Mizuho Osi 5371 User manual

Modular Surgical Tabletop T e c h n i c a l S e r v i c e s D e p a r t m e n t
Preventative Maintenance Checklist Phone: [phone] PST Fax: [phone]

Imaging Spinal Surgical Tabletop

Models: 5827, 5927

of the Modular Table System (MTS) product line

Work Instruction Number 50603-12

Contact Information:

Date: ________________Model/Serial#: _______________________ Account #: ____________________
Hospital Name: ________________________ _________ City & State: ________________________________
Contact Name: _______________________ Position: ___________________ Phone: _____________________
Equipment Location: ___________________________ ____________________________________ _________
Service Representative: _____________________ Service Organization: ____________________________ ___
Service Rep. phone: ________________________ Home location: ____________________________________

Customer contact accepting service: ______________________ __________________ ____________
Name please print Signature Date

Service Representative: ________________________ _______________ ________________ ___
Name please print Signature Date

Using this report: Please proceed through each step and place an “x” in the “( )” as each item representing Pass
Fail ( ) ( ) criteria is inspected. If a step has failed, please indicate with an “x” and note the reasons in the
comments section. If you resolve the failure place an “x” in the “Pass” area and indicate the corrective action again
in the comments section. If you are unable to perform any Pass/Fail check, please contact Mizuhosi Technical
Services for assistance and circle the check.

Biohazards when servicing equipment: Please take appropriate precautions for servicing potentially contaminated
biohazard equipment or working in biohazard surroundings. Please wear protective surgical gloves and log sleeved
gowns at all times. If your gloves or protective clothing tears, replace immediately. Have the hospital staff clean the
equipment appropriately prior to servicing. Clean your tools that may contain biohazards prior to placing back in
your tool kit for removal from the location. If you suspect biohazards are present do not service the equipment until
they have been cleaned.

(If serviced by an outside service organization, the record must be reviewed, signed, and dated by Technical
Services Dept. Refer to last page of this document).

50603-12 Rev. A ECN# 10016 Effective Date 3/9/2010 Page 1 of 3

Modular Surgical Tabletop T e c h n i c a l S e r v i c e s D e p a r t m e n t
Preventative Maintenance Checklist Phone: [phone] PST Fax: [phone]

Surgical bases covered:

5827 Radiolucent Imaging Top, 350lb (pounds) patient weight capacity
5927 Radiolucent Imaging Top, 500lb patient weight capacity

Tools Required:

Cotton swab
Lubricant, silicon, spray
Grease, Lithium bases, white, multi-purpose

Materials Required:

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Pass Fail

1. Top Inspection and fit.

1.1 ( ) ( ) Table top is clean, without signs of hazardous contamination, and all labels are intact and legible.
Comment: __________________________________________________________________________

1.2 ( ) ( ) Carbon fiber top is free of wear, cracks, delamination or splinters. Particular inspection is required
of the siderail-to-top joint. Joint is securely bonded without voids, cracks, or separation.

Comments: _________________________________________________________________________
Diagnostic/repair tip: splinters are easily detected by running a cotton swab along surface. Smooth

splinter area with a light sanding with 400 grit sandpaper then applying a small amount of
Polycyanuacyralate (“super-glue”) to seal affected area.

1.3 ( ) ( ) Gimbals are secure, rotate to stops and return to center position.
Comments: _________________________________________________________________________
Note: earlier models may not be equipped with gimbals.

1.4 ( ) ( ) Fits in all positions on removable H-frames, T-pins slide into locked position freely.
Comments: _________________________________________________________________________

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Warning

will cause severe damage.

1.5 ( ) ( ) With top in 3
and Reverse-Trendelenburg.

Comments: _________________________________________________________________________

1.6 ( ) ( )With top in lowest position on H-frames, top rotates freely at 5 degree Trendelenburg and Reverse­ Trendelenburg.
Comments: _________________________________________________________________________

50603-12 Rev. A ECN# 10016 Effective Date 3/9/2010 Page 2 of 3

: Rotation of tops not equipped with gimbals beyond 5 degree Trendelenburg and Reverse-Trendelenburg

rd

from highest position on H-frames, top rotates freely at 5 degree Trendelenburg