RMA Form - ≡ Plasmadiam® - Swiss Vacuum Solutions

Fill your RMA form

Declaration of Contamination - Form HS2

Read and follow the Procedure HS2 before you complete this Declaration. This Declaration may be completed and signed only by authorized and qualified staff. If you need assistance completing this form please contact sales or customer care in your area.

Equipment

Manufacturer's Product Name

Manufacturer's Serial Number

If applicable

Tool Identification Number

Tool Manufacturer/OEM

Tool Model

Process

Installed Date

De-installed Date

Part Number of Replacement Equipment

Serial Number of Replacement Equipment

Condition of equipment
We will not accept delivery of any equipment that is contaminated with radioactive substances, biological/ infectious agents, mercury, PCB’s, dioxins or sodium azide. Was your equipment infected by one of these substance ?

Question0

YES NO

PLEASE STOP FILLING THE FORM AND CONTACT OUR TEAM AT CONTACT@PLASMADIAM

Condition of equipment
What substance your equipment has been infected by ?

Substance

Chemical Symbol

Precautions required (for example, use protective gloves, etc.)

Action required after a spill, leak or exposure

More substance ?

Question 2

YES NO

Substance

Chemical Symbol

Precautions required (for example use protective gloves, etc.)

Action required after a spill, leak or exposure

More substance ?

Question 3

YES NO

Substance

Chemical Symbol

Precautions required (for example use protective gloves, etc.)

Action required after a spill, leak or exposure

Return information

Reason for return and symptoms of malfunction

For how many hours has the product run ?

Declaration

Name

Job Title

Organisation

Address

Telephone number

Date of equipment delivery

Signature

I have made reasonable enquiry and I have supplied accurate information in this Declaration.
I have not withheld any information, and I have followed the Procedure HS1.

Signature

Date

FR

FR

Fill your RMA form

Declaration of Contamination - Form HS2

Swiss Official Distributor of