Title Page
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Personnel Present:
Project Information
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Hospital Name:
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Hospital Address:
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Address Pin:
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Bunker Name:
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Serial Number:
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Primary Hospital Contact:
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Additional Hospital Contacts (if Applicable):
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Additional Hospital Contacts (if Applicable):
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Elekta Project Contacts:
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Logistic Lead:
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Site Coordinator:
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Project Manager:
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Installation Lead Project Engineer:
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Field Service Engineer:
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K&N Project Contact:
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Rigging Company:
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Rigging Company Contacts:
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Site Survey #1 Date:
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Site Survey #2 Date:
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Additional Survey Dates:
Delivery Information
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Equipment to be delivered - Refer to rigging document for details of components and rigging methods.
Delivery 1 - Pre installation kit, cables and cabinets
Delivery 2 - Gantry
Delivery 3 - Gantry Components
Delivery 4 - Magnet
Delivery 5 - RF Cage structure
Delivery 6 - RF Cage Inner finishes
Delivery 7 - Covers and PSS -
Select Delivery #
- Delivery #1
- Delivery #2
- Delivery #3
- Delivery #4
- Delivery #5
- Delivery #6
- Delivery #7
- Delivery #8
- Delivery #9
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Enter start Date & Time:
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Enter Finish Date & Time:
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Enter Route:
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Pictures of Route:
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Type of vehicle:
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Number of Riggers:
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Additional Information:
Delivery Route #1 (Large Components)
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Delivery Route #1: (Large Components)
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External Site Access:
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Height Restrictions:
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Weight Restrictions:
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Parking Restrictions:
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Road Closers:
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Restricted Working Hours:
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Special External Requirements:
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Off Loading Method:
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Note: If applicable include a copy of the crane lifting plan and survey drawings.
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Tail Lift
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Fork Lift
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Crane
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Barriers / Signage:
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Special Off Loading Requirements:
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Internal Site Access:
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Platform or Ramp Required:
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Floor Protection:
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Enabling Building Works:
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Bunker Access:
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Special Access Requirements:
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Additional Customer Requirements / Considerations:
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List of tools and Tackle:
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Document Route (including pictures where possible)
Delivery Route #2 (Standard Items)
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Delivery Route #2: (Standard Items)
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External Site Access:
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Height Restrictions:
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Weight Restrictions:
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Parking Restrictions:
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Road Closers:
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Restricted Working Hours:
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Special External Requirements:
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Off Loading Method:
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Note: If applicable include a copy of the crane lifting plan and survey drawings.
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Tail Lift
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Fork Lift
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Crane
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Barriers / Signage:
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Special Off Loading Requirements:
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Internal Site Access:
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Platform or Ramp Required:
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Floor Protection:
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Enabling Building Works:
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Bunker Access:
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Special Access Requirements:
Required Tackle to be supplied
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General Tackle (Enter Quantity & Delivery #)
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Pallet Truck:
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Rollers:
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Scoots:
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Skates:
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Power Climber:
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Stair Climber:
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Sleepers:
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Deals:
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Roller Crowbar:
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Skateboard:
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Pallets:
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Shims:
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Blocks:
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Aluminum Plates:
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Hardboard:
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Plywood Sheets:
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Alignment Tool:
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Hilti Drill:
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Chop Saw:
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Tool Chest:
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Sack Truck:
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Road Cones / Barriers:
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Warning Signs:
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Ladders:
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Dust Sheets:
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Vacuum Cleaner:
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Lifting Tackle (Enter Quantity & Delivery #)
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Jacks - 5 Ton:
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Jacks - 10 ton:
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Stacker:
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Genie Lift:
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Fork Lift:
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Gantry:
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Block & Tackle:
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Girder Trolley:
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Shackles:
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Eye Bolts:
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Slings:
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Tirfor Winch:
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Crane:
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Scaffold Tower:
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Specialised Equipment as per Tackle Van (Enter Quantity & Delivery #)
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Master Mover:
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Air Pads:
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Fork Lift Extensions:
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Magnet Lifting Beam:
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Magnet Lifting Wheels:
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Personal Protection Equipment: (Enter Quantity & Delivery #)
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Hard Hats:
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Luminous Jackets:
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Eye Protection:
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Safety Harnesses:
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Radios:
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Footwear:
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Gloves:
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Notes:
Required Items Check Sheet
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General Tackle:
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Pallet Truck:
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Rollers:
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Scoots:
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Skates:
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Power Climber:
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Stair Climber:
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Sleepers:
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Deals:
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Roller Crowbar:
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Skateboards:
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Pallets:
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Shims:
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Blocks:
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Aluminum Plates:
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Hardboard:
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Plywood Sheets:
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Alignment Tool:
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Hilti Drill:
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Chop Saw:
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Tool Chest:
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Sack Truck:
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Road Cones / Barriers:
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Warning Signs:
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Ladders:
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Dust Sheets:
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Vacuum Cleaner:
