Date : Customer :

System : RF/URF System Duo Diagnost

S/N :
Performed By: Hansa Ltda.
Technical Engineer : City: La Paz

Check Subject Ok. Not Ok. NA.

Functioning and visual inspection

covers of system O O O

Control console O O O

Exposure switch and cables O O O

Foot switches O O O

Table Top O O O

Column and rails O O O

Control Cabinets O O O

Colimator, light and controls O O O

Bucky Wall Stand O O O

Monitors and check image quality O O O

Boot Sequence O O O

General Remarks:

Name of FSE Customer