Appendix: Medical Product Passport / Record Of Training - PRO ACTIV TRAVELER 4all Ergo Operating Instructions Service Booklet

Operating instructions TRAVELER 4all Ergo & 4you Ergo

39 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
Stamp / Date / Dealer's signature
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).
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