Philips HeartStart XL+ - Repair Record; I: Incoming; II: Diagnosis

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Appendix C
Appendix1 Repair Record
This is a sample repair record. Make copies of these pages and fill out after each repair.
I: Incoming
Customer (name of facility): _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Customer Issue (describe): _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Device Model:
 861290 Serial #: US _ _ _ _ _ _ _ _
SW: Incoming_ _ _ Accessory Lot Code / Serial # (if received with the unit): _ _ _ _ _ _ _ _ _ _ _
II: Diagnosis
Visual Inspection:  PASS  FAIL / Comments: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
RFU Status:
 Hourglass  Solid Red X  Flashing Red X
Tech. Alarms / Screen messages: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Print and evaluate logs (check all that apply):
 Software Error Log  Hardware Error Log
Errors noted: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Errors related to customer complaint found?
 YES  NO / Comments: _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _