EQUIPMENT USED WITH HAZARDOUS SUBSTANCES CERTIFICATE OF DECONTAMINATION

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Certificate of Decontamination

EQUIPMENT USED WITH HAZARDOUS SUBSTANCES  CERTIFICATE OF DECONTAMINATION

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):

  • Biologically Active ______

  • Hazardous Substances ______

  • Radioactive ______

N.B If the item is potentially radioactively contaminated, proof of decontamination must be supplied.

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


1EQUIPMENT BROUGHT BY THE USERS DESCRIPTIONNAME 2HAS BEEN
2011 CHEVROLET VOLT STANDARD & AVAILABLE EQUIPMENT DESCRIPTION S
230513P---Motor-Requirements-for-HVAC-Equipment-03-07-2022


Tags: certificate of, equipment, certificate, substances, decontamination, hazardous