Certificate Of Decontamination - Promega Maxwell 16 MDx Operating Manual

12. Certificate of Decontamination
Disinfection and decontamination are required prior to shipping the instrument and accessories for repair.
Returned instruments 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 in contact with body fluids or toxic, carcinogenic, radioac-
tive, 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 · 608-274-4330 · Fax 608-277-2516
www.promega.com
Chemical Biological Radioactive**
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TM320 · Revised 4/15