Operating instructions SPEEDY 4all & 4you & 4teen
61
38 Appendix: Medical product passport / record of training
Product specifications:
Serial number:
Customer data:
Surname, forename:
Street:
Postcode, city:
Phone:
Paying organisation:
Training
carried out by:
Medical supplies dealer
PRO ACTIV field
representative
Record of training
I was / we were instructed in accordance with the associated hand-over certificate about the operation
of the product listed and informed about possible operator errors. I was / we were also advised about
situations where the assistance of another person is required. The operating instructions were handed
to me / us.
Instructor
Name, date, signature
1. Person being trained
Name, date, signature
2. Person being trained
Name, date, signature
3. Person being trained
Name, date, signature
For minors, or persons who are not responsible for their actions, legal guardians / supervisors / responsible persons are to be
trained in the use, this is confirmed by their signature. The data is recorded in the feedback system of PRO ACTIV Reha-
Technik GmbH, as the manufacturer of the above named product. It will be managed in accordance with Section 16 BDSG
(Federal Data Protection Law).
Stamp / Date / Dealer's signature
