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MABTECH INSTRUMENTS
Certificate of Instrument
Decontamination
To ensure the safety of your colleagues, transport personnel, Mabtech personnel, service
engineers and any third party involved in the use, service, refurb, disposal or transportation
of the instrument, it is essential that you characterize any potential contaminants to which
the instrument was exposed and describe any decontamination procedure used to clean the
instrument. Prior to returning the instrument to a contracted recycler or Mabtech, whether
for repair, maintenance, trade-in, loan or waste, this form must be completed and signed by
the customer. The form shall thereafter be attached to the outside of transport packing and
emailed to Customer Service. Prior to performance of any service of an instrument, the
completed form must have been received by Mabtech or any contracted third party.
Instrument ID
Model:
Description:
RMA Number (if required):
Potential Contaminants
Radioactive materials: Has this instrument
YES ⎕
NO ⎕
been exposed to radioactive materials?
Biological agents: Has this instrument been
⎕
NO ⎕
exposed to biological agents?
Hazardous chemicals: Has this instrument
been exposed to chemicals that are toxic in
quantities harmful to human contact,
carcinogenic,
mutagenic,
reproduction, sensitizing, and/or which has
not been fully tested?
Serial Number:
Reason for returning:
If YES, please specify the radioactive
isotopes:
I YES, please state the viable biological
YES
agent(s),
Biological Level/Category of Contamination:
If YES, please specify the hazardous
chemicals:
toxic
for
YES ⎕
NO ⎕
their
Hazard
Group(s)
and
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