Proof Of Cleaning Statement - CareWise C-Trak Apollo User Manual

C-Trak Apollo
Appendix E
RMA Number:
Purchase Order Number:
Serial Number(s) and Reason(s) for return:
S/N-1
S/N-2
S/N-3
S/N-4
S/N-5
This "Proof of Cleaning Statement" is a safety requirement. Its purpose is to ensure that the item(s) being returned for
evaluation/repair/maintenance pose no biological threat to any personnel that may be exposed to said product.
A thorough cleaning with 70% denatured alcohol or an enzymatic detergent (such as Klenzyme, Manu-Klenz or similar product) will suffice.
If you are returning an OmniProbe
inside and outside along with the probe body. No residue is to remain on the probe or collimator surfaces.
Improperly cleaned product may be returned to the customer at their expense or incur a £150 (or equivalent in local currency )cleaning charge.
If there are questions on how to properly clean the equipment, please refer to your Product Manual or call Care Wise for instructions.
I attest that the above cleaning procedure has been completed and that the item(s) being returned
is/are not contaminated and pose(s) no biohazard threat to personnel.
Signature:
Date:
Title:
www.carewise.com
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Proof of Cleaning Statement

(Must be included with any C-Trak
device with a collimator, the collimator must be removed and cleaned thoroughly,
®
Device/System return)
®
Date:
REASON-1
REASON-2
REASON-3
REASON-4
REASON-5