Elekta Site Assessment

• Document No.

• Site Name

• Physical Address
  Address

• Conducted on

  Date

• Prepared by

• Personnel

• What is the estimated push in distance?

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

  Yes

  No

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

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

  Yes

  No

• What is the proposed solution?

• Is the ceiling height clear along the path?

  Yes

  No

• What are the details and the proposed solution?

Vault Details

• What is the vault foundation?

  Slab on Grade

  Suspended

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

  Yes

  No

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

  Yes

  No

• Is the suspended floor supported?

  Yes

  No

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

  Yes

  No

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

  Drawing

• 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?

  Yes

  No

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

  Yes

  No

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

  Yes

  No

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

  Stand Alone Chiller

  Facilities Water

  City Water

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

  Yes

  No

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

  Yes

  No

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

  Yes

  No

• 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?

  Yes

  No

• What is the current filtration micron level?

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

  Yes

  No

• 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?

  No

  Yes

• Details

• What is the current input power to the vault?

  480

  208

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

  Yes

  No

• What is the proposed solution?

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

  Yes

  No

• What is the proposed solution?

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

  Yes

  No

• What is the proposed solution?

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

  Yes

  No

• What is the proposed solution?

• Is the site planning on constructing a computer closet?

  Yes

  No

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

  Yes

  No

• Additional notes not included within this assessment.

• Individual completing this assessment.

  Sign

• Facility Entrance

  Media

• Offload Area and Rigging Path

  Media

• Control Room

  Media

• Vault and/or Maze

  Media

• Points of Concern

  Media