Ref SAFIRE:
Declaration of compliance of the Scientific instrument – Version 2015
Declaration of Compliance
of Scientific Instrument
[To be fulfilled by the laboratory]
Name of the instrument
Aircraft
Laboratory name
Laboratory address
I declare the compliance of the named instrument with its description given to SAFIRE in the
document :
"Instrumental Description Form" reference:
And in particular, the different items mentioned below in this document (mass, carrying
hazardous material, etc.).
Head of the laboratory
Name
Date
Signature
Technical person in charge of the instrument
Name
Date
Signature
Ref SAFIRE:
Declaration of compliance of the Scientific instrument – Version 2015
Instrument or rack mass [kg]
(with connectors, cables, etc.)
The instrument contains:
YES
Explosive products
Radioactive products
High Pressure Circuit (static or
dynamic)
Pressurized or under vacuum recipient
(explosion, implosion)
High voltages or high electrostatic
discharges
Electromagnetic or Ionized Radiations
Laser (or other high intensity luminous
sources)
Inflammable/combustible
Material or fluid
Toxic/harmful/corrosive Material or fluid
Other material or systems known as
hazardous or needing special care…
NO
Short Description
Ref SAFIRE:
Declaration of compliance of the Scientific instrument – Version 2015
Attestation of the instrument reception
[To be fulfilled by SAFIRE when receiving the instrument]
Instrument Name
Concerned aircraft
I attest that we have received the above-described instrument and a verification of the visible
parts did not challenge the information given in the declaration of compliance of the scientific
instrument.
Head of SAFIRE
Person at SAFIRE
Which received the instrument
Name
Name
Date
Date
Signature
Signature