful substances: ☐ yes ☐ no
12. ProtectivemeasuresrequiredforVACUUBRANDemployees:
..............................................................................................................................................................
13. If the paint is damaged, we wish a repaint or a replacement of parts for reason of appearance
(repaintandreplacementatcustomer’sexpense).
☐ yes ☐ no
14. Legally binding declaration
We assure for the returned device that all substances, which have been in contact with the device are
listed in section 5 and that the information is complete and that we have not withheld any information. We
declarethatallmeasures-whereapplicable-havebeentakenlistedinsection“Returntothefactory”.
By our signature below, we acknowledge that we accept liability for any damage caused by providing
incompleteorincorrectinformationandthatweshallindemnifyVACUUBRANDfromanyclaimsas
regardsdamagesfromthirdparties.Weareawarethatasexpressedin§823BGB(PublicLawCode
ofGermany)wearedirectlyliableforinjuriesordamagessufferedbythirdparties,particularly
VACUUBRANDemployeesoccupiedwithhandling/repairingtheproduct.
Shipping of the device must take place according to regulations.
Name: .................................................................. Signature: ............................................................
Job title: ................................................................... Company’sseal:
Date: ........................................................................
ReleaseforrepairgrantbyVACUUBRAND(date/signature): ...................................................................................................................
Protective measures: ☐ Protective gloves, -glasses ☐ Hood ☐ External cleaning
VACUUBRANDGMBH+COKG
Alfred-Zippe-Straße 4
97877 Wertheim
Germany
Tel.:+499342808-5660
Fax:+499342808-5666
E-Mail:service@vacuubrand.com
www.vacuubrand.com
Health and safety clearance form BVC page 2 of 2
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