Siemens Polydoros SX LX User manual

POLYDOROS SX/LX

Maintenance Protocol

POLYDOROS

Generator

Customer:

Address:

Department:

Room:

Contact person:

Telephone:

Cust. specific no.:

Cust. no.:

Date.:

The instructions RX63-055.831.02.02.02 are required for this protocol

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.

Print No.: RX63-055.832.02.02.02	English
Replaces: RX63-055.832.02.01.02	Doc. Gen. Date: 04.05

Cust.-No.:		Date:		Protocol

SIEMENS Office:

Address:

Region:

Country:

Contact person:

Tel.:

CSE in charge:

Tel.:

Remarks Regarding the Protocol:

The protocol is valid as proof of quality for one check that must be performed on the system / component in one year.

The check must be performed in the specified intervals.

The results of the check are entered in this protocol.

The chapter numbers in front of the checkpoints indicate the corresponding chapters in the particular instructions (see cover page).

The protocol must be completely filled out by the Customer Service Engineer, i.e.:

•All boxes must be filled out. If a box does not apply to the system or if no entry needs to be made, check the “n.a.“ box.

•Enter the customer number (Cust. No.:) and the date of the check in the header of each page so that each page can be allocated to a customer and to a check date.

•If there are complaints, the IVKs for the component about which a complaint has been made as well as the type of complaint must be entered in the “Open Points“ table provided for this. Correction of these open points also must be documented in this table with the date and a signature. If there are no open points, check “No“ and document this with the date and a signature.

•If movable components (also test phantoms that are part of the system) that can be used in different systems are used for the check, they must be entered in the “Movable Components“ table provided for this.

•The measurement values for the measurements that must be performed during the check must also be entered in the open spaces / tables provided for them.

•After completing the check, Page 3 of this protocol must be filled out and signed.

POLYDOROS SX/LX	RX63-055.832.02.02.02	Page 2 of 10	Siemens AG
	04.05	CS PS 211	Medical Solutions

Protocol	Date:		Cust.-No.:

Further Processing and Archiving of the Protocol

The protocol is a document and thus must be archived. After completing the test, it must be filed in the corresponding register in the “System Owner Manual“ binder. If needed, a copy can be handed to the customer.

System:

Serial No.:

Software Version:

Number of the Service Contract:

Type of Maintenance:

Evaluating the Condition of the System / Component

The system has no deficiencies. The image quality test resulted in no differences from required reference values.

The system / component has slight deficiencies that have no affect on continued operation of the system. However they should be corrected preventively.

The image quality test resulted in no differences from required reference values.

The system / component has serious deficiencies. For safety reasons, continued operation of the system is permitted only after successfully correcting the deficiencies.

After completing all work steps, an evaluation was performed.

Signature:

Date: Name:

The operator or a person assigned for this has taken note of this evaluation. (if national regulations require this)

Signature:

Date: Name:

Siemens AG	RX63-055.832.02.02.02	Page 3 of 10	POLYDOROS SX/LX
Medical Solutions	04.05	CS PS 211

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