BLADE CONTROL RECORD

BLADE TYPE ISSUED BY ISSUERS ISSUED TO DATE TIME RECEIVERS OLD BLADE RETURNED
ISSUED SIGNATURE (NAME AND KNIFE ID. SIGNATURE INTACT YES / NO
(AR, FP, SH, SC) CODE) (IF NO COMPLETE REVERSE)

BLADE TYPE KEY = Automatic Retractable (AR), Folding Pen (FP), Sheath (SH), Scalpel (SC)
HD 16.17 Revision 1
PAGE 1 OF 2 Issue Date: 15.02.00
 BLADE CONTROL RECORD
ISSUERS RECEIVERS REASON FOR NON RETURN OF ACTION TAKEN DATE TIME
SIGNATURE SIGNATURE BLADE/RETURN OF A DAMAGED BLADE

BLADE TYPE KEY = Automatic Retractable (AR), Folding Pen (FP), Sheath (SH), Scalpel (SC)
HD 16.17 Revision 1
PAGE 2 OF 2 Issue Date: 15.02.00