198x Filetype DOC File size 0.98 MB Source: www.nottingham.ac.uk
Equipment Used with Hazardous Substances Certificate of Decontamination This form is to certify that equipment that might have been contaminated with hazardous substances has been decontaminated before repair or disposal. You must know all of the substances that have been used and produced in the equipment before you complete this form, which must accompany the equipment for repair/removal. Section 1: Equipment Equipment model number Serial Number Plant Number Usual Location Section 2: Substances in Contact with the Equipment Are any of the substances used or produced in the equipment (tick as appropriate): N.B If the item is potentially Biologically Active ______ radioactively contaminated, proof Hazardous Substances ______ of decontamination must be supplied. Radioactive ______ Section 3: List of Substances in Contact with the Equipment Substance name or type Associated Hazards Section 4: Method of Decontamination Section 5: Declaration Date of Decontamination Carried out By (Print Name and give Job Title) Contact Details Signed Date Version 2. July 2016
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