Polymobil III

SP Maintenance Protocol

Customer: Address:

Department: Room: Contact person: Telephone: Cust. specific no.:

Customer no.:

Sie mens AG 1995

The Maintenance Instructions RXB8-115.101.03.03.02 are required for this protocol
The reproduction, transmission or use of this document or its contents is not permitted without express written authority. Offenders will be liable for damages. All rights, including rights created by patent grant or registration of a utility model _or_ design,_are_ reserved.

Print Number: RXB8-115.105.03.03.02

Replaces: RXB8-115.105.03.02.02

English Doc. Gen.Date:

07.99

Maintenance Protocol
Information regarding the maintenance protocol
SIEMENS office: Address: Region: Country: Contact person: Telephone: CSE in charge: Telephone:

Cust.-No.:

Information regarding the maintenance protocol The maintenance protocol serves as a quality record of the maintenance performed Maintenance must be performed in the prescribed intervals. The maintenance results must be entered in the maintenance protocol. The page numbers in the check list at the end of the protocol refer to the corresponding pages in the associated maintenance instructions (refer to the cover sheet). The maintenance protocol must be completely filled out by the CSE in charge. In other words,

All fields must be completed. If a field does not apply to the system or if there is no
information to be entered, enter n.a. in the field.

The customer number must be entered in the header of every page (CSE No.) so that
every page is assigned to a customer.

In case of complaints, enter IVKs for the component as well as the type of complaint in
the Open points table provided. Record the open items in the table with the date and signature. Correction of these open points should also be documented in this table along with the date and signature. If there are no open points, draw a line through the entire table and enter the date/initials.

Enter the values measured during the maintenance in the space / table provided. After completing the maintenance, fill out page 3 of the protocol and sign it.
Processing and archiving the maintenance protocol: The maintenance protocol is considered a record and must be archived. It must be filed after completion of maintenance in the corresponding Register of the Maintenance binder. If necessary, a copy should be distributed to the customer..

Siemens AG Medical Solutions

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Polymobil III

Maintenance Protocol

Cust.-No.:

System Status: System: Ser.No.: Software Version: Maintenance contract no.: Type of contract:

The equipment has no problems Results of the image quality test showed no deviations from the required reference values.

The equipment has minor problems that do not restrict its use. However they should be corrected as a preventive measure. Results of the image quality test showed no deviations from the required reference values.

The equipment has major problems. For safety reasons, the equipment may not be used until the problem has been resolved.

Location Date Name of CSE Signature

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Polymobil III

Cust.-No.:
Performed tasks

Maintenance Protocol

Date: Performed tasks:

OK not OK n.a.

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Siemens AG Medical Solutions

Maintenance Protocol
Open points Yes No

Cust.-No.:

IVK

Component

Open Points (Date)

Solved Signature

Explanation of the acronyms:

Abbrev. Explanation SI SIE SIM PM PMP PMA PMF Q QIQ QSQ SW Safety Inspection Safety Inspection Electrical Safety Safety Inspection Mechanical Safety Preventive Maintenance Preventive Maintenance Preventive Parts Exchange, External Inspection, etc. Preventive Maintenance Adjustments Preventive Maintenance Function, Operating-Value Check Quality Check Quality Check Image Quality Check System Software Maintenance

Siemens AG Medical Solutions

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Polymobil III

Cust.-No.:
Measurement devices

Maintenance Protocol
Please enter all measuring devices used for maintenance in the table.

Measurement Devices Type

Serial No.

Date of use

Calibrated until

Polymobil III

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Siemens AG Medical Solutions

Maintenance Protocol

Cust.-No.:

OK

not OK

n.a.

Page

1
1.1. 1.2. 1.3. 1.4. 1.5. 1.6.

General information
Required documentation Required tools, measurement and auxiliary equipment Required lubricant Text emphasis Safety information and protective measures Explanation of abbreviations

1-1
1-1 1-1 1-1 1-1 1-2 1-3

2
2.1.
SIM SIM SIM

Inspection and maintenance

Checking the unit screws
the cassette compartment the pedals the front wheels

2-1
2-1
2-1 2-1 2-1

2.2.
SIM SIM SIM

Checking the handles

the single-tank yoke the single tank the transport handle above the control console

2-1
2-1 2-1 2-1

2.3.
SIM SIM SIM

Checking the wheels

Noise Ease of movement Wear and tear on the rubber cover

2-2
2-2 2-2 2-2

2.4.
SIM SIM SIM

Checking the pedal positions

Braking / Locking Maneuvering movement Forward movement (straight)

2-2
2-2 2-2 2-2

2.5.
SIM SIM SIM SIM PMP

Stand
Support arm locking device Stand mounting Counterbalance Checking the chains of the spring counterbalance Maintenance of the joints and chains

2-3
2-3 2-4 2-4 2-4 2-4

2.6.
SIM SIM

Single tank
Checking the suspension of the single tank Checking the locking device of the single tank

2-5
2-5 2-5

2.7.
PMF PMF PMF PMF

Checking the double-slot diaphragm

Light localizer lamp Rotation Format selection 0 position

2-6
2-6 2-6 2-6 2-6

2.8.
2.8.1 PMP PMP PMP SIE SIE

Visual inspection
Check the system for damage Covers Switches, operating panel Exposure release cable Power and primary cables Electronic assemblies

2-7
2-7 2-7 2-7 2-7 2-7 2-7

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Polymobil III

Cust.-No.:

Maintenance Protocol
OK not OK n.a.

Page

2.9.
2.9.1 PMF 2.9.2 PMF

Checking the voltage supplies

Board D920 Power supply, Board D920 Board D910 Power supply, Board D910

2-8
2-8 2-8 2-8 2-8

2.10.
PMF SIE SIE QSQ

Radiation
kV and tube current (IR) Radiation indicator Acoustic signal Coincidence of light field and radiation field

2-9
2-9 2 - 11 2 - 11 2 - 12

2.11.
PMF PMF

Operating console
Operating elements Indicators

2 - 14
2 - 14 2 - 14

2.12.
SIE

Protective ground/ earth measurement

Measured value:

2 - 14
2 - 14

2.13.
SIE

Equivalent leakage current measurement

Measured value:

2 - 14
2 - 14

2.14.
PMP PMP

Concluding steps
Cleaning Disinfection

2 - 15
2 - 15 2 - 15

Changes to previous version

3-1

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Siemens AG Medical Solutions