Mizuho Osi 6844 User manual

6844 INSITE Surgery 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]

Preventive Maintenance (PM) Checklist

INSITE Surgery Table

Model: 6844

Work Instruction number: 50603-15 Rev. A

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 Mizuho OSI Technical Services
for assistance and circle the check.

Biohazards when servicing equipment: Please take appropriate precautions for servicing potentially biohazard
contaminated equipment or working in biohazard surroundings. Wear protective surgical gloves and long 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 become contaminated with biohazards prior to
placing back in your tool kit for removal from the location. If you suspect biohazards are present, do not handle until
they have been cleaned.

ESD Precautions: Electro-Static Discharge can damage sensitive electronic printed circuit boards. If you are
servicing components that are located near or in contact with PCBs or other sensitive devices, please ground
yourself with a proper ESD strap.

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

50603-15 Rev. A ECN# 100249 Eff Date: 07/20/2012 Page 1 of 5

6844 INSITE Surgery 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]

Tools Required:

Normal handtools

Materials Required:

NW0635 Rev B. 6844 – INSITE Surgery Table Owner’s Manual

Pass

1. General Overall Condition

1.1 ( ) ( ) Table base is clean, without signs of hazardous contamination, and is consistent with proper care.

Fail

Comments: _________________________________________________________________________

1.2 ( ) ( ) All labels are intact and legible.

Verify attachment to base cover of “Warning – Not for Storage” label. If possible, advise customer of
potential table damage if items are stored on this surface.

Comments: _________________________________________________________________________

2. Power Input Inspection

2.1 ( ) ( ) Power Cord is free of wear, corrosion, and insulation cracks.
Comments: _________________________________________________________________________

2.2 ( ) ( ) Power Cord has OSI tag (indicating “Hospital Grade”) attached.
Comments: _________________________________________________________________________

2.3 ( ) ( ) Power Cord Base Receptacle is properly secured and operational.
Comments: __________________________________________________________________________________________________________________________________________________

2.4 ( ) ( ) ON/OFF Power Switch/Circuit Breaker is properly secured; plastic cover is not torn or pierced.
Comments: _________________________________________________________________________

3. Basic Controls

3.1 ( ) ( ) Power Switch ON

a. Connect the Power Cord to AC power source and also to a power receptacle.
b. Toggle Power Switch to “ON” (located on table-base panel). If illuminated, table is connected

to live AC power. If not illuminated, ta ble may still operate on internal battery power (Hand
Pendant buttons and lights will be illuminated).

c. Verify that the Three Circuit Breakers (located on table-base panel) are not tripped.
d. Verify that the Hand Pendant Battery Status “OK” LED illuminates green.

Comments: _________________________________________________________________________

50603-15 Rev. A ECN# 100249 Eff Date: 07/20/2012 Page 2 of 5