SITE INSPECTION/PRE-INSTALLATION CHECKLIST Document P/N 4550 193 09571 Rev B

PHILIPS CT - SITE INSPECTION/PRE-INSTALLATION CHECKLIST

SITE INFORMATION
NOTE Complete this Check List in conjunction with the Site Preparation Guidelines and site-specific final
drawings. In case information is inconsistent, please consult CT Customer Support Helpdesk. This Check
List is to be completed one week prior to the planned delivery date and sent by email to CT Customer
Support Helpdesk (HFA/CLV/Best).

System Type:

Site name:
Site Address: Street:
City: State
Country:
Area:

Phone Number:
Customer Representative:

Person performing inspection: Name:

Email:
Email:
Mobile:
Subsidiary:

Date of Inspection:

REFERENCE DOCUMENTS
NOTE Always use the latest revision of the site preparation documents that can be found on the PRD website (Planning
Reference Data) http://incenter.medical.philips.com relevant for your system configuration.

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SITE INSPECTION/PRE-INSTALLATION CHECKLIST Document P/N 4550 193 09571 Rev B

GENERAL / SITE REQUIREMENTS Y N

1 Have the final drawings been approved and distributed to the contractors?
2 Are the final drawings "signed off" to approve equipment layout / orientation?
3 Has the Site administrator reviewed and approved the room layout and shielding requirements?
4 Is someone assigned to review and verify that all installation requirements are met?
Name:
5 Where all third-party vendors identified, notified and scheduled?
(Examples: Laser lights, injectors, power cond., etc.)
NOTE All general site requirements shall be completed prior to installation.

SCHEDULE DATE COMMITMENTS Y N

1 Has the project schedule been verified with the facility's department, contractor, and Philips?
2 Will the committed site-ready date be met?
3 Does the completion date for any/all construction meet or preced the delivery date?
4 Is the Power & Ground survey complete?
Date:
Facility contact:
5 Is the Site-Readiness visit scheduled?
Date:
6 Is the delivery date scheduled?

Date:
7 Is the installation start date scheduled?
Date:
8 Installation will be performed on: Weekday Weekend
Date:
If "Weekend", has the facility's management been notified?

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SITE INSPECTION/PRE-INSTALLATION CHECKLIST Document P/N 4550 193 09571 Rev B

SCHEDULE DATE COMMITMENTS (Continued) Y N

9 Has local zone and country specialist been contacted for installation?
If "No", when is the expected completion? Date:
10 Has all construction sub-contractors been notified?
11 Will Pre-Installation process be used?
Pre-Installation Kit delivery Date:
Pre-Installation start Date:
12 Is removal of existing equipment required?
If "Yes", has removal date been set-up and confirmed?
When is the expected removal? Date:
13 Were arrangements made to prepare the scan room for the new installation?
If "No", when will this be completed? Date:

SYSTEM DELIVERY REQUIREMENTS Y N

1 Where will the system be unloaded?
O Ground level O Loading dock
2 What is the floor type throughout the delivery route?
Is there a slope on the route?
3 The customer's structural engineer must certify that the floor is capable of supporting the
equipment weight along the entire delivery path, including exam room. Has this been done?
If "No", when will this be completed? Date:
4 Is there special equipment, or manpower that will be required for the delivery? (Select all that applies)
Riggers Flatbed truck Forklift
Extra manpower Protective floor covering Elevator padding
Crane Dollies/Floor jacks, etc.
Other:

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SITE INSPECTION/PRE-INSTALLATION CHECKLIST Document P/N 4550 193 09571 Rev B

SYSTEM DELIVERY REQUIREMENTS (Continued) Y N

5 Has the special equipment or manpower been arranged for the day of the installation?
Delivery path:
6 Are ALL door heights and widths adequate for transporting the equipment to the CT room?
Smallest door opening along route: Width x Height [O in O mm]
7 Are corridors and corners of sufficient width and height (including low hanging obstacles exit signs,
sprinkler heads) for transporting equipment to CT room?
8 Can equipment be transported to the CT room during working hours?
If "No", when will this be completed? Date:
9 Is the use of an elevator required?
If "Yes", Elevator weight capacity lbs. Kg
NOTE If elevators weight capacity is exceeded, contact the facility to make the necessary arrangements.
Elevator inside dimensions: W x D x H O in O mm
Elevator door opening: W x H O in O mm
10 Will an elevator technician be present during delivery?

11 Will delivery of Gantry require use of a crane for lifting through roof or wall opening?

SCANNER ROOM Y N
1 The customer's structural engineer must certify that the scan room floor is capable of supporting
the equipment weight. Has this been done?
If "No", when will this be completed? Date:
2 Are walls finished with a minimum of one coat of paint?
If "No", when will this be completed? Date:
3 Have lead glass view window(s) been installed?
If "No", when will this be completed? Date:

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SITE INSPECTION/PRE-INSTALLATION CHECKLIST Document P/N 4550 193 09571 Rev B

SCANNER ROOM (Continued) Y N

4 Is radiation shielding installed according to the Radiation Safety Officer's specifications?
NOTE A certified radiation physicist/safety advisor must review and approve all the required shielding in the
CT room and all surrounding areas.
5 Have all arrangements been made for installing the system's options (CCTV, Injectors,
power cond., etc)?
6 Are cable tunnels clear and clean?
7 Is a leading wire installed in the tunnels?
8 Is at least one socket installed within close proximity to the Gantry (required for servicing)?
If "No", when will this be completed? Date:
9 Have the Gantry and Patient Table anchoring holes drilled using the Mylar floor template?
10 What floor type exists in the scanner room?
Concrete Raised Floor Other:
11 Is the floor levelness and waviness within the required specifications (not exceeding 6.3mm within
Gantry area)?
12 Are all electrical ducts, conduits, and junction boxes installed per site installation drawings and
meet the specifications?
If "No", when will this be completed? Date:
13 Is an Air-conditioning system with a dedicated room thermostat installed?
14 Does the incoming power kVA capacity and line impedance meet the system requirements?

15 Facility input voltages (nominal)

Volts three-phase:
Frequency: O 50 Hz 60 Hz
16 All light fixtures installed and operational with dimmers where suggested?
If "No", when will this be completed? Date:
17 Is a suite door switch to be used to disable the X-Ray system?
If "No", when will this be completed? Date:
18 Is an X-Ray On indicator to be used outside the scan room?
If "No", when will this be completed? Date:
19 If a magnet is installed (or was installed) in vicinity of the CT room, have the system magnetic fields
specifications been met?

20 Does the floor meet vibration limits?

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SITE INSPECTION/PRE-INSTALLATION CHECKLIST Document P/N 4550 193 09571 Rev B

EQUIPMENT / TECHNICAL ROOM Y N

1 Will equipment closet or auxiliary room be provided for CT equipment?
If "Yes", do trough conduit routings comply with system cable length limit?
2 Is a network drop available for the CIRS?

3 Are the walls finished with at least one coat of paint?

If "No", when will this be completed? Date:

4 Is there at lease one electrical socket next to the Console available to Service Engineer?
If "No", when will this be completed? Date:

5 Are cable tunnels clear and clean?

6 Is a leading wire installed in the tunnels?

7 Is at least one socket installed within close proximity to the Gantry (required for servicing)?

If "No", when will this be completed? Date:

8 Are all electrical ducts, conduits, and junction boxes installed per site installation drawings and
meet the specifications?
If "No", when will this be completed? Date:

9 Is an Air-conditioning system with a dedicated room thermostat installed?

10 Does the incoming power kVA capacity and line impedance meet the system requirements?

11 Facility input voltages (nominal)

Volts three-phase:
Frequency: O 50 Hz 60 Hz
12 All light fixtures installed and operational with dimmers where suggested?
If "No", when will this be completed? Date:

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SITE INSPECTION/PRE-INSTALLATION CHECKLIST Document P/N 4550 193 09571 Rev B

CONTROL ROOM Y N
1 Are the walls finished with at least one coat of paint?
If "No", when will this be completed? Date:
2 Are all light fixtures installed and operational with dimmers where suggested?
If "No", when will this be completed? Date:
3 Is there at lease one electrical socket next to the Console available to Service Engineer?
If "No", when will this be completed? Date:
4 Are two network connections available: for the Host and CIRS?

5
6 Is Electricity emergency shutdown button installed?

7 If a magnet is installed in vicinity of the CT control room, are magnetic fields specifications met?

NOTE If there is a magnet installed (or was installed) in vicinity of the CT room, a measurement should be
taken to ensure the specifications listed in the document are met. Please provide results of the
measurements.

GENERAL Y N
1 Will a full system UPS be installed?
If "Yes", has commissioning of the UPS been scheduled with the UPS manufacturer?
If "Yes", is floor weight a concern?

If "Yes", where will the full UPS be installed?

O Control room O Scanner room O Auxiliary room
2 Will a Console UPS be installed?
If "Yes", where will the Console UPS be installed?
O Control room O Scanner room O Auxiliary room
3 Will a CIRS be installed?
If "Yes", where will the CIRS be installed?
O Control room O Scanner room O Auxiliary room
NOTE Commissioning of the UPS must be performed by the manufacturer's engineer, occurring the day
scheduled to apply input power to the system for the first time.

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SITE INSPECTION/PRE-INSTALLATION CHECKLIST Document P/N 4550 193 09571 Rev B

CONNECTIVITY
1 Image transfer connectivity:
PACS Information:
System:
Model:
Version:
HIS/RIS Information:
System:
Model:
Version:
DICOM Printer Information:
Vendor Model Version Already Installed Planned Date Remarks

Other DICOM Systems connections:

Type Vendor Model Already Installed Planned Date Remarks

2 RSN: Is the site already connected to RSN ? Yes No Don't know

Site IT Administrator details: Name:

Telephone:

E-mail:

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SITE INSPECTION/PRE-INSTALLATION CHECKLIST Document P/N 4550 193 09571 Rev B

PHOTOS
Provide photos to show the site's installation status.

COMMENTS

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REVISION HISTORY
ECO # Revision Date Comments
H3001561 A April 2008 New release
B November 2009 Changed the RSN information fields

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