Bio-Rad Bio-Plex® 200 Systems User Manual
Page 48
Equipment Return Information Label and
DECONTAMINATION CERTIFICATE
Before Bio-Rad can accept this equipment, you must certify that it is NOT CONTAMINATED with
chemical, radioactive, or biological materials or hazards. Please indicate if any of the following
potential hazards may have come in contact with the equipment, and the steps you have taken to
decontaminate the equipment by marking the appropriate box (
❏).
If the equipment was used in a class 2, 3, or 4 biohazard work area, or if the equipment was
exposed to known carcinogens or teratogens, or exposed to radioisotopes other than those listed
below, we will not accept it for repair in-house. If you need service for such instruments, or if you
have any questions, please call 1-800-4BIO-RAD.
1.
Chemicals
❏ Strong acids or bases (names and concentrations)
❏ Solvent(s) (name)
❏ Other
❏ No hazardous chemicals came in contact with this equipment.
2.
Radioactive Materials (Have any of the following isotopes been used with the equipment?)
❏ P32
❏ I 125
❏ S 35
❏ C 14
H 3
❏ N 15
❏ Other isotopes
If so, were these:
❏ Beta emitters ❏ Gamma emitters ❏ Alpha emitters
Equipment has been surveyed by (method) prior to shipment.
Reading
❏ No radioactive materials came in contact with this equipment.
3.
Biological Hazards (Are any of the following applicable to this equipment?)
❏ The equipment contained live microorganisms (for example, bacteria) or live virus.
❏ The equipment contained live bacteria other than E. coli.
If so, name of bacteria:
❏ Equipment was used in a class 2, 3, or 4 biohazard work area. (We will not accept it for
repair. Please call to make other arrangements.)
❏ The equipment contained or was exposed to blood, serum, blood products, or other
bodily fluids.
❏ No biological hazards have come in contact with this equipment.
4.
Decontamination This equipment has been decontaminated with:
5.
❏ This instrument has never been used and is in new condition.
I certify that this instrument has been cleaned and decontaminated of any chemical, radioactive, or
biological materials or hazards that may have come in contact with the equipment during the
equipment’s use and operation.
Signed Title
Date Printed Name
Institution Phone
Address Fax
43