Proprietary to General Electric System ID:

Optima CT660 / Revolution EVO - PM Report Schedule A SR#:

Date:

PM Report Schedule A

Optima CT660 / Revolution EVO

Customer Name:       Service Record #:      

System ID/ Serial Number:       Customer Equipment ID:      
Service Manual Document Number:       Software Version:      
PM Frequency:       months
System Type (Select:) Select

PRELIMINARY TASKS
Last PM Inspection
Verify last PM Inspection
Last Inspection Date :       Last Schedule Completed: Select
List any Schedule A tasks that were completed earlier      

PM Schedule Sys A

Initial Procedures
Check Temperature and Humidity
Task Temperature Humidity Pass/Fail Comments/Follow-up
Scan room Temp & Humidity             Select      

General Gantry Inspection

Task Pass/Fail Comments/Follow-up
Test Display Lights Select      
Test E-stops Select      
Test Patient Tilt Sensors Select      

Phantom
Task Pass/Fail Comments/Follow-up
QA Phantom Inspection Select      

Checklist PM Document #: DOC1737451 Page 1 of 6

Revision Number: 1
 Proprietary to General Electric System ID:
Optima CT660 / Revolution EVO - PM Report Schedule A SR#:
Date:

Gantry Power Off (Covers Off)

General Tasks
Task Pass/Fail Comments/Follow-up
Emergency Off Switch (on wall) Select      
UPS Power Off Inspection Select      
Gantry Cover Cables Inspection Select      

General Console Cleaning & Inspection

Task Pass/Fail Comments/Follow-up
Clean Component Filters, Fans & Grills Select      
Visual Fan Inspection Select      
Seismic Anchor Check (if necessary) Select      

Slip Ring & Brush Block Inspection and Maintenance

Task Pass/Fail Comments/Follow-up
Remove Slip Ring Brush Debris Select      
Slip Ring Tracks Inspected Select      
Clean Brush Blocks Select      
Brush Tip Inspection Select      

Gantry Filter Cleaning

Task Pass/Fail Comments/Follow-up
Clean DAS Detector Plenum Filter Select      
Clean Detector Face Plate Select      
Clean Gantry Heater Filter Select      
Clean Top Cover Fans Select      
Inspect Rotating Path Components & Cables Select      

Gantry Power On (Covers Off)

General Tasks
Task Select Comments/Follow-up
UPS Powered and Operational Select      

Checklist PM Document #: DOC1737451 Page 2 of 6

Revision Number: 1
 Proprietary to General Electric System ID:
Optima CT660 / Revolution EVO - PM Report Schedule A SR#:
Date:

Plenum Fans (5) Operational Select      

Grease Gantry Main Bearing Select      
No. Revs since last greasing      

Tube Heat Exchanger & Pump

Task Select Comments/Follow-up
Inspect/Clean Tube Heat Exchanger Select      
Inspect/Clean JEDI Inverter Fan Select      

Gantry Power On (Covers On)

General Tasks
Task Select Comments/Follow-up
Scan Window Inspection/Replacement Select      
Inspect Rotational Clearances Select      

General Table Cleaning & Inspection (for GT1700V & VT2000)

Task Select Comments/Follow-up
Inspect/Clean Table Pan Select      
Inspect Table anchors Select      
Inspect Drive Belts Select      
Clean Roller Select      
Grease Table Rails Select      
Grease Table Leg Bearing Select      
Inspect Bearing Retainer Select      
Inspect Flat Tabletop Mount Select      
Inspect Table Covers Select      
Inspect Cradle Accessory Attachment Select      
Check Tape Switches Select      

Checklist PM Document #: DOC1737451 Page 3 of 6

Revision Number: 1
 Proprietary to General Electric System ID:
Optima CT660 / Revolution EVO - PM Report Schedule A SR#:
Date:

Finalization
System Scanning Test
Task QA Phantom Location Gantry Serial #
Serial #
                 
Scan Scan Failures Artifacts Artifact Types
Series 1 (Scout/Auto Voice) Select Select      
Series 2 (Axial/Tilt) Select Select      
Series 3 (Helical/Auto Voice) Select Select      
Task Select Comments/Follow-up
X-ray On Indicators Select      
Scan Control Pushbuttons Test Select      

Finishing Up
Task Completed Comments/Follow-up
Update Site Log      
Complete PM Paper Work      
Complete Customer Reports      

Is follow-up work required?: Select

Service Scheduled Date:      
This inspection passed and meets all GE Healthcare PM specifications

Comments:
     

Characters Remaining:

Checklist PM Document #: DOC1737451 Page 4 of 6

Revision Number: 1
 Proprietary to General Electric System ID:
Optima CT660 / Revolution EVO - PM Report Schedule A SR#:
Date:

Tools Used:
Description Serial Number Bar Code Cal Due Date
                       
                       
                       
                       
                       
                       
                       
                       

GE Representative:
FSEs completing this PM

FSE Name:       FSE Signature Data...

SSO #:      
FSE SR #:      

Customer Signature: Yes No

Checklist PM Document #: DOC1737451 Page 5 of 6

Revision Number: 1
 Proprietary to General Electric System ID:
Optima CT660 / Revolution EVO - PM Report Schedule A SR#:
Date:

Date
Final PM Complete Completed:

Checklist PM Document #: DOC1737451 Page 6 of 6

Revision Number: 1