Appendix: Medical Product Passport / Record Of Training - ProActiv SPIKE Adaptive bike Operating Instructions Service Booklet

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28 Appendix: Medical product passport / record of training

Product specifications:

Serial number:

Customer data:

Surname, forename:

Street:

Postcode, city:

Phone:

Paying organisation:

Training carried out by:

Medical supplies dealer

PRO ACTIV field

representative

Record of training

I was / we were instructed in accordance with the associated hand-over certificate about the operation

of the product listed and informed about possible operator errors. I was / we were also advised about

situations where the assistance of another person is required. The operating instructions were handed

to me / us.

Instructor

Name, date, signature

1. Person being trained

Name, date, signature

2. Person being trained

Name, date, signature

3. Person being trained

Name, date, signature

For minors, or persons who are not responsible for their actions, legal guardians / supervisors / responsible persons are to be

trained in the use, this is confirmed by their signature. The data is recorded in the feedback system of PRO ACTIV Reha-

Technik GmbH, as the manufacturer of the above named product. It will be managed in accordance with Section 16 BDSG

(Federal Data Protection Law).

Operating instructions SPIKE adaptive bike

Stamp / Date / Dealer's signature

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