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Claim Report Form
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Fields marked with * are mandatory
When did the error occur?
Product was in use:
Is the product available for examination?
Are photos of the faulty product available?
Was the product cleaned/disinfected/sterilised during use?
If yes, with what? How often?
Person reporting the event (hospital, doctor, nurse or other):
DECONTAMINATION
Defective products must be returned thoroughly cleaned and decontaminated.
I hereby confirm that (please tick the appropriate box(es)):
CAUTION: Do not use disinfectants that release chlorine or those containing strong alkaline or phenolic derivatives.
Return in airtight packaging to: TRACOE medical GmbH | Reichelsheimer Str. 1 / 3 | 55268 Nieder-Olm
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TRACOE medical GmbH
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