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CS No.:
SIEMENS Office:
Address:
Region:
Country:
Contact person:
Telephone:
CSE in charge:
Telephone:
Notes about the Maintenance Protocol
The Maintenance Protocol is valid as proof of quality for one completed maintenance.
Maintenance must be performed in the specified intervals.
The results of maintenance are entered in this Maintenance Protocol.
The page numbers in the checklists at the end of the protocol refer to the corresponding
pages in the associated maintenance instructions (see cover page).
The maintenance protocol must be completed by the CSE. In other words:
•
All fields must be filled in. If a field does not apply to the system or if no entry is
necessary, check the "n.a." box.
•
The customer number (Cust. No.) and the maintenance date must be entered into the
header on each page so that every page can be matched to a customer and to a
maintenance date.
•
In case of complaints, enter the IVKs for the relevant components as well as the type of
complaint in the "Open items" table provided. Correction of these open points also must
be documented in this table with the date and a signature. If there are no open items,
check "No" and document this with the date and a signature.
•
If movable components (including test phantoms that are part of the system) are present
that can be used in different systems, you must enter them in the "Movable Components"
table provided.
•
The measurement values for the measurements that must be performed during
maintenance must also be entered into the open spaces/tables provided for this.
•
When the maintenance is completed, you must fill out and sign page 3 of this protocol.
Processing and archiving the maintenance protocol
The Maintenance Protocol is a document and must therefore be archived. After comple-
ting maintenance, it must be filed in the appropriate register of the Maintenance binder.
If needed, give the customer a copy of it.
Polymobil 10
Date:
RXR8-120.105.01
Rev. 05
Maintenance Protocol
Page 2 of 8
07.05
CS PS 24
Siemens AG
Medical Solutions
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