See Waste Management –
Environmental Management
Procedure for guidance
(FMENV016).
Equipment / Article Clearance Certificate (FM ENV REC 029)
Safety, Health & Environment Section
Equipment Producer Details
Name of person
disposing/moving
equipment:
Ext No:
Producing Building
& Room Number:
Producing
School/Service:
Description of Equipment/Article:
Please complete either section A or B:
Section A: Equipment/Article fully decontaminated: I certify that the equipment / article listed above has been decontaminated and is radiologically,
chemically and biologically clean (so far as reasonably practicable). Please state the substances and or processes used during decontamination.
Name:
Signature:
Date:
List of substances
/process used for
decontamination
Section B: Equipment/Article NOT fully decontaminated: I certify that the above equipment/article has not (so far as reasonably practicable) been
decontaminated and may not be radiologically, chemically or biologically clean. Please state below the nature of the risk and safety precautions necessary.
Name:
Signature:
Date:
List contaminants
still present / nature
of risks:
Version 2.0
Handling /
storage / disposal
precautions: