Handicare PRISM MEDICAL C450, Owner'S Manual

Page: 35 / 37

C450/ C625 - User Guide (753101) Rev: 14 MAR 2017 Page: 35
Service Record History
Complete this section after each service, repair inspection and/
or maintenance. Photocopy additional pages as required.
Service Type:
□ Periodic Inspection □ Monthly Inspection □ Semi-Annual Inspection □ Repair □ Annual Inspection □ Other:_________
Completed By :
_________________________
_____________________________
Printed Name Signature
Company: _____________________________________________________________
Remarks & Action Taken:
Date: _______________________ Time: ________________________
Service Type:
□ Periodic Inspection □ Monthly Inspection □ Semi-Annual Inspection □ Repair □ Annual Inspection □ Other:_________
Completed By :
_________________________
_____________________________
Printed Name Signature
Company: _____________________________________________________________
Remarks & Action Taken:
Date: _______________________ Time: ________________________
Service Type:
□ Periodic Inspection □ Monthly Inspection □ Semi-Annual Inspection □ Repair □ Annual Inspection □ Other:_________
Completed By :
_________________________
_____________________________
Printed Name Signature
Company: _____________________________________________________________
Remarks & Action Taken:
Date: _______________________ Time: ________________________
Service Type:
□ Periodic Inspection □ Monthly Inspection □ Semi-Annual Inspection □ Repair □ Annual Inspection □ Other:_________
Completed By :
_________________________
_____________________________
Printed Name Signature
Company: _____________________________________________________________
Remarks & Action Taken:
Date: _______________________ Time: ________________________
Service Type:
□ Periodic Inspection □ Monthly Inspection □ Semi-Annual Inspection □ Repair □ Annual Inspection □ Other:_________
Completed By :
_________________________
_____________________________
Printed Name Signature
Company: _____________________________________________________________
Remarks & Action Taken:
Date: _______________________ Time: ________________________
Service Type:
□ Periodic Inspection □ Monthly Inspection □ Semi-Annual Inspection □ Repair □ Annual Inspection □ Other:_________
Completed By :
_________________________
_____________________________
Printed Name Signature
Company: _____________________________________________________________
Remarks & Action Taken:
Date: _______________________ Time: ________________________