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TLC CALIBRATIONS COMPANY

DECONTAMINATION FORM

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Decontamination Form

Please answer the following questions to ensure that your equipment meets the needs for decontamination prior to calibrating or repairing your equipment.

Has your equipment been exposed internally or externally to the following:

Blood, body fluids, pathological specimens?

Biodegradable material that could be hazardous?

Other hazards?

Radioactive substances?

Blood, body fluids, pathological specimens?

If you answered yes to any of the above, please provide comments as to the names and quantities of isotopes below:

Method of Sterilization

Full Name

I certify that instruments included are free of any radioactive, bio-hazardous, pathological, or other dangerous substances and are safe for human handling.

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