Certificate Of Decontamination - Promega Maxwell 16 AS1000 Operating Manual

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VII.D. Certificate of Decontamination
Disinfection and decontamination are required prior to shipping the instrument and instrument
accessories for repair. Instruments returned must be accompanied by a signed and dated Certificate
of Decontamination, which must be attached to the outside packaging of the instrument.
To disinfect and decontaminate: Wipe off the magnetic rod assembly, plunger bar, inside platform,
and inside and outside surfaces using a cloth dampened with 70% ethanol then a cloth dampened
with a 1–2% bleach solution in deionized water. Follow immediately with a cloth dampened with
deionized water to remove any residual bleach from the instrument surfaces. Repeat the procedure
as many times as required to effectively disinfect and decontaminate the instrument.
Failure to confirm disinfection and decontamination will result in decontamination charges
before the instrument will be serviced.
Select either (A) or (B):
A.
I confirm that the returned items have not been contaminated by body fluids or by 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:
Briefly describe the decontamination procedure performed:
Date:
Place:
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:
Place:
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
Printed in USA.
Revised 6/08
Chemical
Biological
Radioactive**
Part# TM274
Page 31

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Maxwell 16 as1002

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