Siemens Uroskop D Maintenance Protocol
UROSKOP D
Maintenance Protocol
Customer:
Address:
SP
Department:
Room:
Contact person:
Telephone:
Cust. specific no.:
Customer no.:
© Siemens AG 1993
The reproduction, transmission or
The Maintenance Instructions
RLL5-310.101.02.02.02 are required for this protocol
English
Print Number: RLL5-310.105.02.02.02 Doc. Gen.Date: 01.97
Replaces: RLL5-310.105.02.01.02
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
Information regarding the maintenance protocol
SIEMENS office:
Address:
Region:
Country:
Contact person:
Telephone:
CSE in charge:
Telephone:
Information regarding the maintenance protocol
The maintenance protocol serves as a quality record of the maintenance performed
Cust.-No.:
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 CSE in charge.
In other words,
• All fields must be completed. If a fi eld does not apply to the system or if ther e is no
information to be entered, enter ’n.a. ’ in the field.
• The customer number must be entered in the header of every page (CSE No.) so that
every page is assigned to a customer.
• In case of complaints, enter I VKs for the component as well as the type of complai nt in
the ’Open points’ table provided. Recor d the open items in the table with the date and
signature. Correction of these open poi nts should also be documented in this table along
with the date and signature. If there are no open points, draw a line through the entir e
table and enter the date/initials.
• Enter the values measured during t he maintenance in the space / table provided.
• After completing the maintenance, fi ll 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 corr esponding Register of the Maintenance binder.
If necessary, a copy should be distrib uted to the customer..
Siemens AG RLL5-310.105.02 Page 2 of 10 UROSKOP D
Medical Solutions Rev. 02 01.97 TDSP 1
Maintenance Protocol
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.
Cust.-No.:
The equipment has maj or problems. For safety reasons, the
equipment may not be used until
the problem has been resolved.
Location
Date
Name of CSE
Signature
Siemens AG RLL5-310.105.02 Page 3 of 10 UROSKOP D
Medical Solutions Rev. 02 01.97 TDSP 1
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