Title Page

  • Document No.

  • Site Name

  • Physical Address
  • Conducted on

  • Prepared by

  • Personnel

Rigging Path

  • What is the estimated push in distance?

  • Is there sufficient room for the truck parking and offload?

  • Is there a proposed solution for equipment delivery or an alternate location?

  • Are path doorway wide enough for equipment travel? (45.5")

  • What is the proposed solution?

  • Is the ceiling height clear along the path?

  • What are the details and the proposed solution?

Vault Details

Vault Details

  • What is the vault foundation?

  • Does the site have the concrete break results for the existing concrete?

  • Is the concrete strong enough to support our equipment and meet our spec of 4500 psi?

  • Is the suspended floor supported?

  • Are support pillars in a proper location for Elekta Linac placement?

  • Draw the basic vault dimensions and include approximate location of HVAC vents.

  • What is the distance from the current ISO center to the back wall?

  • What is the current height from finished floor to vault ceiling?

  • Is there a functional sink inside the vault?

  • Is there a current location for the electron applicator storage?

  • Can it be altered to accommodate the Elekta electron cones?

Mechanical and Plumbing

  • What kind of cooling system is the site currently using?

  • Is city water capable of maintaining 60-70 degrees Fahrenheit at 40psi year round?

  • Are the water lines coming from the "A" side of the vault?

  • Are they capable of routing the lines to the appropriate location?

  • What is the proposed solution?

  • What is the current flow rate? (GPM)

  • What is the current temperature? (Fahrenheit)

  • What is the current pressure? (PSI)

  • Is there currently a supply side filtration system?

  • What is the current filtration micron level?

  • Is the current HVAC system capable of being split for 2 zones within the vault?

  • What is the sites plan to keep the equipment room at 68 degrees and the treatment room at 72-75 degrees?

  • Do any of the current HVAC vents need to be relocated to accommodate the Elekta equipment installation?

  • Details


  • What is the current input power to the vault?

  • Are they able to pull in 2 separate 480 supplies for the Linac and XVI generator?

  • What is the proposed solution?

  • Are they able to get a 480 circuit pulled into the vault if they are getting XVI?

  • What is the proposed solution?

  • Are there suficient outlets in the vault to support Mosaiq and Hexapod in-room systems if applicable?

  • What is the proposed solution?

  • Are there currently sufficient power outlets in the control room?

  • What is the proposed solution?

  • Is the site planning on constructing a computer closet?

  • Are they able to achieve proper air flow and ventilation?

Summary and Details

  • Additional notes not included within this assessment.

  • Individual completing this assessment.

  • Facility Entrance

  • Offload Area and Rigging Path

  • Control Room

  • Vault and/or Maze

  • Points of Concern

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