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Bio-Hazard Decontamination Certification

Safety is our number one concern.
Please complete the form, if you have any questions please contact our office administrator @ 1-877-460-8200

General Information

Company Name
Website
Company Address
Contact Person
Title
Phone
Fax
E-Mail
Alternate Contact
Title
Phone
Fax
E-Mail

Equipment Location Information

Location of equipment
being picked up:
Room #
Equipment Manufacturer:
Equipment Model Number
Equipment Serial Number

Certification

I certify that I am authorized to act on behalf of:
And that all items described have been thoroughly cleaned (inside and out) and that if this equipment was used in a Bio-hazard application that we have decontaminated the equipment to eliminate all safety and health hazards that could be associated with the Bio-hazard being used by person(s) handling the equipment while in transits or when received at Advanced Environmental Service & Installation Group, Inc. shop facilities.
The decontamination procedures which have been taken are in accordance with OSHA, 29CFR Part 1910.1030 (Amended by 61FR Feb 13, 1996)
Name:
Title:
Date: