Medical Device Usability - Thermo Scientific TSB140R Operating And Maintenance Instructions Manual

2. Medical Device Usability

The purpose of this questionnaire is to identify the aptitude of medical device use (MD) and to check if the
information provided is correct.
This form shall be filled in its entirety for each installed MD by the person (s) responsible (s) of its usage. A copy must
be kept at the ward hospital where the MD has been installed and another must be signed by the person in charge
of the hospital ward and sent back to C.F di Ciro Fiocchetti & C. s.n.c. at one of the following addresses:
e-mail : tecnico@fiocchetti.it
Fax : +39 0522 976028
Medical Device Identification
Model
Model Code
Serial number
INTENDED USE
Ward where the MD is installed
Type of stored product
List of Personnel Intended for Use
First Name
If required, the usage of MD can be evaluated according to the following criteria (select only one):
Evaluation Description
1 Very poor
2 Poor
3 Satisfactory
4 Very good
5 Excellent
54 | Annexes
Surname Position
Medical Devices -Touch Controller