Instruction Manual
K SERIES Cryostorage System
IM: CryoCeK
Revision: 02
Approved by: CB
Page
68
of
87
Appendix A2
– INITIAL INSTRUCTION LOG
IMPORTANT
: Fill in this form after the initial instruction of your Worthington Industries Cryostorage System has been done.
Customer Information
Operating Company Name:
Service Company Name:
Cryostorage System Information
Cryostorage Model:
Serial No:
Controller Model:
Serial No:
Version No:
Following users have been instructed using this instruction manual:
Print Name:
Personal No:
Signature:
Print Name:
Personal No:
Signature:
Print Name:
Personal No:
Signature:
Print Name:
Personal No:
Signature:
Print Name:
Personal No:
Signature:
Print Name:
Personal No:
Signature:
Print Name:
Personal No:
Signature:
Print Name:
Personal No:
Signature:
With your signature you confirm that you has been committed to the proper handling of the respective
medical device with reference to this instruction manual including all relevant aspects for the proper
operation and necessary safety precautions, and any inspections to be performed prior to each
application, and maintenance to be carried out in certain intervals.
Initial Instruction completed
Service Company
Operating Company
Print Name:
Print Name:
Date/Signature:
Date/Signature:
Instruction Date:
LOG NO
NOTE
: Please send a copy of this form to Worthington Cylinders GmbH, Customer Service via Fax: +43 7485
606 100 or Email: [email protected].
