Certificate Of Decontamination - Promega Quantus Fluorometer Operating Manual

6.C. Certificate of Decontamination
Disinfection and decontamination are required prior to shipping the
instrument and instrument accessories for repair. Returned instruments must
be accompanied by a signed and dated Certificate of Decontamination
attached to the outside packaging of the instrument.
To disinfect and decontaminate: Unplug the instrument, and then wipe the
outside surfaces with a cloth dampened with a mild detergent. Do not
submerge the instrument in water.
Failure to confirm disinfection and decontamination will result in
decontamination charges before the instrument is serviced.
Select (A) or (B):
A. I confirm that the returned items have not been contaminated by body
fluids or toxic, carcinogenic, radioactive or other hazardous materials.
B. I confirm that the returned items have been decontaminated and can be
handled without exposing personnel to health hazards.
Circle the type of material used in the instrument: Chemical
Briefly describe the decontamination procedure performed:
Date:___________________________
Return Authorization Number:___________________________
Institution:____________________________________________________________
Signature:
Name (block capital letters):
** The signature of a Radiation Safety Officer is also required if the instrument
was used with radioactive materials.
This instrument is certified by the undersigned to be free of radioactive
contamination.
Date:________________________
Institution:____________________________________________________________
Signature:
Name (block capital letters):
Promega Corporation · 2800 Woods Hollow Road · Madison, WI 53711-5399 USA
Toll Free in USA 800-356-9526 · Phone 608-274-4330 · Fax 608-277-2516 · www.promega.com
Part# TM396
Page 18
Biological
Radioactive**
Printed in USA.
Revised 1/20