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2 #1 Equipment Receiving; Registration Form (+resseritthe ont, standatony) [iqaarus 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 CamScanner 2 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 [iqarus| 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

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