AVITUM REQUEST FOR SERVICE FORM

Fault Details:

during disinfection following alarm noted- rinse out chemical

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disinfectant not possible. tried to stop disinfection and restart,

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changed citric acid solution. off and on machine, but alarm not
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going . machine moved to tech room.
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1860
Error Number : _______________

During Preparation During Treatment During Disinfection

BBAU Technical Services: service.au@bbraun.com

mike.wittl@bbraun.com

Date reported: 14/03/2024

Time reported: 21.30

Reported by: Alvy Augustine

Location: Toto Ora Dialysis Unit

Model: Serial Number: WTC:

Machine Number : 13

Software Version: LLC Status: LLS Status:

Service Request sent to BioServe: 14/03/2024

Date: ___________ Time: 21.30
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Email: service@bioserve.co.nz
mbarnard@bioserve.co.nz
Ph: +64 9 846 4802

Copy email: service.au@bbraun.com

mike.wittl@bbraun.com
babu.ramalingam@middlemore.co.nz

BBAU Technical Service Internal Use

Issue Resolved Internally – WO # _____________________

BBAU Purchase Order #: Date: Authorised by Name / Signature:

BBAUTS- _______________ _______________ _________________________