Watson-Marlow 120U/D1 - Manual (Page 14)

Watson-Marlow 120 IP31 pumps: general information 12
1.14 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 substances which have been in contact with
product(s) you return to Watson-Marlow or its sub-
sidiaries or distributors. Failure to do so will cause
Your name Company
Address
Postcode/zip Country
Telephone Fax
Product type Serial number
To speed the
repair, please
describe all
known faults
The product has ...
■
Been used
■ ■
Not been used
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 Watson-Marlow Pumps at +44 1326 376009.
delays. Please ensure that you fax us this form and
receive an RGA (Returned Goods Authorisation)
before you despatch the product(s). A copy of this
form must be attached to the outside of the pack-
aging containing the product(s). Please complete a
separate decontamination certificate for each prod-
uct.
You are responsible for cleaning and decontaminat-
ing the product(s) before return.