Incident report
This incident report form should be used where an incident constitutes an event that has contributed to, or could have potentially caused or contributed to, a death or serious injury, where SteriPack is the legal manufacturer.
In an emergency please call our vigilance hotline +48 516 152 739 / +48 515 181 891 or complete the form.
Data Protection Policy: With accordance to the Regulation (EU) 2016/679 of the European Parliament and of the Council of 27 April 2016 on the protection of natural persons with regard to the processing of personal data and on the free movement of such data, and repealing Directive 95/46/EC (General Data Protection Regulation) you have the right to withdraw your consent at any time, however in case you withdraw your consent, we will not be able to contact you. To withdraw your consent, please, contact us by email and describe the field of objection: GDPR_consent_withdraw@steripackgroup.com. You have the right to access personal data, rectify, delete or limit their processing, the right to objection, the right to transfer data, the right to lodge a complaint with a supervisory authority. The personal data controllers are joined companies from the SteriPack Group indicated below: 1) Poland: SteriPack Medical Poland sp. z o.o., Łęg, ul. Japońska 1, 55-220 Jelcz-Laskowice, 2) US: SteriPack USA, Ltd., 4255 S. Pipkin Road, Lakeland, Florida 33811, 3) Malaysia: SteriPack Asia Sdn Bhd, Lot 119992, Jalan Canang Emas 8, Telok Gong Industrial Estate, Klang 42000, Selangor. Withdrawal of consent for one of the companies means the withdrawal of consent for the whole SteriPack Group.
Incident report form
Please include as much detail as possible