Registration of medical devices add-in card
Operator:
_____________________________________________
_____________________________________________
_____________________________________________
1.
Designation of the medical device:
_________________________________________________________
2.
Functional test and introduction:
Functional test carried out
on:________________ by:___________________________________
Introduction carried out
on:________________ by:___________________________________
Introduced person: ____________________________________
____________________________________
____________________________________
____________________________________
3.
Metrological inspection: at least every two years
Next inspection:
_______________________________________
by (person's name: _______________________________________
4.
Safety inspection/maintenance test: at least every 12 months
Next inspection:
_______________________________________
by (person's name): _______________________________________
5.
Date, type and consequence of the defect and repeated identical operating
fault: ____________________________________________________
_________________________________________________________
_________________________________________________________
6.
Reports of incidents to authorities and manufacturer:
_________________________________________________________
_________________________________________________________
