MedRad Stellant Inventory Check Sheet

Facility: _________________________________________ Date: ___________________

Department: _____________________ Lab: __________ Service Report #: _________

Head Mounting (circle one): Ceiling Wall Pedestal

Local ID #: ______________ Software Version: _______________

____________________________________________________________________________________

Original Parameters:
Phase 1: ____________________________________________________________________________________________

Phase 2: ____________________________________________________________________________________________

Phase 3: ____________________________________________________________________________________________

Phase 4: ____________________________________________________________________________________________

Phase 5: ____________________________________________________________________________________________

Phase 6: ____________________________________________________________________________________________

Pressure: _______ Delay: _____ Scan Inject No Delay

____________________________________________________________________________________

Main System ID #: ________________________

Display: Part # 3007032 Serial # : __________ Base: Part # 3007039 Serial # : __________

Injector Head: Part # (circle one) 3007033 (New) or 3007038 (Old) Serial # : __________

Size Sensor Assy A and B: Part # (circle one) 3013368 (New) or 3009234 (Old)

A Side Serial # : __________ B Side Serial # : ___________

Power Regulator PCB (below Size Sensor Assy A): Part # 3007297 Serial # : __________

Power Drive Cards A and B: Part # 3007293 A Side Serial # : __________ B Side Serial # : __________

Interface PCB (underside of injector head): Part # (circle one) 3007294 (New) or 3011778 (Old) Serial # : ________

Servo PCB (under injector head display): Part # (circle one) 3007431 (New) or 3011675 (Old) Serial # : ________

____________________________________________________________________________________

Additional Notations: _________________________________________________________________

Condition of H-Cover Screw Downs: ____________________________________________________

Condition of Heaters: _________________________________________________________________

Florida Service Plus, Inc. 30XXX, 7-2008

1-800-352-7821 Page 1 of 5
 Stellant Operational and Preventive Maintenance Check Sheet
Operational Checkout Procedure
1. Visually Inspect Remote Panel
2. Visually Inspect Injector Head
3. Visually Inspect Head Mounting
Device
4. Operational Checks
5. Identification
Florida Service Plus, Inc.
1-800-352-7821
Pass Fail
1.1. Remote Panel Screen
1.2. Coiled Start Hand Switch (if applicable)
1.3. Remote Cable
1.4. Base Unit Cables
1.4.1. Power Cord
1.4.2. Remote Panel Cord
1.4.3. Injector Cord
1.5. Remote Panel Securely Mounted
2.1. Integrity of Buttons
2.2. Pivot Knuckle
2.3. Integrity of Syringe Wells
2.4. Injector Head Cable and Extension Cable
3.1. Pedestal
3.1.1. Head Swings Freely on Post
3.1.2. Weights are Secure
3.1.3. Moves Freely About the Room
3.1.4. Cable Neat and Orderly
3.2. Counter-Poise Arm
3.2.1. Properly Installed; Secured to Unistrut
3.2.2. Screws are Tight
3.2.3. Injector Head Secured to Post
3.2.4. Arm Swings Smoothly; No Drift
3.2.5. Integrity of Spring Section
3.2.6. Cable Neat and Orderly
4.1. Remote Panel Powers Up Properly
4.2. Annotate Customer’s Last Settings
4.3. Proper Volumes Displayed
4.4. Proper General Injector Operation
4.5. Proper Auto-Load Injector Operation
4.6. Proper Auto Advance Injector Operation
4.7. Smooth Plunger Motor Movement
4.8. Heat Maintainers Get Warm (if applicable)
Record Main System #, unit serial #s, local identification
#s, and board serial numbers on Inventory Check Sheet Complete ______
30XXX, 7-2008
Page 2 of 5
 6.1. Remove and Clean Components
6.1.1. Manual Motor Knobs
6.1.2. Lens Caps
6.1.3. Head Covers
6.1.4. Plunger Head Tips
6. Cleaning 6.2. Clean Injector Assembly Complete ______
6.2.1. Remote Panel
6.2.2. Injector Head
6.2.3. Head Mounting Device and Base
6.2.4. Cables
7.1. Integrity of Power Cord
7.2. Cables, Connectors and Pins
7. Maintenance 7.3. Start Switch Housing (if applicable)
7.4. Observe Internal Wiring Path and Condition
8.1. Reassemble Injector
8. Parts and Servicing 8.2. Install All Parts Listed on Service Work Sheet
8.3. Complete All Service Listed on Service Work Sheet

Florida Service Plus, Inc. 30XXX, 7-2008

1-800-352-7821 Page 3 of 5
 MedRad Stellant Calibration/Verification Check Sheet

Procedure Specifications Actual Values Status

A Side Volume _____ ml Pass _____ Fail _____
9. Calibration of Plunger Perform only if necessary (if
Pots syringe volume reads > 1 ml)
B Side Volume _____ ml Pass _____ Fail _____

Syringe A
10 secs +/- .5 secs A Time: ______ secs Pass _____ Fail _____

50 ml +/- 1 ml A Volume: ______ ml Pass _____ Fail _____

10. Volume and Flow
Rates
Syringe B
10 secs +/- .5 secs B Time: ______ secs Pass _____ Fail _____

50 ml +/- 1 ml B Volume: ______ ml Pass _____ Fail _____

Syringe A
20 s ± 5 s Fast Forward A FF __________ secs Pass _____ Fail _____

20 s ± 5 s Fast Reverse A FR __________ secs Pass _____ Fail _____

120 s ± 10 s Slow Forward A SF __________ secs Pass _____ Fail _____

120 s ± 10 s Slow Reverse A SR __________ secs Pass _____ Fail _____

11. Motor Speeds
Syringe B
20 secs ± 5 secs Fast Forward B FF __________ secs Pass _____ Fail _____

20secs ± 5secs Fast Reverse B FR __________ secs Pass _____ Fail _____

120 s ± 10 s Slow Forward B SF __________ secs Pass _____ Fail _____

120 s ± 10 s Slow Reverse B SR __________ secs Pass _____ Fail _____

12. Electrical Safety Per Local Procedures

< 100 PSI, +/- 20 __________ PSI Pass _____ Fail _____

13. A-Side Pressure Limit < 200 PSI, +/- 30 __________ PSI Pass _____ Fail _____

< 325 PSI, +/- 40 __________ PSI Pass _____ Fail _____

< 100 PSI, +/- 20 __________ PSI Pass _____ Fail _____

14. B-Side Pressure Limit < 200 PSI, +/- 30 __________ PSI Pass _____ Fail _____

< 325 PSI, +/- 40 __________ PSI Pass _____ Fail _____

15. Final Inspection Final Operational Check Complete ______

Calibration verifications performed by,

X_________________________________ Date: _____________

Florida Service Plus, Inc. 30XXX, 7-2008

1-800-352-7821 Page 4 of 5
 MedRad Stellant Service Work Sheet:
Service Report #: ______________ Service Rep: ________________ Date: ___________

1. Parts Installed:

2. Work Performed:

3. Next Year:

Florida Service Plus, Inc. 30XXX, 7-2008

1-800-352-7821 Page 5 of 5