Polymobil 10

SP

Maintenance protocol

Customer:
Address:

Department:
Room:
Contact person:
Telephone:
Customer number:
CS No.:
Date:

© Siemens AG 2005
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
This protocol is accompanied by the created by patent grant or registration
of a utility model or design, are
Maintenance instructions RXR8-120.101.01.05.02 reserved.

English
Print No.: RXR8-120.105.01.05.02 Doc. Gen. Date: 07.05
Replaces: RXR8-120.105.01.04.02
CS No.: Date: Maintenance Protocol

SIEMENS Office:

Address:

Region:
Country:
Contact person:
Telephone:
CSE in charge:
Telephone:

Notes about the Maintenance Protocol

The Maintenance Protocol is valid as proof of quality for one completed maintenance.
Maintenance must be performed in the specified intervals.
The results of maintenance are entered in this Maintenance Protocol.
The page numbers in the checklists at the end of the protocol refer to the corresponding
pages in the associated maintenance instructions (see cover page).
The maintenance protocol must be completed by the CSE. In other words:
• All fields must be filled in. If a field does not apply to the system or if no entry is
necessary, check the "n.a." box.
• The customer number (Cust. No.) and the maintenance date must be entered into the
header on each page so that every page can be matched to a customer and to a
maintenance date.
• In case of complaints, enter the IVKs for the relevant components as well as the type of
complaint in the "Open items" table provided. Correction of these open points also must
be documented in this table with the date and a signature. If there are no open items,
check "No" and document this with the date and a signature.
• If movable components (including test phantoms that are part of the system) are present
that can be used in different systems, you must enter them in the "Movable Components"
table provided.
• The measurement values for the measurements that must be performed during
maintenance must also be entered into the open spaces/tables provided for this.
• When the maintenance is completed, you must fill out and sign page 3 of this protocol.
Processing and archiving the maintenance protocol
The Maintenance Protocol is a document and must therefore be archived. After comple-
ting maintenance, it must be filed in the appropriate register of the Maintenance binder.
If needed, give the customer a copy of it.

Polymobil 10 RXR8-120.105.01 Page 2 of 8 Siemens AG

Rev. 05 07.05 CS PS 24 Medical Solutions
Maintenance Protocol Date: CS No.:

System:
Serial No.:
Software version:
Number of the service contract:
Type of maintenance:

The system has no deficiencies.

The image quality test showed no
differences from required refe-
rence values.

The system has minor deficien-

cies which do not affect system
operation.
It is recommended, however,
to correct them as a preventive
measure.
The image quality test showed
no differences from
required reference values.

The system has serious

deficiencies. For safety reasons,
continued operation of the
system is possible only after
the deficiencies have been
successfully corrected.

Town:

Date:

Technician's name:

Signature:

Siemens AG RXR8-120.105.01 Page 3 of 8 Polymobil 10

Medical Solutions Rev. 05 07.05 CS PS 24
CS No.: Date: Maintenance Protocol
Activities performed
If there is no entry in the table, see the entries beginning on Page 7.

Date:
Activities performed: OK not OK n.a.

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Rev. 05 07.05 CS PS 24 Medical Solutions
Maintenance Protocol Date: CS No.:

Open items

Yes No Date/signature:

If 'Yes', enter the component with the IVK and the open item (number only) into the table.
Record in the table when maintenance has been completed.

IVK Component Open items Completed

(Date) Signature

Explanation of abbreviations in the maintenance certificate

Abbrev. Description
SI Safety Inspection
SIE Electrical Safety
SIM Mechanical safety
PM Preventive Maintenance
PMP Preventive Maintenance, Preventive Parts Replacement, Visual Inspection
PMA Preventive maintenance adjustments
PMF Preventive Check of Operating Values/Functions
Q Quality Check
QIQ Image Quality Check
QSQ System Quality
SW Software Maintenance
CSE Customer Service Engineer

Siemens AG RXR8-120.105.01 Page 5 of 8 Polymobil 10

Medical Solutions Rev. 05 07.05 CS PS 24
CS No.: Date: Maintenance Protocol
Measuring device
Enter the measuring devices that were used for maintenance in the table.

Next
Measuring device Type Serial no. Date of use calibration
due

Movable Components

Yes No Date/signature:

If 'Yes', enter the component (including Serial No.) into the table that was used for mainte-
nance.
Movable components (including test phantoms that are part of the system) are parts that
can be used on different systems.

Movable Component Serial No.

Polymobil 10 RXR8-120.105.01 Page 6 of 8 Siemens AG

Rev. 05 07.05 CS PS 24 Medical Solutions
Maintenance Protocol Date: CS No.:

OK not n.a.
OK
Page

1 General information 1-1

1.1. Required documents 1-1
1.2. Tools, measurement and auxiliary devices required 1-1
1.3. Required lubricants 1-1
1.4. Text conventions 1-2
1.5. Safety information and protective measures 1-3
1.6. Explanation of abbreviations 1-6
1.7. Information on the ground wire resistance test 1-6
1.8. Information on measuring the leakage current 1-8
1.9. Technical safety checks (TSC) 1 - 11

2 Inspection and Maintenance 2-1

2.1. Visual inspection 2-1
2.1.1 Check the system for damage 2-1
SIM Cover panels 2-1
SIM Switch box/control console 2-1
SIM Release cable 2-1
SIM Power and primary cable 2-1
2.1.2 Labels 2-1
SIM Labels 2-1
2.1.3 Customer documents 2-1
SI Customer documentation 2-1
2.2. Check screws 2-1
SIM Cassette holder 2-1
SIM Pedals 2-1
SIM Front wheels 2-1
2.3. Check handles 2-1
SIM Single tank holder 2-1
SIM Single tank 2-1
SIM Control handle above the control console 2-1
2.4. Check wheels 2-3
SIM Noises 2-3
SIM Easy movement 2-3
SIM Wear of the rubber lining 2-3
2.5. Check pedal positions 2-3
SIM Brakes/Locking 2-3
SIM Maneuvering 2-3
SIM Straight travel 2-3
2.6. Single tank 2-4
SIM Suspension 2-4
SIM Locking mechanism 2-4
2.7. Double-slot diaphragm 2-5
PMF Light localizer lamp 2-5
SIM Rotatability 2-5
PMF Format setting 2-5
PMF 0° position 2-5

Siemens AG RXR8-120.105.01 Page 7 of 8 Polymobil 10

Medical Solutions Rev. 05 07.05 CS PS 24
CS No.: Date: Maintenance Protocol

OK not n.a.
OK
Page

2.8. Stand 2-6

SIM Support arm locking mechanism 2-6
SIM Stand mounting 2-7
SIM Spring counterbalance 2-7
SIM Chains of the spring counterbalance system 2-7
PMP Maintenance of the joints and chains 2-8
2.9. Radiation 2-8
SIE Radiation indicator 2-8
SIE Acoustic signal 2-8
PMF kV and tube current (IR) 2-9
QSQ Check if light and radiation fields match 2 - 10
2.10. Control console 2 - 11
SIE Operating elements 2 - 11
SIE Displays 2 - 11
2.11. Ground wire test 2 - 12
SIE Protective conductor test 2 - 12
2.12. Leakage current measurement 2 - 13
SIE Leakage current measurement 2 - 13
2.13. Concluding work 2 - 14
PMP Cleaning 2 - 14

3 Electrical safety/Reports 3-1

3.1. Protective conductor resistance/report 3-1
3.2. System leakage current/report 3-3

4 Changes to previous version 4-1

Polymobil 10 RXR8-120.105.01 Page 8 of 8 Siemens AG

Rev. 05 07.05 CS PS 24 Medical Solutions