u

Y
s
n
m
ie
S

AX Systems
AX

Installation Protocol
System

Installation Certificate

© Siemens, 2008

10272500
10094012
07008530

© Siemens, 2008
All documents may only be used for rendering
services on Siemens Healthcare Products. Any
document in electronic form may be printed
once. Copy and distribution of electronic docu-
ments and hardcopies is prohibited. Offenders
will be liable for damages. All other rights are re-
served.

Print No.: AX00-000.813.03.01.02 English

Replaces: n.a. Doc. Gen. Date: 09.08
SSME AX SCU
n.a.

2008
2 Copyright / Version / Disclaimer

Copyright
1Copyright / Version / Disclaimer

“© Siemens, 2008“ refers to the copyright of a Siemens entity such as Siemens Aktienge-
sellschaft - Germany, Siemens Mindit Magnetic Resonance Ltd. - China, Siemens Shang-
hai Medical Equipment Ltd. - China, Siemens Medical Solutions USA Inc. - USA and/or
Siemens Healthcare Diagnostics Inc. - USA.

Document Version
Siemens reserves the right to change its products and services at any time.
In addition, manuals are subject to change without notice. The hardcopy documents corre-
spond to the version at the time of system delivery and/or printout. Versions to hardcopy
documentation are not automatically distributed. Please contact your local Siemens office
to order current version or refer to our website http://www.healthcare.siemens.com.

Disclaimer
Siemens provides this documentation “as is“ without the assumption of any liability under
any theory of law.
The installation and service of equipment described herein requires superior understand-
ing of our equipment and may only be performed by qualified personnel who are specially
trained for such installation and/or service.

AX Systems AX00-000.813.03.01.02 Page 2 of 6 © Siemens, 2008

09.08 SSME AX SCU
Installation Certificate 3
2Installation Certificate

System Model / Sys- ___________________________________________________

tem-Type:
Order No. / ___________________________________________________
Auftrags-Nr.
Customer / Kunde: ___________________________________________________
Installation Location ___________________________________________________
/ Montagort:
Installation Team / ___________________________________________________
Montageteam:
Start of Installation _______________ End of Installtion / _________________
/Montagebeginn: M.-Ende:

© Siemens, 2008 AX00-000.813.03.01.02 Page 3 of 6 AX Systems

09.08 SSME AX SCU
4 Installation Certificate

Torque values set per the

Mechanical Installation Per-
Installation Instructions1 /
formed / Mechanische Montage
Drehmomente nach Mon-
durchgeführt
tageanleitung fixiert
System Com-
ponents not
Configured /
yes / ja no/ nein yes / ja
Anlagenteile
nicht
vorhanden
Monitor Trolley System
(MTS) / Monitorträger- ❐ ❐ ❐ ❐
system (MTS)
3D Ceiling Stand / Deck-
❐ ❐ ❐ ❐
enstativ 3D
Unit / Gerät ❐ ❐ ❐ ❐
Unit/Stand (2nd Plane) /
❐ ❐ ❐ ❐
Gerät/Stativ (2. Ebene)
Patient Table / Patienten-
❐ ❐ ❐ ❐
tisch
Bucky Exposure Table /
❐ ❐ ❐ ❐
Rasteraufnahmetisch
Electronics Cabinets /
❐ ❐ ❐ ❐
Elektronikschränke
Computer Cabinet /
❐ ❐ ❐ ❐
Rechnerschrank
Colling Unit / Kühlaggre-
❐ ❐ ❐ ❐
gat
Consoles / Konsolen ❐ ❐ ❐ ❐
Tableside Control Unit /
❐ ❐ ❐ ❐
Nahbedienung
Monitors / Monitore ❐ ❐ ❐ ❐
Video Recorder / Video-
❐ ❐ ❐ ❐
recorder
Hardcopy/Printer ❐ ❐ ❐ ❐

1. Safety-relevant installation work steps; absolutely observe next paragraph!/ sicherheitsrelevante Mon-
tagearbeiten, unbedingt nächsten Absatz beachten!

Notes in the protocol should be written in English! / Hinweise im Protokoll sollen in

AX Systems AX00-000.813.03.01.02 Page 4 of 6 © Siemens, 2008

09.08 SSME AX SCU
Installation Certificate 5

Englisch geschrieben werden!

1
The system was installed according to the following installation instructions; all safety-rel-
evant work steps were performed according to the applicable and enclosed installation
instructions / Die Anlage wurde anhand folgender Montageanleitungen montiert, alle
sicherheitsrelevanten Arbeiten wurden nach den gültigen und mitgelieferten Montageanle-
itungen durchgeführt:
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
If “no” is checked, give reason / Wenn “nein” angekreuzt, dann Begründung:
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________

___________________ _____________________ _____________________

Location, Date / Ort, Responsible Installer / Ver- Responsible Project Manager /
Datum antwortlicher Installateur Projektverantwortlicher

_____________________ _____________________
Name in block letters / Name in block letters / Name in
Name in Druckbuchstaben Druckbuchstaben

If there is a country-specific certificate that covers the same topic, it may also be used. /
Wenn ein landesspezifisches Protokoll existiert, welches den selben Sachverhalt abdeckt,
darf auch dieses verwendet werden.

Work steps that were also performed / Welche Arbeiten wurden zusätzlich durchgeführt:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

© Siemens, 2008 AX00-000.813.03.01.02 Page 5 of 6 AX Systems

09.08 SSME AX SCU
6 Installation Certificate

Please make absolutely certain to return the certificate

to / Protokoll bitte unbedingt zurücksenden an:
Siemens Shanghai Medical Equipment, Ltd. Fax +86 (21) 38895001
AX SCU
278 Zhou Zhu Rd. Shanghai 201318
P.R.China
e-mail: ssmeaxinstallationpublic.med@siemens.com

AX Systems AX00-000.813.03.01.02 Page 6 of 6 © Siemens, 2008

09.08 SSME AX SCU