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Maintenance Protocol
System:
Serial No.:
Software version:
Number of the service contract:
Type of maintenance:
The system has no deficiencies.
The image quality test showed no
differences from required refe-
rence values.
The system has minor deficien-
cies which do not affect system
operation.
It is recommended, however,
to correct them as a preventive
measure.
The image quality test showed
no differences from
required reference values.
The system has serious
deficiencies. For safety reasons,
continued operation of the
system is possible only after
the deficiencies have been
successfully corrected.
Town:
Date:
Technician's name:
Signature:
Siemens AG
Medical Solutions
Date:
RXR8-120.105.01
Rev. 05
07.05
CS No.:
Page 3 of 8
CS PS 24
Polymobil 10
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