Mizuhosi 6875 Preventive Maintenance

6875 hana Table
Preventative Maintenance Checklist
Preventive Maintenance (PM) Checklist
Contact Information:
Date: ________________Model/Serial#: _______________________
Hospital Name: _________________________________ City & State: ________________________________
Contact Name: _______________________ Position: ___________________ Phone: _____________________
Equipment Location: ________________________________________________________________________
Service Representative: _____________________ Service Organization: _______________________________
Service Rep. phone: ________________________ Home location: ____________________________________
Customer contact accepting service: ______________________
Service Representative: ________________________
Name please print
Using this report: Please proceed through each step and place an "x" in the "( )" as each item representing Pass
Fail ( ) ( ) criteria is inspected. If a step has failed, please indicate with an "x" and note the reasons in the
comments section. If you resolve the failure place an "x" in the "Pass" area and indicate the corrective action again
in the comments section. If you are unable to perform any Pass/Fail check, please contact Mizuhosi Technical
Services for assistance and circle the check.
Biohazards when servicing equipment: Please take appropriate precautions for servicing potentially biohazard
contaminated equipment or working in biohazard surroundings. Please wear protective surgical gloves and long
sleeved gowns at all times. If your gloves or protective clothing tears, replace immediately. Have the hospital staff
clean the equipment appropriately prior to servicing. Clean your tools that may become contaminated with
biohazards prior to placing back in your tool kit for removal from the location. If you suspect biohazards are present
do not handle until they have been cleaned.
ESD Precautions: Electro-Static Discharge can damage sensitive electronic printed circuit boards. If you are
servicing any part of the equipment inside that is near or in contact with PCB's or other sensitive devices, please
properly ground yourself with a proper ESD strap.
(If serviced by an outside service organization, the record must be reviewed, signed, and dated by Technical
Services Dept. Refer to last page of this document).
50603-06 Rev. A
Model: 6875 Hana table
Work Instruction number 50603-06
Name please print
_______________
Signature
ECN# 10016
T e c h n i c a l S e r v i c e s D e p a r t m e n t
Phone: 800-777-4674 PST
Account #: ____________________
__________________
Signature
___________________
Date
Effective Date 3/9/2010
Fax: 510-429-8324
____________
Date
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