FujiFilm Sonosite PX System, Service Manual

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96 Appendix B: Service Event Reporting
Service Event Report Form
Service Event Report
Instructions on reverse
Service Type
(check one)
Parts Status
(check one)
For SonoSite Use O
†
Out of Box Failure
†
No parts necessary for this repair. Service
Event Report for your information.
Service Request
† Warranty Service †
I need parts for this repair (list the parts below
and attach Purchase Order)
Order Number
†
Out of Warranty Service
†
I need parts to replenish my stock (list the
parts used below and attach Purchase Order)
RMA Number
†
Will not replenish stock. Please give me a
RMA for the return of the faulty parts.
Work Order
†
No parts necessary. Please issue a RMA for
repair at SonoSite.
Service Provider
Name: Provider Reference:
Company: Date Reported:
Address:
Phone Number: Fax Number:
E-mail address:
Device Description
Ref Number: Serial Number:
Name: Lot Number:
ARM/SHDB Version: Configuration:
Problem Found
Service Performed
Performed By: Date:
Parts Removed
Part Name Part Number Serial Number Lot Number Rev Replace
Parts Installed
Part Name Part Number Serial Number Lot Number Rev Replace
Tests Performed (attach test data)
Test: Test:
Enter complete
contact information
Enter product information for
the system being repaired
Put the system configuration here.
You can find this on the System
Information Page
Enter details for parts being
removed from the system.
Choose a Service Type
Choose a Part Status
Enter DETAILED problem
description here.
Enter details for parts being
installed into the system.