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