Prism Medical UK FREEWAY SA160 User Manual page 24

Service Record History
Date: _______________________
Service Type:
□ Periodic Inspection
_________________________
Completed By:
Company: _____________________________________________________________
Remarks & Action Taken:
Date: _______________________
Service Type: □ Periodic Inspection
_________________________
Completed By:
_____________________________________________________________
Company:
Remarks & Action Taken:
Date: _______________________
Service Type:
□ Periodic Inspection
_________________________
Completed By:
Company: _____________________________________________________________
Remarks & Action Taken:
Date: _______________________
Service Type:
□ Periodic Inspection
_________________________
Completed By:
Company: _____________________________________________________________
Remarks & Action Taken:
Date: _______________________
Service Type:
□ Periodic Inspection
_________________________
Completed By:
Company: _____________________________________________________________
Remarks & Action Taken:
Date: _______________________
Service Type:
□ Periodic Inspection
_________________________
Completed By:
Company: _____________________________________________________________
Remarks & Action Taken:
SA160 User Manual
□ Monthly Inspection
Printed Name
□ Monthly Inspection
Printed Name
□ Monthly Inspection
Printed Name
□ Monthly Inspection
Printed Name
□ Monthly Inspection
Printed Name
□ Monthly Inspection
Printed Name
Complete this section after each service, repair inspec-
tion and/or maintenance. Photocopy additional pages
as required
.
Time: ________________________
□ 6 Month Inspection □ Repair □ Yearly Inspection □ Other:_________
_____________________________
Signature
Time: ________________________
□ 6 Month Inspection □ Repair □ Yearly Inspection □ Other:_________
_____________________________
Signature
Time: ________________________
□ 6 Month Inspection □ Repair □ Yearly Inspection □ Other:_________
_____________________________
Signature
Time: ________________________
□ 6 Month Inspection □ Repair □ Yearly Inspection □ Other:_________
_____________________________
Signature
Time: ________________________
□ 6 Month Inspection □ Repair □ Yearly Inspection □ Other:_________
_____________________________
Signature
Time: ________________________
□ 6 Month Inspection □ Repair □ Yearly Inspection □ Other:_________
_____________________________
Signature
Rev 5—October 2016 Page 24