6875 hana Table
T e c h n i c a l S e r v i c e s D e p a r t m e n t
Preventative Maintenance Checklist Phone: 800-777-4674 PST Fax: 510-429-8324
50603-06 Rev. A ECN# 10016 Effective Date 3/9/2010 Page 1 of 4
Preventive Maintenance (PM) Checklist
Model: 6875 Hana table
Work Instruction number 50603-06
Contact Information:
Date: ________________Model/Serial#: _______________________
Account #: ____________________
Hospital Name: _________________________________ City & State: ________________________________
Contact Name: _______________________ Position: ___________________ Phone: _____________________
Equipment Location: ________________________________________________________________________
Service Representative: _____________________ Service Organization: _______________________________
Service Rep. phone: ________________________ Home location: ____________________________________
Customer contact accepting service: ______________________ __________________ ____________
Name please print
Signature Date
Service Representative: ________________________ _______________ ___________________
Name please print Signature Date
Using this report:
Please proceed through each step and place an “x” in the “( )” as each item representing Pass
Fail ( ) ( ) criteria is inspected. If a step has failed, please indicate with an “x” and note the reasons in the
comments section. If you resolve the failure place an “x” in the “Pass” area and indicate the corrective action again
in the comments section. If you are unable to perform any Pass/Fail check, please contact Mizuhosi Technical
Services for assistance and circle the check.
Biohazards when servicing equipment:
Please take appropriate precautions for servicing potentially biohazard
contaminated equipment or working in biohazard surroundings. Please wear protective surgical gloves and long
sleeved gowns at all times. If your gloves or protective clothing tears, replace immediately. Have the hospital staff
clean the equipment appropriately prior to servicing. Clean your tools that may become contaminated with
biohazards prior to placing back in your tool kit for removal from the location. If you suspect biohazards are present
do not handle until they have been cleaned.
ESD Precautions:
Electro-Static Discharge can damage sensitive electronic printed circuit boards. If you are
servicing any part of the equipment inside that is near or in contact with PCB’s or other sensitive devices, please
properly ground yourself with a proper ESD strap.
(If serviced by an outside service organization, the record must be reviewed, signed, and dated by Technical
Services Dept. Refer to last page of this document).