Submission Form EO
to be attached to products shipped to Medistri SA for EO processing
Company’s name :
Your Reference (Delivery Note or Order) :
Lot / Article Reference (if applicable) :
Select one of the followings, Sterilization EO, Treatment EO or Validation EO
Do you have a Customer Card?
Yes - Sterilization EO Certificate - If you do not have a sterilization validation, please select treatment
Quantity of pallets / boxes (total, only the given amount will be checked)
Quantity of cycles
1
2
More :
Customer Card no. :
Pallets :
Boxes :
Is a first treatment cycle required? (please fill the information on treatment section below)
Express processing - Products are processed in less than 5 days
including weekends and Holidays. 25% extra will be charged. Analyses
results and certificates are released only on working days
Quantity of pallets / boxes (total, only the given amount will be checked)
1
2
More :
Yes
No
Standard processing - Products are processed according to contract or within 5-7 working days
Offer / quotation :
Treatment card no. :
Boxes :
No - Treatment EO Certificate - No validation : the shipped products are for EO treatment
Quantity of cycles
S#
Pallets :
#
Remarks:
Degassing time in degassing cell after full cycle :
hours
Ambient aeration time after full cycle :
days
Quality certificate report : Standard
e-mail address for sending the certificates :
Invoicing : e-mail address for sending the invoices :
Express processing - Products are processed in less than 5 days
including weekends and Holidays. 25% extra will be charged. Analyses
results and certificates are released only on working days
Standard processing, Products are processed according to contract or within 5-7 working days
Manufacturing - If shipped load contains products that shall be processed according to a Technical File
Technical File no. :
Laboratory - If shipped load contains products for laboratory analyses
Quantity:
Bioburden (to be taken out before sterilization)
Endotoxins / LAL (to be taken out after sterilization)
Lot Number:
Residue testing (to be taken out after sterilization)
Others :
Quantity:
Sterility testing (to be taken out after sterilization)
Lot Number:
Quantity:
Samples storage conditions
Frozen (min -20°C)
Quantity:
Lot Number:
Quantity:
Lot Number:
Lot number:
Refrigerated (2-8°C)
Express processing - Analyses start according to our planning (please
contact our Customer Service to fix a delay). 50% extra will be charged.
Analyses results and certificates are released only on working days
Room temperature (15-25°C)
Samples disposition after analyses
Discard
Return
Standard processing – Analyses start according to our planning ( working days only)
Packaging - For packaging please contact us for quotation according to your requirements
Single Packaging
Dimensions:
Remarks:
Double Packaging
Dimensions:
Labelling
Cleaning under controlled conditions
Validation EO - The shipped products are for validation
Pallets :
Offer / quotation :
Boxes :
#
Pieces :
Transport - Fill in if you do not have a Customer Card or if different
Medistri organizes the transport by using its own transport company (Post)
Yes
No
Transport company’s name:
Transport company’s address:
If no:
Medistri organizes the transport by using customer’s transport
Transport company’s email:
Account #:
Customer’s email for copy:
Remarks:
By your signature, you attest that all batteries have been removed from your devices
Date
Name
Signature
To be filled by Medistri SA
Date de réception :
Heure de réception :
Quantité de palettes :
Conditions de réception
Quantité de boxes :
Bon état
Endommagés (Tampon bleu) :
Signature Opérateur
Medistri :
Plus –value
Dommages mineurs
Tampon noir
Dommages majeurs
Tampon jaune - HOLD
Signature Chauffeur :
Plus-value
Manipulation
Photos - Etiquettes, palette générale, cartons endommagés
Labo Batch :
1/1