Equipment Decontamination Form template
A checklist in the Equipment and Calibration procedure (PR16), mapped to ISO 15189:2022 clause 6.4. Fill it in whenever the task occurs. Used by the laboratory team.
ChecklistISO 15189 · 6.4As needed
Calculated automaticallyRed = outside limits
Your LaboratoryEquipment Decontamination Form | YL-LAB-FRM-16-F03 v1.0
Record: Equipment Decontamination Form — October 2026
EquipmentChemistry analyser
Equipment ID / serialEQ-012
LocationMain laboratory
ReasonService
Disinfectant used
Concentration / contact time08:00
| No. | Requirement | Response | Evidence / comment |
|---|---|---|---|
| 1 | Samples, reagents and consumables removed and stored or disposed of | Yes | Within limits |
| 2 | Appropriate PPE worn | Yes | |
| 3 | External surfaces cleaned and disinfected | Yes | |
| 4 | Internal parts / fluidics decontaminated as per manufacturer's instructions | No | Within limits |
| 5 | Probes, carriers, racks and trays decontaminated | Yes | |
| 6 | Waste and liquid waste containers emptied and decontaminated | Yes | |
| 7 | Contact time for the disinfectant respected | Yes | Within limits |
| 8 | Equipment labelled "Decontaminated — date / initials" | Yes | |
| 9 | Service engineer informed of any residual hazard | Yes |
Declaration: this equipment has been decontaminated as recorded above and is safe for service, repair, transport or disposal.
Sign-off
| Role | Name | Signature | Date |
|---|---|---|---|
| Decontaminated by | |||
| Verified by (Section Head) | |||
| Received by (engineer / supplier) |
Shaded cells are calculated automatically. Values in red are outside their limits. † marks a corrected value (see Corrections).
Controlled document. Printed copies are uncontrolled unless stamped.Page 1
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What it records
- Requirement
- Response
- Evidence / comment
Instructions on the form
- Declaration: this equipment has been decontaminated as recorded above and is safe for service, repair, transport or disposal.
Sign-off
- Decontaminated by
- Verified by (Section Head)
- Received by (engineer / supplier)
Related templates
- Equipment Inventory List (PR16-F01)
- Equipment Operating List (PR16-F02)
- Equipment Maintenance & Occurrence Log (PR16-F04)
- Calibration Certificate Review Form (PR16-F05)
- Interpolation Calculator (PR16-F06)
- Guide: ISO 15189 documentation checklist
Clause references are to ISO 15189:2022; check them against your licensed copy of the standard.