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39 Decontamination certificate
In compliance with the UK Health and Safety at Work Act and the Control of Substances Hazardous to Health Regulations, you are required to declare the sub- stances which have been in contact with product(s) you return to
You are responsible for cleaning and decontaminating the product(s) before return.
Your name |
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| Company |
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Address |
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Postcode/zip |
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| Country |
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Telephone |
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Product type |
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| Serial number |
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To speed the |
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repair, please |
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describe all |
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known faults |
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The product has ... |
| Been used | ■ | Not been used |
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If the product has been used, please complete all the following sections.
If the product has not been used, please just sign this form.
Names of chemicals handled with product(s)
Precautions to be taken in handling these chemicals
Action to be taken in the event of human contact
I understand that the personal data collected will be kept confidentially in accordance with the UK Data Protection Act 1998.
RGA number
Signature | Your position |
Date
Please print out, sign and fax to
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