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
No contamination Decontaminated Contaminated Others:
□Yes □No □Yes □No □Yes □No □Yes □No
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 with Freezer
Model :
Serial number :
Date of Installation :
Please decontaminate the unit yourself before calling the service engineer.
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