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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:
DYes
DNo
Risk
of
infection:
DYes
DNo
Risk
of
toxicity:
DYes
DNo
Risk from radioactive sources:
DYes
DNo
(List all potentially hazardous materials that have been stored
in
this unit.)
Notes:
2.
Contamination
of
the unit
Unit interior
DYes
DNo
No
contamination
DYes
DNo
Decontaminated
DYes
DNo
Contaminated
DYes
DNo
Others:
3.
Instructions for safe repair/maintenance of the unit
a) The unit is safe to work on
DYes
DNo
b)
There is some danger (see below)
DYes
DNo
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:
MPR-311
(H)
MPR-311D(H)
MPR-311DR(H)
Serial number:
Please decontaminate the unit yourself before calling the service engineer.
17
Date
of Installation:
I