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Reject Analys Form (Daily/Weekly Test)

_________________________
Periode ____________
Jenis Modalitas :
Nama Alat :
No. Seri tabung :
No. Izin BAPETEN :
Jenis reject
Hari/tanggal Radiografer Shift Patien Too Too Quantity
Positioning Artefact Processor Others
motion dark light
Reject Analys Form (Semi Annual Test)
_________________________
Bulan____________
Jenis Modalitas :
Nama Alat :
No. Seri tabung :
No. Izin BAPETEN :

Causes Quantity Percent


Positioning
Patient Motion
Artefact
Too dark
Too Light
Pocessor
Others

Total
Reject Analys Form (Annual Test)
_________________________
Tahun ____________
Jenis Modalitas :
Nama Alat :
No. Seri tabung :
No. Izin BAPETEN :

Causes Quantity Percent


Positioning
Patient Motion
Artefact
Too dark
Too Light
Pocessor
Others

Total

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