Mizuho Osi 5820 User manual

Andrews Surgical Table 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]

Andrews Spinal Surgery Table, Manual

Models: 5820

Work Instruction Number 50603-13

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).

50603-13 Rev. A ECN# 10016 Effective Date 3/9/2010 Page 1 of 6

Andrews Surgical Table 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:

5820, Andrews Table

Tools Required:

Digital Volt Multimeter (DVM) with probe and hook leads
Grease, Lithium, white, multi-purpose
Hex keys, (Allen), ball head, minimum handle length 4 inch (in): 5/64 in, 5/32 in, 3/16 in, 5/16 in.
Wrench, open end, 3/8 in.
Philip Driver
Screw Driver (medium size)
Mirror, small inspection.
Thread-lock, non-permanent, Loctite, blue, or equiv.
Surgical gloves.

Materials Required:

Andrews SST-3000 Spinal Surgery Table User Guide
Andrews Spinal Surgery Table Maintenance and Repair Manual -

Pass Fail

1. General Overall Condition.

1.1 ( ) ( ) Table is clean, without signs of hazardous contamination, is consistent with proper care.
Comments: _________________________________________________________________________

1.2 ( ) ( ) All sheet metal covers are secure without missing fasteners.
Comments: _________________________________________________________________________

1.3 ( ) ( ) Sheet metal covers and paint are free of dents or scratches.
Comments: _________________________________________________________________________

1.4 ( ) ( ) All labels and control panel are intact and legible.
Comments: _________________________________________________________________________

1.5 ( ) ( ) Table Pads retain good shape, are free of punctures, tears or excessive wear.

1. Torso Pads, left and right.

2. Torso Lift Pad.

3. Lateral (Hip) Support Pads (2x).

4. Seat Pad.

5. Thigh (Femoral) Pad.

6. Tibial Pad.

7. “Head Support” pad.

50603-13 Rev. A ECN# 10016 Effective Date 3/9/2010 Page 2 of 6