STELLANT MEDRAD PREVENTIVE MAINTENANCE PACKAGE CHECKLIST

Hospital

Address

City State ZIP Code

Department

System Serial Number 3010091 3007301 ___________________

3007300

Display Serial Number 3007032 ___________________

Head Serial Number 3007062 3007033 ___________________

3007040

Base Serial Number 3007039 ___________________

Software Version ___________________

Test Equipment (Europe Only)

DMM Inventory No. Pres. Gauge Inv. No.

Bender Inventory No. Timer Inventory No.

Document 202823 revision level:

Upon signing this PMP Checklist the Medrad Field Representative concurs with the following statement:

"This Stellant Injector System has been fully updated, repaired, tested, and calibrated according to Medrad Service procedures and
meets all product acceptance criteria. All necessary documentation has been completed and reviewed."

Performed by DATE
(Signature)

Name
(Print)

MEDRAD 202824 REV A Page 1 of 2 F U L L M A N U F A C T U R I N G

 STELLANT MEDRAD PREVENTIVE MAINTENANCE PACKAGE CHECKLIST

This checklist must be used in conjunction with the current revision of the Stellant PMP, document number 202823 (record revision
level on page 1). A check mark must be used for steps not requiring data to be recorded. If step was not performed (e.g., an option
checkout the unit does not have) write "NA" in step. When completed the checklist will reflect status of the unit. Sections 1 through 6
require no information to be recorded.

7.0 Head inspection/update _____

8.0 Display inspection/update _____

9.0 Base inspection/update. _____

10.0 Options and Accessories inspection/update. _____

10.1 Hand switch _____

10.2 Syringe Heater _____

10.3 CRU Pedestal Mount _____

10.4 Wall Mounting Bracket. _____

11.0 Functional: _____

12.0 Pressure Check. _____

13.0 System Leakage Test.

Ground open, line normal Leakage must be less than 100 mVAC. Unit ______ mVAC

Ground open, line reversed Leakage must be less than 100 mVAC. Unit ______ mVAC

Test lead Leakage must be less than 10 mVAC. Unit ______ mVAC

14.0 Final Preparation:

14.5 Reset calibration reminder. _____

MEDRAD 202824 REV A Page 2 of 2 F U L L M A N U F A C T U R I N G