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Return of Edwards Equipment – Declaration
You must:
• Know about all of the substances which have been used and produced in the equipment before you complete this Declaration
• Read the Return of Edwards Equipment – Procedure (HS1) before you complete this Declaration
• Contact Edwards to obtain a Return Authorisation Number and to obtain advice if you have any questions
• Send this form to Edwards before you return your equipment
Manufacturer's Product Name____________________________
Manufacturer's Part Number_____________________________
Manufacturer's Serial Number ____________________________
Has the equipment been used, tested or operated ?
YES
Go to Section 2
Are any substances used or produced in the equipment:
• Radioactive, biological or infectious agents,
mercury, poly chlorinated biphenyls (PCBs),
dioxins or sodium azide? (if YES, see Note 1) YES
• Hazardous to human health and safety ?
SECTION 1: EQUIPMENT
NO
Go to Section 4
SECTION 2: SUBSTANCES IN CONTACT WITH THE EQUIPMENT
NO
YES
NO
IF APPLICABLE:
Tool Reference Number__________________________________
Process________________________________________________
Failure Date____________________________________________
Serial Number of
Replacement Equipment__________________________________
Note 1: Edwards will not accept delivery of any equipment that is
contaminated with radioactive substances, biological/infectious
agents, mercury, PCB's, dioxins or sodium azide, unless you:
• Decontaminate the equipment
• Provide proof of decontamination
YOU MUST CONTACT EDWARDS FOR ADVICE BEFORE YOU RETURN
SUCH EQUIPMENT
Form HS2
Return Authorisation Number:
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