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F-13-01
Page
1 / 3
Version
01
Effective Date
01.01.2008
Declaration about decontamination and
cleaning of equipment and components
When returning equipment or components, please describe on page 2 of this form the problem(s) or fault(s) you have found. Please
also indicate the remedial actions you require.
To protect our personnel, we require all equipment or components be free of biological, chemical, or radioisotopic contaminants. We
will only accept such equipment or components when:
the equipment or components have been adequately cleaned and decontaminated.
•
this declaring document has been completed, signed and returned by an authorized person.
•
Please help us in assuring a safe, hazard-free work environment.
A. Description of the Equipment or Component(s)
Description / Cat. No.
Serial no.
No. of invoice/delivery note
Date of delivery
B. Contamination / Cleaning
Attention: Please specify exactly the biological, chemical, or
radioisotopic contaminant
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40
Declaration about decontamination
Return of material
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Attention: Please describe the cleaning and decontamination
procedure/method
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has been cleaned and decontaminated by
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