To be incorporated in the company-specific Installation Complotion- Handover- Acceptance report Installation Report (Separate report to be submitted for every equipment) Whether the equipment is New (J Pre owned(used) =) Pre owned (Refurbished) Details of equipment installed: Equipment (type of equipment) Model name. ‘Type Approval Number ‘Maximum operating potential = Maximum current ‘Any specific conditions: Mobile protective barrier 9 Lead Apron (1 No.) o ‘Type Approval number is pasted on the equipment o | The folloing documents are handed over to customer Copy of valid NOC/Type Approval Certificate __AERB guidelines on radiation safety a Warning symbols and placards are provided Address of the Customer for correspondence Equipment Location and address Contact person | Ph No, email patient use, | oustomer. (Summary report enclosed) is safe for operation. (Report enclosed) | The above equlpment and accessories have bean handed over In good working condlen In absordance” To ‘specifications of valid Type Approval Certificate. The ‘equipment is Installed at our premises and Is ready for first ‘Acceptance tests are demonstrated to the user as per AERB format on (Date) and test Report handed over to Radiation Protection survey of the installation is carried cut and radiation levels are found within the limit. Installation ‘Accepted by Designation Name Seal of the Institution Signature of the service engineer Date: Name Designation SEAL OF THE COMPANY CC: Head, RSD, AERB, Niyamak Bhavan, Anushakti Nagar, Mumbai - 400094