Siemens Fluorospot H HK Maintenance Protocol
FLUOROSPOT H/HK
Maintenance Protocol
AX
Customer:
Department: Room:
Address:
Contact person: Telephone:
Cust. specific no.: Customer no:
The Maintenance Instructions
RX41-020.101.04.01.02
are required for this protocol
Register 9 English
Print Number: RX41-020.105.04.01.02 Doc. Gen.Date: 05.97
Replaces: n. a.
© Siemens AG 1997
The reproduction, transmission or
use of this document or its contents
is not permitted without express
written authority. Offenders will be
liable for damages. All rights,
including rights created by patent
grant or registration of a utility
model _or_ design,_are_ reserved.
Maintenance Protocol CS No.: . . . . . . . .
SIEMENS office:
Address:
Region: Country:
Contact person: Telephone:
FSE in charge: Telephone:
Information regarding the maintenance protocol
The maintenance protocol serves as a quality record of the maintenance performed
Maintenance must be performed in the prescribed intervals.
The maintenance results must be entered in the maintenance protocol.
The page numbers in the check list at the end of the protocol refer to the corresponding
pages in the associated maintenance instructions (refer to the cover sheet).
The maintenance protocol must be completely filled out by the FSE in charge.
In other words,
• All fields must be completed. If a field does not apply to the system or if there is no
information to be entered, enter ’n.a. ’ in the field.
• The customer number must be entered in the header of every page (CS No.) so that
every page is assigned to a customer.
• In case of complaints, enter the product identification (IVK = WE) for the component as
well as the type of complaint in the ’Open items’ table provided. Record the open items in
the table with the date and signature. Correction of these open points should also be
documented in this table along with the date and signature. If there are no open points,
draw a line through the entire table and enter the date/initials.
• Enter the values measured during the maintenance in the space / table provided.
• After completing the maintenance, fill out page 3 of the protocol and sign it.
Processing and archiving the maintenance protocol:
The maintenance protocol is considered a record and must be archived. It must be filed
after completion of maintenance in the corresponding Register of the Maintenance binder.
If necessary, a copy should be distributed to the customer.
Siemens AG Register 9 RX41-020.105.04 Page 2 of 18 FLUOROSPOT H/HK
Medical Engineering Rev. 01 05.97 TD AX 5 Register 9
Maintenance Protocol CS No.: . . . . . . . .
System Status:
System: Ser. No.:
Software Version:
Maintenance contract no.:
Type of contract:
The equipment has no problems
Results of the image quality test
showed no deviations from the
required reference values.
The equipment has minor problems that do not restrict its use.
However they should be corrected as a preventive measure.
Results of the image quality test
showed no deviations from the
required reference values.
The equipment has major problems. For safety reasons, the
equipment may not be used until
the problem has been resolved.
Location
Date
Name of the FSE
Signature
Siemens AG Register 9 RX41-020.105.04 Page 3 of 18 FLUOROSPOT H/HK
Medical Engineering Rev. 01 05.97 TD AX 5 Register 9
Maintenance Protocol CS No.: . . . . . . . .
Performed tasks
Date:
Performed tasks:
OK not OKn.a.
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Siemens AG Register 9 RX41-020.105.04 Page 4 of 18 FLUOROSPOT H/HK
Medical Engineering Rev. 01 05.97 TD AX 5 Register 9
Maintenance Protocol CS No.: . . . . . . . .
Open points
IVK
(WE)
Component Open points Solved
Explanation of the acronyms:
Abbrev. Explanation
(Date)
FSE
(Date)
SI Safety Inspection
SIE Safety Inspection Electrical Safety
SIM Safety Inspection Mechanical Safety
PM Preventive Maintenance
PMP Preventive Maintenance Preventive Parts Exchange, External Inspection, etc.
PMA Preventive Maintenance Adjustments
PMF Preventive Maintenance Function, Operating-Value Check
Q Quality Check
QIQ Quality Check Image
QSQ Quality Check System
SW Software Maintenance
Siemens AG Register 9 RX41-020.105.04 Page 5 of 18 FLUOROSPOT H/HK
Medical Engineering Rev. 01 05.97 TD AX 5 Register 9
Maintenance Protocol CS No.: . . . . . . . .
Measurement devices
Please enter all measuring devices used for maintenance in the table.
Measurement Device Type Serial-No. Date of use Calibrated
until
TV Dynamics Test
Luminous intensity meter
Siemens AG Register 9 RX41-020.105.04 Page 6 of 18 FLUOROSPOT H/HK
Medical Engineering Rev. 01 05.97 TD AX 5 Register 9
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