2
#1
Equipment Receiving; Registration Form (+resseritthe ont, standatony)
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Asset Details
sero A\CO — Tw ri
FE Howutto 14 f Leto!
[pensar se on
Hanutton.
Accessories Details:
[Accesories Name Accessories Received With the Unit),
onion ar
other Details:
hechicen Name:
Mohawecl Ati
Received bate:
QA- bs - 9}
site omen omen
{ton
Received From (nan tam)
Or. Spe Moyo
Unit Condition & Remarks:
Not whoring :
* Seth Tot for .
Technicon Signature:
Nome, Signature, Cate
Fastest,
Provider Signature:
‘Name, Signature, Date
w
Scanned with CamScanner2 Declaration of Equipment Contamination Status
2. Equipment Details 1. Customer Details
sete 13 ste “Teo
ast = “To so Tala onan Te
wna oHaad line hone NSS
mode TL ene
senate Ble Responsible Person
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3, Contamination Status/information
S.-H the Device been contaminated to any harardousmateil/substances? Yes Na
YES, mack relevant Boxand spect
os, 58 sepia aes, palo amples or eter hand
Pease spect
17 coemicats or substances harardous to heath
Diese spect
43.2-Hasthe device been decontaminated? Speifyas Decontamination Policy: YS No
vr bow
so% clon Slsion
romero neato
omer Pease spe,
No vere,
4. Decontaminated by:
name Mohowed .
peste BMET
Telephone:
ou Aleta be completed (ite At ep)
Scanned with CamScanner#3 Equipment Technical Report >
{ 1QARUS
THE POWER OF HEALTH
| [otnie Name ‘Tr [Date Received 29 -b-O)
ecatnsive Voatat Crpho Moyo. |
[contac
: Mobos) Ae
eqvgment Dein [ED \2\c0 ew Honk, [seria Number 12inl
fem emi eee
CNeaneel tre Eoipwenl wrth 10-/. Gopopy
walet Whee
# Ak Cost fd
® Wrong Coat
% Origen Connector glob MaCdluny
Ttem Deseription T Part Number Quantity
AE Checked the cquip went and — Petformast He
Ackk dest .
# role | Neod bo change Oxy? “nleE Lose
Connector
Date Completed ‘Time Completed es Spent For Deviee | ga
ae = " Carn dove | yuo vie
Fatxine | nol ba! | Position I ;
Conactn oe auc Coa] ese | “
Scanned with CamScanner
Eng Details#4 Equipment Handover Form (-eeritte ts Attandaton)
[1oarus]
Asset Details: THE POWER OF HE:
13150 Jace ve: t fonkdets
La sete \gib\
Han Lan [he ot
Monufacturen
Accessories Details:
[Acessories Name (Acessories Received With the Unit) Condition wy
Other Details:
frewswmme —[atohaml Berto Ton
feo [og ta 21 fomtwemnd | Stoo Moyo |
Unit Condition & Remarks:
# PRexfonue EST and SST .
4 Note > rlewd oO echange Ompain ite
Hose Connecto,
‘Technician Signature ‘ecopture Signature:
Name, Date Name, Date
Scanned with CamScanner