Us00-000.832.01.02.02 G20 Sonoline

System
US
Maintenance Protocol
Planned Maintenance
ACUSON/SONOLINE Planned Maintenance

Customer:
Address:
Department:
Room:
Contact person:
Telephone:
Cust. specific no.:
Cust. no.:
Date.:
The instructions US00-000.831.01.02.02 are required for

© Siemens AG 2005
this protocol The reproduction, transmission or use
of this document or its contents is not
permitted without express written
authority. Offenders will be liable for
Siemens Medical Solutions damages. All rights, including rights
created by patent grant or registration
Ultrasound Division of a utility model or design, are
lne reserved.
Print No.: US00-000.832.01.02.02 English

Replace: US00-000.832.01.01.02 Doc. Gen. Date: 1105
n.a.
Part No.: n.a.

sd
Cust.-No.: Date: Protocol
1Protocol
SIEMENS Office:
Address:
Region:
Country:
Contact person:
Tel.:
CSE in charge:
Tel.:
Remarks Regarding the Protocol:

The protocol is valid as proof of quality for one check that must be performed on the sys-
tem / component in one year.
The check must be performed in the specified intervals.
The results of the check are entered in this protocol.
The chapter numbers in front of the checkpoints indicate the corresponding chapters in
the particular instructions (see cover page).
The protocol must be completely filled out by the Customer Service Engineer, i.e.:
• All boxes must be filled out. If a box does not apply to the system or if no entry needs to
be made, check the “n.a.“ box.
• Enter the customer number (Cust. No.:) and the date of the check in the header of each
page so that each page can be allocated to a customer and to a check date.
• If there are complaints, the IVKs for the component about which a complaint has been
made as well as the type of complaint must be entered in the “Open Points“ table pro-
vided for this. Correction of these open points also must be documented in this table
with the date and a signature. If there are no open points, check “No“ and document this
with the date and a signature.
• If movable components (also test phantoms that are part of the system) that can be
used in different systems are used for the check, they must be entered in the “Movable
Components“ table provided for this.
• The measurement values for the measurements that must be performed during the
check must also be entered in the open spaces / tables provided for them.
• After completing the check, Page 3 of this protocol must be filled out and signed.
System US00-000.832.01.02.02 Page 2 of 8 Siemens AG

1105 sd Medical Solutions USA, Inc.
Protocol Date: Cust.-No.:
Further Processing and Archiving of the Protocol

The protocol is a document and thus must be archived. After completing the test, it must
be filed in the corresponding register in the “System Owner Manual“ binder. If needed, a
copy can be handed to the customer.
System:
Serial No.:
Software Version:
Number of the Service Contract:
Type of Maintenance:
Evaluating the Condition of the System / Component
The system has no deficiencies. The image quality test

resulted in no differences from required reference values.
The system / component has slight deficiencies that have
no affect on continued operation of the system. However
they should be corrected preventively.
The image quality test resulted in no differences from
required reference values.
The system / component has serious deficiencies. For
safety reasons, continued operation of the system is per-
mitted only after successfully correcting the deficiencies.
After completing all work steps, an evaluation was performed.
Signature:
Date: Name:
The operator or a person assigned for this has taken note of this evaluation.
(if national regulations require this)
Signature:
Date: Name:
Siemens AG US00-000.832.01.02.02 Page 3 of 8 System

Medical Solutions USA, Inc. 1105 sd
Explanation of Abbreviations in the Protocol
Abbrev. Explanation Abbrev. Explanation

SI Safety Inspection PMF Preventive Maintenance, Operat-
ing Value Check, Function Check
SIE Electrical Safety Inspection Q System Quality, Image Quality
SIM Mechanical Safety Inspection QIQ Image Quality
PM Preventive Maintenance QSQ System Quality Check
PMP Periodic Preventive Mainte- SW Software Maintenance
nance
PMA Preventive Maintenance CSE Customer Service Engineer
Adjustments
Additional activities performed

Only activities that are not described in the instructions for the system / component need
to be listed.
Date:
Additional activities performed: OK not n.a.
OK
Open Points:
Yes: No: Signature:
Date: Name:
If “Yes“, enter the component with the IVK and the open point (only the number) in the
table. After completing maintenance, record this in the table.
IVK Component Open Points Completed

Date Signature

Measuring Devices queried electronically:
Yes: No: Signature:
Date: Name:
If the measurement devices are queried electronically, for example with a Scout Mobile
Device, entry of the measuring devices in the table can be skipped.
Measuring Devices Type Serial No. Date Used Next Cali-

bration
Due
Movable Components:
Yes: No: Signature:
Date: Name:
If “Yes“, enter the movable component with which the check was performed along with the
with the Serial No. in the table.
Movable components (also test phantoms that are part of the system) are parts that can
be used on different systems).
Component Serial No.
Siemens AG US00-000.832.01.02.02 Page 5 of 8 System

OK not n.a.
OK
1 Preventive Maintenance
1.2 Preparations
PM Discussing Customer Concerns:
PM Maintaining the Patient Database:
PM Performing a Disk Defragmentation:
PM Performing a Check Disk (SW Version 2.0 and above only):
1.3 Performed Maintenance

PM Checking System Performance
PM Performing System Calibration
PM Cleaning the System
PM Cleaning and Inspecting Transducers
PM Cleaning Air Filters
PM Cleaning the Trackball
1.4 Safety Checks

SI Checking Wheels and Wheel Locks
SI Checking Monitor
SI Checking Keyboard Movement
SI Checking Cooling Fans
SI Checking the Power Cord
Startup Date / Date of Last Replacement . .

DD MM YYYY
SI Checking Electrical Safety
1.5 General System Maintenance

PM Checking Modules and Cables
PM Verifying Mandatory System Modifications
1.6 Functional System Check

QSQ Checking the System
QIQ Checking Image Quality and Transducers
1.7 Peripheral Devices Check

QSQ B/W and Color Printers

OK not n.a.
OK
Option present: Yes: No:
Signature:
Date: Name:
Signature:
Date: Name:
QSQ VCR
Signature:
Date: Name:
1.8 Concluding the Maintenance

PM Checking System Preset Data
SI Checking the Protective Ground Wire
PM Concluding the Maintenance
Maintenance of this section was performed completely:
Signature:
Date: Name:
Siemens AG US00-000.832.01.02.02 Page 7 of 8 System11



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System

ACUSON/SONOLINE Planned Maintenance

The instructions US00-000.831.01.02.02 are required for

Print No.: US00-000.832.01.02.02 English

Part No.: n.a.

Remarks Regarding the Protocol:

System US00-000.832.01.02.02 Page 2 of 8 Siemens AG

Further Processing and Archiving of the Protocol

Evaluating the Condition of the System / Component

The system has no deficiencies. The image quality test

After completing all work steps, an evaluation was performed.

Siemens AG US00-000.832.01.02.02 Page 3 of 8 System

Abbrev. Explanation Abbrev. Explanation

Additional activities performed

Yes: No: Signature:

IVK Component Open Points Completed

System US00-000.832.01.02.02 Page 4 of 8 Siemens AG

Measuring Devices queried electronically:

Yes: No: Signature:

Measuring Devices Type Serial No. Date Used Next Cali-

Yes: No: Signature:

Component Serial No.

Siemens AG US00-000.832.01.02.02 Page 5 of 8 System

1.3 Performed Maintenance

1.4 Safety Checks

Startup Date / Date of Last Replacement . .

SI Checking Electrical Safety

1.5 General System Maintenance

1.6 Functional System Check

1.7 Peripheral Devices Check

System US00-000.832.01.02.02 Page 6 of 8 Siemens AG

Option present: Yes: No:

Option present: Yes: No:

Option present: Yes: No:

1.8 Concluding the Maintenance

Maintenance of this section was performed completely:

Siemens AG US00-000.832.01.02.02 Page 7 of 8 System11

System US00-000.832.01.02.02 Page 8 of 8 Siemens AG

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