Remed ELPIS-2, Руководство пользователя, Страница: 44 / 45

ELPIS-4 / 3 / 2 User Guide
2017.08.21 Ver M-1.0.0
44/45
Customer Service Request Form
The purpose of this form is to obtain information that will enable us to expeditiously process
your service request. Please describe the fault or abnormality in as much detail as possible.
1. User information
- Name of hospital:
- Address of hospital:
- User name/telephone number:
(Tel: )
2. Information on the equipment in use
- Name of model
: ELPIS-
4, 3, 2
- Date of purchase :
- Serial number of product :
3. Description of technical problems (Describe as much detail as possible.)
4. User checklist
If it is impossible to answer the question yes or no, please add information in the remarks
column. If you are unsure of the answer, you can leave the item blank.
Number Inspection item
Evaluation
result
Remarks
1
Is use of the equipment impossible due to the
current failure?
Yes/No
2
When the power switch of the equipment is turned
on, does the display function, or any part of the
equipment function?
Yes/No
3 Is output generated by the equipment? Yes/No
4
Is the strength of the output from equipment
conspicuously different from when it was first
installed?
If so, how would you rank the difference in
performance, in terms of a percentage?
Yes/No
5
Can you perceive a change of output if the output
strength of equipment is adjusted?
Yes/No
6
Is there any damaged part in the
external appearance? Describe this in the
remarks column.
Yes/No
After completely filling in the form, please return it to us.
Telephone : 031-696-4875
FAX : 042-934-5562
E-mail : service@remed.kr