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CS No.:
Measuring device
Enter the measuring devices that were used for maintenance in the table.
Measuring device
Movable Components
Yes
If 'Yes', enter the component (including Serial No.) into the table that was used for mainte-
nance.
Movable components (including test phantoms that are part of the system) are parts that
can be used on different systems.
Movable Component
Polymobil 10
Date:
Type
No
Date/signature:
RXR8-120.105.01
Rev. 05
Maintenance Protocol
Serial no.
Page 6 of 8
07.05
CS PS 24
Next
Date of use
calibration
due
Serial No.
Siemens AG
Medical Solutions
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