page 67 of 99
cos105000_170-190_65, rev. 1.03
© 1988 - 2019 h/p/cosmos sports & medical gmbh
17.3 Commissioning and instruction protocol, signatures
By signing this protocol, the authorized h/p/cosmos service personnel and the customer confirm the receipt and understanding of all
safety information, the performed instruction and commissioning according to the instruction protocol [cos15228-03]. The customer
confirms the receipt of the listed devices including all accessories and options according to the h/p/cosmos delivery note. Disregard
of safety information, intended or forbidden use, as well as unauthorized maintenance or lack of maintenance and regular safety
checks may lead to injury or even death and can damage the device. Furthermore, this will result in loss of liability and warranty.
Please fill out the instruction protocol and send it back to h/p/cosmos by fax (+49 18 05 16 76 69), email
or
mail.
h/p/cosmos device, model name
device serial number
instructor
name in clear block letters
h/p/cosmos dealer / technician
date and signature
instructed persons (customer
, operator
, etc.)
name in clear block letters
h/p/cosmos dealer / technician
date and signature
h/p/cosmos sports & medical gmbh
Am Sportplatz 8
DE-83365 Nussdorf-Traunstein
Germany
customer´s stamp / address:
