Oh the time i've spent on this symbol. I'm not going to spend
too much more extremely long on this. Authorities will force you so if you're looking for the certification advice then just do it™, but sanely speaking BW should be fine if the system works; for context, this:
The blue colour with the circular shape are intended to communicate a mandatory nature, versus
the red colour with the circular+diagonal bar shape which indicates a prohibition, versus
the yellow colour with the triangular shape, indicates the need to (be aware in certain conditions) to perform or abstain from an
action. It is accented with a black border surrounding it because yellow is able to fade/bleed over into other colours so easily the shape is lost.
The colours emphasize the shapes, but are redundant to the core message of the shapes, which are maintained even when fading or printed in BW.
A symbol that can be contained in any of the above has a contrasting colour so it is highly identifiable and visible.
The colours are specified to a very high degree of accuracy in the colour spaces in those standards, but generally no-one cares as long as humanly seen they don't deviate too much from the primary colours which I've written above, because we're only human after all™.
Why does all this matter, especially with regards to the 60601-1?
The old booklet (Symbol 1641) was used as a general information sign in black and white at the should level, and as the symbol within the blue circle old (Safety sign 01 of 60878). Without the colour these could not necessarily be distinguished well from each other.
The new symbol, man holding booklet (M002) is very different from just the booklet (Symbol 1641). The blue colour thus is no longer essential to communicate the difference in intent. That intent however, is hardly used appropriately.
It mandates you to consult the manual. Risk management wise, it should be used on the location and preferably only during the time it is relevant, and not when it detracts from more important information. However, most people get through certification by sticking it somewhere on the device, once, without reference to the relevant part of the manual you would need at that point (which is logical, because section numbering can change). Long live human flexibility in interpretation.
Source: I've bought all the relevant standards, read the manual on "Writing and Designing Manuals and Warnings, fifth edition", and had the approval to go into lengthy discussion on this with varied people because of similar reasons. Advice: save the money, go the colour route. Some people will use it as a pet peeve find, because it is easy to identify and hard to argue against and ultimately cheaper to give in.
Fun note: practically speaking the presumption of compliance for these symbols is not reflected by reference to study on their effectiveness, because (from OBP) "Test data obtained according to ISO 9186-1:2007 are not available. Consequently, a supplementary text sign shall be used to increase comprehension except when the safety sign is supplemented by manuals, instructions or training.". Or in other words: mass-delusion.
Also
@Tidge ++ man. Every time. Also
@Peter Selvey ++.