F Care Systems EVRF - 7 Defect Report Form

MANUAL THERMOCOAGULATION - EVRF
Date
26/06
/20
18
Page 34 of 34 Revision N° : 18
7 Defect report form
This card must be returned to F CARE SYSTEMS within 15 days after occurrence of a
problem with the EVRF
F Care Systems NV
Oosterveldlaan 99
B-2610 –WILRIJK-ANTWERP - Belgium
Fax: +32 3 451 51 39
Email:
Info@fcaresystems.com
I, undersigned (name and function) ............................................................ state that,
when using EVRF N°: ***********., on date ******. to have
experienced the following problem with the EVRF:
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NAME and SIGNATURE STAMP
Telephone number: ......................................................................................................
Email: ......................................................................................................