Watson-Marlow SPS - Manual (Page 141)

MasoSine SPS sinusoidal pumps User Manual 141
26 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 subsidiaries
or distributors. Failure to do so will cause 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 packaging con-
taining the product(s). Please complete a separate decontamination certificate for each
product. You are responsible for cleaning and decontaminating the product(s) before
return. Products which have not been cleaned and decontaminated will incur a charge.
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 MasoSine Process Pumps at +49 (0) 07062 64593