Avidien - Instrument Decontamination Form

Avidien Technologies Instrument Decontamination Form

Thank you for completing the decontamination form and process. Please feel free to contact us at any time about this document or the instrument (979-634-1404).
Date*

MonthDayYear
Date
RMA #*
Model:*

microPro 300microPro 20
Serial Number:*
Contact Information
Company/Institution Name*
Decontamination performed by:*

First NameLast Name
Email
example@example.com
Do you certify that the instrument is still in its original packaging AND has not come in contact with any substances or chemicals? If YES, then skip to Comments section below.*

YESNO
List all chemicals or substances used with this instrument:*
Decontamination procedure followed:*
Parts that may have been contaminated by potentially hazardous substances, should be cleaned with a damp cloth and 10% bleach solution or any other appropriate disinfectant. Decontamination is the sole responsibility of the owner and/or operator of the instrument. For more information, or if you have any questions regarding decontamination, please contact Avidien Customer Service at support@avidien.com or call (978) 634-1403.
Instrument Return Shipping Address

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Comments:
Signature*
Please verify that you are human*
Should be Empty:

Avidien Technologies Instrument Decontamination Form