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Product Name/Model:
Serial Number:
Return Authorization Number:
Sender Name:
Address:
Phone:
Please complete all parts of Sections A, B, C and D, including additional information, as requested.
Section A:
Yes
No
This equipment has not been in contact with unfixed biological samples.
Section B:
This equipment has been internally or externally exposed to hazardous materials:
Yes
No
Blood, body fluids, pathological samples.
Other biohazards.
Chemicals/substances hazardous to health.
Other hazards.
Section C:
This equipment has been cleaned and decontaminated:
Yes
If yes, give details of method:
No
If no, indicate why not:
Section D:
Yes
No
This equipment has been prepared to ensure safe handling/transportation.
If possible, use the original shipping box.
Section E:
Has this unit has been operated in a laboratory environment in which work with infections
microorganisms and/or laboratory animals is performed:
Yes
No
If yes, provide Biosafety Level to which the lab operates:
IMPORTANT: To avoid refusal of shipment, place one copy of this form inside box and attach one copy to
outside of box. Customer assumes all responsibility for the immediate return shipment of units sent to Brady
without proper decontamination documentation.
Signature: __________________________________________________________________
(issuer of decontamination certificate)
Decontamination Certificate
Provide further detail here:
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