Planned maintenance check form, B30
D-1
Document no. 2044677-001
APPENDIX D: Planned maintenance check form,
B30
OK = Test OK N.A. = Test not applicable Fail = Test failed
Customer
Service
Service engineer
Date
Monitor Installation
L- E- N-
Measuring equipment used:
Equipment / tool: Manufacturer: Model/Type/Part
Number:
Serial Number /
ID:
Calibration
Date:
Visual Inspection OK N.A. Fail
4.1.2. General
4.1.3. E-PSM(P)W Module S/N
Notes
Functional Inspection OK N.A. Fail
4.2.1. General
4.2.2. Display
4.2.3. Keyboard(s)
Notes