Pre-service declaration form

INTRODUCTION
Before sending Environics Oy products for servicing, you must inform Environics Oy if substances you have used or measured with our products can be hazardous. This information is fundamental to the safety of our service employees and will determine the procedures employed to service your equipment.

Following pre-service declaration form has to be completed and send before sending the equipment for service to Environics Oy. You can declare multiply equipment with one form if they have been contacted with same substances.

GUIDELINES

  •  Equipment is 'uncontaminated' if it has not been used, or if it has only been used with substances that are not hazardous or harmful. Your equipment is 'contaminated' if it has been used with any substances classified as hazardous and/or harmful. Contaminants of particular concern are any radioactive substances, biological or infectious agents, carcinogens, mutagens, reprotoxic substances, and substances corrosive, harmful or toxic by skin contact or inhalation.
  • If your equipment is contaminated, you must remove all traces of contamination before servicing can take place. It is your responsibility to ensure all known remaining potential hazards are clearly identified. Please follow the decontamination procedures given in this form and contact Environics Oy (customer.services@environics.fi) for further information.
  • Environics Oy reserves the right to refuse to service on the equipment(s) at any time, if a safety hazard is suspected.

PROCEDURE

1.    Read and complete the declaration

2.    Contact Environics Oy about servicing the equipment and submit the following form by sending it

3.    After reception of the completed form Environics Oy will contact you and give you a RMA number and instructions on delivering the device(s) to service.    Attach one copy of the filled form including the RMA number with the device(s) to be sent to Environics Oy.

DECONTAMINATE THE EQUIPMENT FOLLOWING THESE INSTRUCTIONS:

For lightly contaminated outside surfaces decontamination can be conducted with mild soap (or unscented dish washing liquid) and water. If the equipment has been heavily exposed or moderately contaminated with CWA, a more thorough cleaning method is required.

Typical method:

  1. Wash the outer surfaces of the equipment with mild soap (or unscented dish washing liquid) and water.
  2. Wipe the surface using towel dampened with a 5 % sodium hypochlorite solution. If surface is badly contaminated let the hypochlorite solution to effect 15 to 30 minutes.
  3. Wipe the surface using towel dampened either soap or dish washing liquids and clean water.
  4. Monitor the decontamination result using chemical detector.
  5. Repeat the steps 1 to 4 if required.

Here is a list of the recommended cleaning agents in order of recommendation:

  1. Soap and water
  2. Mild, odorless dish detergent
  3. 5 % sodium hypochlorite

For chemical contamination the best way to perform decontamination is conduct passive decontamination (climate effect, ventilation, sunlight and time), but it is time consuming.

The towels and water should be treated as hazardous wastes in accordance with the national regulations and instructions.

The best way to decontaminate radiation dust is mechanical decontamination. Remove radiological dust e.g. with vacuum cleaner, brush or wetted towel.  Try not to use pressured air for cleaning, because of dust dispersion.

Perform systematic decontamination to clean all possible contaminated parts. Pay attention to the items and the places where radioactive dust may stick. If the contaminated part is not possible to clean it has to be changed. Dispose all contaminated parts by local regulation.

Typical method:

  1. Remove radiological contamination from surface either using brush, wetted towel or vacuum cleaner.
  2. Monitor the decontamination result using radiation detector.
  3. Repeat the steps 1 and 2 if required.

Remember that radiological decontamination do not destroy the radiation, only removes it.

Follow the instructions given by your own organization. Basically all the radiation exceeding normal background level should be taken into account and basic mechanical radiation decontamination need be to done.

It’s recommended to use identifying radiation detector for deeper inspection due to difference between harmfulness of the radioisotopes.

In the case the devices have been exposed to biological agents/biological simulants that belong to the Class 1 “Biological agents unlikely to cause human disease” perform the decontamination according to the instructions sent by Environics.

In the case the device has been in contact with biological agents belonging to the classes II – IV, please take contact with Environics for special instructions before shipping the device for service.

DECLARATION OF DECONTAMINATION

In order to protect the health of our staff, we kindly ask for your understanding and assistance in ensuring that equipment are fully decontaminated prior to coming into contact with our personnel.









DEVICE INFORMATION

SUBSTANCES IN CONTACT WITH THE EQUIPMENT

If the Environics Oy products have been exposed to hazardous and/or harmful materials and the equipment is contaminated, you must remove all traces of contamination before servicing can take place.

Have any of the following substances been in contact with the equipment?

Radioactive Substances
YesNo

Chemical Agents
YesNo

Carcinogens substances
YesNo

Reprotoxic substances
YesNo

Any other substances corrosive, harmful or toxic by skin contact or inhalation
YesNo

Any other substances that are explosive
YesNo

Any other substances that are flammable or combustible
YesNo

Hazardous biological agents (bacteria, viruses, rickettsia, toxins, fungi)
YesNo

Biological simulants for hazardous biological agents (like for BWAs = biological warfare agents)
YesNo

If you answered yes, please specify the group and details of the biological agents/biological simulants that have been in contact with the device. Please note that the European Union Directive “2000/54/EC Biological agents at work” gives guidelines for protecting the employees from harmful biological agents. In the directive, biological agents are classified into four risk groups according to their level of risk of infection.

Class 1: Biological agents unlikely to cause human disease.

Name & strain of the agent, the form of exposure:

Class 2: Biological agents that can cause human disease and may be a hazard to employees; it is unlikely to spread to the community and there is usually effective prophylaxis or treatment available.

Name & strain of the agent, the form of exposure:

Class 3: Biological agents that can cause severe human disease and may be a serious hazard to employees; it may spread to the community, but there is usually effective prophylaxis or treatment available.

Name & strain of the agent, the form of exposure:

Class 4: Biological agents that can causes severe human disease and is a serious hazard to employees; it is likely to spread to the community and there is usually no effective prophylaxis or treatment available.

Name & strain of the agent, the form of exposure:

Has decontamination been performed according to the given guidelines?
YesNoNo, waiting for further decontamination instructions from Environics

SENDER DETAILS

SHIPPING ADDRESS

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By sending this form I declare that the above information is true and accurate to the best of my knowledge and belief.

Copy of this form will be send to email provided. Please print the e-mail and attach one signed copy with the device(s) to be sent to Environics Oy.