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    FSR00045198--1

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    Marikumaran M

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    FSR00045198--1

    Uploaded by

    Marikumaran M
    4 views2 pages

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    4 views2 pages

    FSR00045198--1

    Uploaded by

    Marikumaran M

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    FIELD SERVICE & ON-SITE REPAIR REPORT

    No :CHE-0003492 MVAN : 40611 Date : 17/12/2024


    Customer(Hospital) Name/Address : SRI RAMACHANDRA CALL LOG NO : 00045198
    HOSPITAL, NO. 1,
    RAMACHANDRA NAGAR, Site : Local Outstation
    PORUR, CHENNAI, Tamil Nadu EQUIPMENT
    - 600116, IN Under Warranty Under Contract
    City / Area : CHENNAI
    State : Tamil Nadu Pin : 600116 Under No Warranty No Contract OMSI Asset
    Department : Gastroenterology PURPOSE OF VISIT
    Inspection Training Equipment Collection
    PIC (Name) : Deepan shanmugam
    Mobile / e-mail : +918508902101 PM OSR Lamp Replacement Other
    Problem/s As Reported by Customer : Multiple Dots Came in Scope Screen While doing Bronchoscopy procedure in Pediatric
    Bronchoscope
    ENDOSCOPE (RIGID / FLEXIBLE / OTHER) - INSPECTION (BASIC)
    SCOPE MODEL : BF-XP160F Angulation : ok
    SR. NO : 2651575 Bending Tube : ok
    DESCRIPTION : BF-XP160F EVIS EXERA Connecting Tube : Crush in CT
    BRONCHOFIBERVIDEOSC Distal End /Tip (Ob/LG) : ok
    Elevator Wire / Channel (TJF/GF) : na
    LEAKAGE Done Could not be Done AUX Channel (if applicable) : na
    TEST:
    Balloon Channel (EU scope) : ok
    (IF DONE) : Positive Negative
    Control Body / Remote Switches : ok
    LEAKAGE FROM :
    AIR WATER BLOCKAGE (IF FOUND), WHETHER IN : Display Image (Video / Fib / EUS) : black dots
    AW NOZZLE AW CHANNEL EU / TJF scope Nozzle : na
    OTHER ROUTINE ON-SITE INSPECTION : Other Remarks : black dots -SSI4101

    Done Not Done Only limited


    FSE's Corrective Action :
    ELECTRICAL / SAFETY CHECKS & OTHER INSPECTIONS
    ELECTRICAL SAFETY TEST (EST) : Passed Not Passed Test Not Reqd Report Attached: Yes NO

    POWER ANALYZER TEST : Passed Not Passed Test Not Reqd Summary Sheet Attached : Yes NO
    SITE VOLTAGE : L-N L-G N-G
    POWER SUPPLY THROUGH : CVT/SERVO/ISO-TRANSFORMER CERTRAL SUPPLY ON-LINE UPS
    DIRECT GEN-SET
    OTHER FINDINGS (AS APPLICABLE) Water TDS level (OER input) : Temperature : Humidity :
    EQUIPMENT / ARTICLE COLLECTION
    NO INSPECTION COULD BE DONE ON-SITE : (Yes ) EQPMT. TO BE SENT TO WORKSHOP : (Yes )
    EQUIPMENT COLLECTED FOR DETAILED INSPECTION / EVALUATION : ( YES COLLECTED ),

    IF EQUIPMENT COLLECTED FOR WORKSHOP BY OMSI FSE / REPRESENTATIVE, the Details of Additional articles (if any) :
    1. Carrying Case (Thermocol Packing) Hard Box ) 2. Any additional article/s :
    ON-SITE REPAIR/s (Description of Job): ->
    1. Part No 2. Part No 3. Part No
    Qty Qty Qty
    4. Part No 5. Part No 6. Part No
    Qty Qty Qty
    7. Part No 8. Part No 9. Part No
    Qty Qty Qty
    10. Part No 11. Part No 12. Part No
    Qty Qty Qty
    13. Part No 14. Part No 15. Part No
    Qty Qty Qty
    EVENT / MALFUNCTION OCCURRED DURING :
    A. Right Before Procedure B. During the Procedure (GIR Required)
    (a.) Patient Anesthetized (GIR Required) C. During Routine Inspection by Customer (GIR Required)
    (b.) Patient not Anesthetized (GIR Not Required) Customer / User got injured / harmed
    (c.) Customer / User got injured / harmed (GIR Required)
    NOTE : If point A (a,c), B & C are ticked, the GIR is to be filled.
    OMSI Engineer's Name & Signature : Customer Sign / Stamp :
    Sivasankaran S

    Engineer's Remarks : Customer's Remarks :


    Crush in Connecting tube.

    NOTE:
    Any Stored Data in Peripheral (CV / OTV / IMH / EU-MEs / Others), to be retrieved and saved by Customer before handing over the
    Equipment to OMSI Engineer for inspection or repair at Olympus Workshop facility. OMSI will not be responsible for any loss of stored
    data.
    For Fiberoptic / Hybrid Scopes, the black dots (due to glass fiber breakage) may slightly increase while carrying out inspection / repair.
    Repair Quotations / Invoices generation, Warranty Repairs will be executed only after finalization from Olympus HQ / Workshop Facility.
    Technical findings at field level are further subject to confirmation / correction from OMSI in-house Work-shop facility.
    Equipment / Accessories, if carried by Olympus engineer, are on sole risk & responsibility of customer.
    Leaking Endoscope can further deteriorate to an extent to CCD failure, in addition to other major ailments like Imaging / display issues /
    Corrosion / Rusting in metal parts, Angulation Knobs / Bending Stiffness, malfunction of electrical / electronics parts etc.

    OLYMPUS MEDICAL SYSTEMS INDIA PVT. LTD. (OMSI)

    Ground Floor, Tower-C, SAS Tower, The Medicity Complex, Sec – 38, Gurgaon – 122001 (Haryana) India. TEL : +91-124-4999191,
    FAX : +91-124-4999190, Direct Service : +91-124-4999192, Email : [email protected],
    Web : www.olympusmedical.co.in, CIN : U33110HR2009FTC039611, Olympus Sales and Service App : MY VOICE

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