GE Healthcare

Definium 6000 I/II/III System

Planned Maintenance Checklist
Schedule A
System Installation Date:      
Customer: Customer Name
PM Start Date:      
Address:      
PM Schedule: Every 24 months
City:      
– starting 6
State/Province:      
months after
Country:      
Installation
OTS Replacement
Task Interval Result
Replace Counterpoise Assembly Every 10 Years after first installation Complete Notes Not Applicable
Replace main Reel Every 5 Years after first installation Complete Notes Not Applicable
Replace main OTS Cable Every 10 Years after first installation Complete Notes Not Applicable
Table Replacement
Task Interval Result
Replace Grease Cup Every 5 Years after first installation Complete Notes Not Applicable
Test Equipment List
Type Model Serial Number Calibration Due Date
                       
                       
                       
                       
                       
                       
                       
Workstation
Airflow Complete Notes
Clean PC case Complete Notes
Table
Task Result
Visual Inspection Complete Notes
Cabling Inspection Complete Notes
Grease Cup & Screw Inspection Complete Notes
Table Top Complete Notes
Longitudinal Bearings Complete Notes
Longitudinal Track/Rails Complete Notes
Lateral Bearings Complete Notes
Lateral Track/Rails Complete Notes
Bumper End Stops Complete Notes
Patient Hand Grips Complete Notes
T-Rad Cable
Task Result
Inspect T-RAD Table Front & Rear Connection Complete Notes N/A
Inspect T-RAD WS Connection Complete Notes N/A
Inspect T-RAD Extension Cable Complete Notes N/A
 Calibrations, Regulatory, and Image Quality
SID Focal Spot Collimator Alignment Results
Collimator
100 cm Small Pass Fail Notes
Alignment
100 cm Large Pass Fail Notes
mR/mAs Value       Pass Fail Notes Beam Quality HVL       Pass Fail Notes
Table       Pass Fail Notes
AEC Dose QAP Pass Fail Notes
WS       Pass Fail Notes
Power & Grounds, Leakage Tests
(This item needs to be executed in USA and other countries with relevant laws and regulations.)
Voltage:       mV
Critical Care & Wet Location
USA Leakage:       µA
only
N/A
Voltage:       mV
Customer/Country Specified Leakage:       µA
N/A

Notes (if you selected in any above – please complete here)

Preventive Maintenance – Completion Sign-off

Engineer Name:        Date Completed:        GE Reference #: