DOC0743280r3 ScheduleA PM Report
DOC0743280r3 ScheduleA PM Report
GE Healthcare
PM REPORT Schedule A
Optima CT660 / Revolution EVO
SITE INFORMATION
Site Name
System ID Room Number
System Type (Select:) Select
FE Name Inspection Date RFS#
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.
Initial Procedures
Check Temperature and Humidity
Record the temperature and humidity. Indicate if these are within spec.
Room Temperature Humidity Pass/Fail Comments/Follow-up
Scan room Select
Control Room Select
Console
Task Completed Comments/Follow-up
Console Monitor Cleaning & Inspection
System Options
Task Pass/Fail Comments/Follow-up
Ceiling Component Bolt Inspection Select
Nemoto Injector Inspection Select
Cardiac Option Inspection Select
Phantom
Task Pass/Fail Comments/Follow-up
QA Phantom Inspection Select
General Tasks
Task Pass/Fail Comments/Follow-up
UPS Powered and Operational Select
Plenum Fans (5) Operational Select
Grease Gantry Main Bearing Select
No. Revs since last greasing
Finalization
System Scanning Test
Task QA Phantom Location Gantry Serial #
Serial #
Scans 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
General Tasks
X-ray On Indicators Select
Scan Control Pushbuttons Test Select
Completed
Site Log Updated
PM Paper work completed for this site
Comments:
Is follow-up work required?: Select
Service Scheduled Date:
This inspection passed and meets all GE Healthcare PM specifications.
Revision History
Rev Date (m/d/y) Reason for Change
1 03/18/2010 Initial Release
2 06/04/2014 Addition of Revolution EVO.
3 09/12/2014 Addition of Phantom Check