Handicare PRISM MEDICAL C450 Owner's Manual page 34

Service Record History
Date: _______________________
Service Type:
□ Periodic Inspection □ Monthly Inspection □ Semi-Annual Inspection □ Repair □ Annual Inspection □ Other:_________
_________________________
Completed By:
Company: _____________________________________________________________
Remarks & Action Taken:
Date: _______________________
Service Type:
□ Periodic Inspection □ Monthly Inspection □ Semi-Annual Inspection □ Repair □ Annual Inspection □ Other:_________
_________________________
Completed By:
Company: _____________________________________________________________
Remarks & Action Taken:
Date: _______________________
Service Type:
□ Periodic Inspection □ Monthly Inspection □ Semi-Annual Inspection □ Repair □ Annual Inspection □ Other:_________
_________________________
Completed By:
Company: _____________________________________________________________
Remarks & Action Taken:
Date: _______________________
Service Type:
□ Periodic Inspection □ Monthly Inspection □ Semi-Annual Inspection □ Repair □ Annual Inspection □ Other:_________
_________________________
Completed By:
Company: _____________________________________________________________
Remarks & Action Taken:
Date: _______________________
Service Type:
□ Periodic Inspection □ Monthly Inspection □ Semi-Annual Inspection □ Repair □ Annual Inspection □ Other:_________
_________________________
Completed By:
Company: _____________________________________________________________
Remarks & Action Taken:
Date: _______________________
Service Type:
□ Periodic Inspection □ Monthly Inspection □ Semi-Annual Inspection □ Repair □ Annual Inspection □ Other:_________
_________________________
Completed By:
Company: _____________________________________________________________
Remarks & Action Taken:
C450/ C625 - User Guide (753101)
Printed Name
Printed Name
Printed Name
Printed Name
Printed Name
Printed Name
Complete this section after each service, repair inspection and/
or maintenance. Photocopy additional pages as required.
Time: ________________________
_____________________________
Signature
Time: ________________________
_____________________________
Signature
Time: ________________________
_____________________________
Signature
Time: ________________________
_____________________________
Signature
Time: ________________________
_____________________________
Signature
Time: ________________________
_____________________________
Signature
Rev: 14 MAR 2017 Page: 34