Prism Medical UK C800 Owner's Manual page 31

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:
C 800 - User Guide (753106)
□ 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 inspection 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: 9 JUNE 2016 Page: 31