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Maintenance Protocol
Open items
Yes
If 'Yes', enter the component with the IVK and the open item (number only) into the table.
Record in the table when maintenance has been completed.
IVK
Explanation of abbreviations in the maintenance certificate
Abbrev.
SI
SIE
SIM
PM
PMP
PMA
PMF
Q
QIQ
QSQ
SW
CSE
Siemens AG
Medical Solutions
Date:
No
Date/signature:
Component
Description
Safety Inspection
Electrical Safety
Mechanical safety
Preventive Maintenance
Preventive Maintenance, Preventive Parts Replacement, Visual Inspection
Preventive maintenance adjustments
Preventive Check of Operating Values/Functions
Quality Check
Image Quality Check
System Quality
Software Maintenance
Customer Service Engineer
Open items
RXR8-120.105.01
Rev. 05
07.05
CS No.:
Completed
(Date)
Page 5 of 8
CS PS 24
Signature
Polymobil 10
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