Project Information

Hospital Name:

Hospital Address:

Address Pin:

Bunker Name:

Serial Number:

Primary Hospital Contact:

Additional Hospital Contacts (if Applicable):

Additional Hospital Contacts (if Applicable):

Elekta Project Contacts:

Logistic Lead:

Site Coordinator:

Project Manager:

Installation Lead Project Engineer:

Field Service Engineer:

K&N Project Contact:

Rigging Company:

Rigging Company Contacts:

Site Survey #1 Date:
Site Survey #2 Date:

Additional Survey Dates:

Delivery Information

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 #
Enter start Date & Time:
Enter Finish Date & Time:

Enter Route:

Pictures of Route:

Type of vehicle:

Number of Riggers:

Additional Information:

Delivery Route #1 (Large Components)

Delivery Route #1: (Large Components)

External Site Access:

Height Restrictions:

Weight Restrictions:

Parking Restrictions:

Road Closers:

Restricted Working Hours:

Special External Requirements:

Off Loading Method:

Note: If applicable include a copy of the crane lifting plan and survey drawings.

Tail Lift

Fork Lift

Crane

Barriers / Signage:

Special Off Loading Requirements:

Internal Site Access:

Platform or Ramp Required:

Floor Protection:

Enabling Building Works:

Bunker Access:

Special Access Requirements:

Additional Customer Requirements / Considerations:

List of tools and Tackle:

Document Route (including pictures where possible)

Delivery Route #2 (Standard Items)

Delivery Route #2: (Standard Items)

External Site Access:

Height Restrictions:

Weight Restrictions:

Parking Restrictions:

Road Closers:

Restricted Working Hours:

Special External Requirements:

Off Loading Method:

Note: If applicable include a copy of the crane lifting plan and survey drawings.

Tail Lift

Fork Lift

Crane

Barriers / Signage:

Special Off Loading Requirements:

Internal Site Access:

Platform or Ramp Required:

Floor Protection:

Enabling Building Works:

Bunker Access:

Special Access Requirements:

Required Tackle to be supplied

General Tackle (Enter Quantity & Delivery #)

Pallet Truck:

Rollers:

Scoots:

Skates:

Power Climber:

Stair Climber:

Sleepers:

Deals:

Roller Crowbar:

Skateboard:

Pallets:

Shims:

Blocks:

Aluminum Plates:

Hardboard:

Plywood Sheets:

Alignment Tool:

Hilti Drill:

Chop Saw:

Tool Chest:

Sack Truck:

Road Cones / Barriers:

Warning Signs:

Ladders:

Dust Sheets:

Vacuum Cleaner:

Lifting Tackle (Enter Quantity & Delivery #)

Jacks - 5 Ton:

Jacks - 10 ton:

Stacker:

Genie Lift:

Fork Lift:

Gantry:

Block & Tackle:

Girder Trolley:

Shackles:

Eye Bolts:

Slings:

Tirfor Winch:

Crane:

Scaffold Tower:

Specialised Equipment as per Tackle Van (Enter Quantity & Delivery #)

Master Mover:

Air Pads:

Fork Lift Extensions:

Magnet Lifting Beam:

Magnet Lifting Wheels:

Personal Protection Equipment: (Enter Quantity & Delivery #)

Hard Hats:

Luminous Jackets:

Eye Protection:

Safety Harnesses:

Radios:

Footwear:

Gloves:

Notes:

Required Items Check Sheet

General Tackle:

Pallet Truck:

Rollers:

Scoots:

Skates:

Power Climber:

Stair Climber:

Sleepers:

Deals:

Roller Crowbar:

Skateboards:

Pallets:

Shims:

Blocks:

Aluminum Plates:

Hardboard:

Plywood Sheets:

Alignment Tool:

Hilti Drill:

Chop Saw:

Tool Chest:

Sack Truck:

Road Cones / Barriers:

Warning Signs:

Ladders:

Dust Sheets:

Vacuum Cleaner:

Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.