Watson-Marlow 621CC - Manual (Page 46)

35 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 containing the product(s).
Please complete a separate decontamination certificate for each product.
You are responsible for cleaning and decontaminating the product(s) before return.
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.
Signature
 
 
RGA number
Your position
Date
Please print out, sign and fax to Watson-Marlow Pumps at +44 1326 376009.
Page 46 of 46 Watson-Marlow Bredel E-Manuals
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