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8.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 attached to the outside packaging of the instrument.
To disinfect and decontaminate: Wipe off the outside surfaces using 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 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 1/11
Chemical Biological Radioactive**
Part# TM338
Page 25
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