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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 :
Risk of infection:
Risk of toxicity:
Risk from radioactive sources:
(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:
3. Instructions for safe repair/maintenance of the unit
a) The unit is safe to work on
b) There is some danger (see below)
Procedure to be adhered to in order to reduce safety risk indicated in b) below.
Date :
Signature :
Address, Division :
Telephone :
Product name :
Pharmaceutical
Refrigerator
Model :
MBR-704G
MBR-704GR
Serial number : Date of Installation :
Please decontaminate the unit yourself before calling the service engineer.
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No