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Versapulse ProntoForm Rev. D

CHECKLIST INFORMATION

Case Information

Account APOLLO MULTISPECIALITY HOSPITALS - Kolkata, WEST

BENGAL - 363441
Serial Number 21-VERSAPULSE POWERSUITE 100W US
Work Order Number WO-01088978

PREVENTIVE MAINTENANCE

Form Information

Reference: Complete checklist 92805751 Rev B - CE, Lumenis Versa

Pulse Power Suite Preventive Maintenance Checklist, per
0636-499-00 Lumenis Versa Pulse Power Suite Service
Manual.

1. Installed System Site Information

Evaluation Unit: Yes

System model: VPPS 100W

3. System Software Information

Step 4.1.2 and 4.7: Software Version 1.0

Step 4.1.2 and 4.7: Verified latest software is installed (if not Yes
upgraded, Section 4.1.2)

4. Visual Inspection

Step 3.8: No external damage – Dent or cracks on panels or Pass

water leaks.

No Internal damage - No loose hardware, broken components,

abnormal wear or cuts/frays in electrical wiring, water leak
stains or water leaks.
Step 3.8: Optic Components Check – Inspect all optics, clean Pass
or replace as necessary.
Step 3.8: Dust/dirt inspection – Inspect the panel air vents for Pass
dust and clean panels externally and internally as necessary.

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Step 3.8: Air Filter check (underneath the system), (clean as Pass
necessary).
Step 3.7: Blast Shield check. (Replace if damaged). Pass

5. Parts Replacement

Step 5.6.3: Replace the Deionizer and Particle Filter. Yes

6. Safety and Operational Checks

Step 3.8 and 2.1.4: Check the coolant level and add coolant as Yes
needed.
Step 4.7: System startup. Self-test was successful. No error Pass
appeared.
Step 3.7: Circuit breaker, Key switch and E-stop check. Pass
Step 3.7: BRH (Interlock) Plug. Pass
Step 3.7: Flow switch check. Pass
Step 3.7: Footswitch and Fiber Switch. Pass
Step 3.7: LCD and LCD display check (including Aiming Beam Pass
Intensity check)
Step 3.7: Blast Shield check (operational and clean) Pass
Step 3.7: Remote control panel check Pass
Step 3.6.1: Fiber Alignment test was successful. Fail
Please Provide Justification 4th cavity energy calibration plot data 127, 3.5 J

7. Energy Calibration Plot Data (3.5 Joules)

Step 5.3 (Fig5-16): Brick 1 Yes

Step 5.3 (Fig5-16): Brick 2(If not applicable, enter "NA" Yes
Step 5.3 (Fig5-16): Brick 3 Yes
Step 5.3 (Fig5-16): Brick 4 (If not applicable, enter "NA") Yes

8. Energy Checks (Power Meter Checks) For the VersaPulse PowerSuite 100W (HoYAG: 2100nm)

Note: Max pulse width: 600us; Max Pulse rate: 40 pulses/sec

Step 3.6.2: Pulse Energy (0.2 J), Pulse Rate (10 Hz), 1.9
Acceptance Range (1.8 - 2.2 Watts) Pass

Step 3.6.2: Pulse Energy (2 J), Pulse Rate (10 Hz), 19.2
Acceptance Range (18 - 22 Watts) Pass

Step 3.6.2: Pulse Energy (2 J), Pulse Rate (25 Hz), 0

Acceptance Range (45 - 55 Watts) Fail

Please Provide Justification Energy high, 4th cavity energy plot value 127
Step 3.6.2: Pulse Energy (3 J), Pulse Rate (20 Hz), 0
Acceptance Range (54 - 66 Watts) Fail

Please Provide Justification Energy high, 4th cavity energy plot value 127

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Step 3.6.2: Pulse Energy (2 J), Pulse Rate (40 Hz), 0
Acceptance Range (72 - 88 Watts) Fail

Please Provide Justification Energy high, 4th cavity energy plot value 127
Step 3.6.2: Pulse Energy (2.5 J), Pulse Rate (40 Hz), 0
Acceptance Range (90 - 110 Watts) Fail

Please Provide Justification Energy high, 4th cavity energy plot value 127

CHECKLIST CLOSING - ENGLISH

Checklist Closing

Service Status Service Complete

Work Order Assigned Technician: Debasish Saha
Completed By Username: debasish.saha@bsci.com
Date of Service Aug 29, 2023

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