EPD FAULT LOG FORM
HB40521
Owning Organisation: Site or Location:
REPORT NO.: Related / Repeated Report Nos.:
Raised By: Date:
/ /
Contact / Telephone
No:
EPD Supplier ( Thermo Electron or
Distributor ):
Form Returned to:
BATTERY Type (Alkaline or LTC): Manufacturer: Supplied by:
EPD Serial No.s:
Date/Time fault occurred:
Fault type, e.g. Display fault Code:
Customer fault reference:
EPD returned to supplier ?
Date battery installed ?
Do IR communications still work ?
EPD Status Faults attached ? *
Event History attached ? *
Dose Profile attached ? *
* Extracted from EasyEPD2
DESCRIPTION OF FAULT:
DETAIL OF ACTIONS TAKEN TO RECTIFY FAULT :
Did fault recur after battery replacement or EPD Reset:
CONDITIONS PRIOR TO FAULT ( Environment etc ):
FURTHER DETAILS MAY BE GIVEN ON REVERSE
FOR MANUFACTURERS USE
Rec’d: Assessed by:
Notes:
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