Service Event Report Form - FujiFilm SonoSite EDGE II Service Manual

Service Event Report Form

Service Event Report
Instructions on reverse
Service Type
(check one)
† Out of Box Failure
† Warranty Service
† Out of Warranty Service
Service Provider
Name:
Company:
Address:
Phone Number:
E-mail address:
Device Description
Ref Number:
Name:
ARM/SHDB Version:
Problem Found
Service Performed
Performed By:
Parts Removed
Part Name
Parts Installed
Part Name
Tests Performed (attach test data)
Test:
Performed By:
Result: Pass Fail
Page ____ of ____
80 Appendix B: Service Event Reporting
Parts Status
(check one)
No parts necessary for this repair. Service
†
Event Report for your information.
I need parts for this repair (list the parts below
†
and attach Purchase Order)
I need parts to replenish my stock (list the
†
parts used below and attach Purchase Order)
Will not replenish stock. Please give me a
†
RMA for the return of the faulty parts.
No parts necessary. Please issue a RMA for
†
repair at FUJIFILM SonoSite.
Part Number Serial Number Lot Number
Part Number Serial Number Lot Number
Test:
Performed By:
Result:
Attach additional sheets as required
For FUJIFILM SonoSite Use Only
Service Request
Order Number
RMA Number
Work Order
Provider Reference:
Date Reported:
Fax Number:
Serial Number:
Lot Number:
Configuration:
Date:
Rev Replaced By
Rev Replaced By
Pass Fail
F00019 Rev F