DECONTAMINATION CERTIFICATE
ENSURE THAT ITEMS RETURNED TO YOUR SUPPLIER ARE
DISINFECTED IN ACCORDANCE WITH THE APPROPRIATE
HOSPITAL PROCEDURE FOR EQUIPMENT OF THIS TYPE
This form MUST be completed and attached to the outside of the carton when returning the
product to your supplier. Without this form being visible the courier and/or your supplier are at
liberty to refuse handling of the product.
I hereby certify that the machine referred to in this
document by model number and serial number has been
disinfected in accordance with Hospital Procedure
Model No: …………………………………………………..
Serial No: ……………………………………………………
Hospital: ……………………………………………………..
Name: ………………………………………………………..
Signature: ……………………….. Date: ………………..
Prestige PM-D3 Washer Disinfector
