Sanyo MPR-1411R Safety check sheet, Please fill in this form before servicing

CAUTION

Please fill in this form before servicing.

Hand over this form to the service engineer to keep for his and your safety.

Safety check sheet

1. Refrigerator contents :	Yes	No
Risk of infection:	Yes	No
Risk of toxicity:	Yes	No
Risk from radioactive sources:	Yes	No

(List all potentially hazardous materials that have been stored in this unit.) Notes :

2.Contamination of the unit

Unit interior	Yes	No
No contamination	Yes	No
Decontaminated	Yes	No
Contaminated	Yes	No
Others:

3. Instructions for safe repair/maintenance of the unit	Yes	No
a) The unit is safe to work on
b) There is some danger (see below)	Yes	No

Procedure to be adhered to in order to reduce safety risk indicated in b) below.

Date :

Signature :

Address, Division :

Telephone :

Product name : Pharmaceutical Refrigerator

Model : MPR-1411 MPR-1411R

Serial number :

Date of Installation :

Please decontaminate the unit yourself before calling the service engineer.

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