Title Page

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Personnel Present:

Project Contacts and Details

  • Hospital Name:

  • Hospital Address:

  • Address:
  • Vault/Bunker Reference:

  • Primary Hospital Contact:

  • Radiation Safety Officer/ Radiation Protection Advisor

  • Has a General Contractor been assigned to the project?

  • General Contractor:

  • Electrical Contractor:

  • Mechanical Contractor:

  • Elekta Project Contacts:

  • Client Manager:

  • Site Coordinator:

  • Project Manager:

  • Installation Lead Project Engineer:

  • Field Service Engineer:

  • K&N Project Contact:

  • Rigging Company:

  • Rigging Company Contacts:

  • Crane Certification:

  • RF Cage Contact:

  • Estimated Date for Slab Inspection:

  • Estimated Date for Electrical & Mechanical Inspection:

  • Estimated Date for Final Inspection:

Large Component Delivery (Gantry & Magnet)

  • Is the LARGE item delivery route ready to be assessed?

  • Is there a suitable off-loading area for fork lift and crane?

  • Is there an area allocated to park the delivery trucks?

  • Pictures of the off-loading area:

  • What type of vehicles will be used for heavy equipment delivery?

  • Is the off-loading area the same height as the hospital?

  • Have provisions been made to build a ramp or platform?

  • Does the site require any floor protection for manhole covers or ducts?

  • Have provisions been made to protect the hazards?

  • What route is being used to access the treatment room?

  • Has the size and location of the access hole been verified? (2500mm X 2700mm)

  • Has the size and location of the hole been verified? (2500mm X 2600mm)

  • Has the path been verified for proper clearance? (2500mm X 2600mm)

  • Has a minimum clear height of 2600mm been checked for the delivery path?

  • Has a minimum clear width of 2500mm been checked for the delivery path?

  • Are all corners large enough for the specified turning circle of the equipment?

  • Are the floors able to withstand a point load of 2750 Kg?

  • Is the route flat and free of any gradients on the route or treatment area?

  • Have provisions been made to correct?

  • Has the access route been cleared of debris and swept clean?

  • When will this be completed?

  • Is there a lockable storage space of approximately 25 square meters nearby?

  • Additional notes for HEAVY equipment delivery:

Standard Size Component Delivery

  • Is the STANDARD size delivery route ready to be assessed?

  • Is this the same location and route as the Heavy list items?

  • Detailed description of route:

  • Pictures of new route:

  • Is there suitable off-loading space for the deliveries?

  • Is there suitable parking for the delivery trucks?

  • What types of vehicles will be used for standard size deliveries?

  • Is the off-loading area the same height as the hospital?

  • Have provisions been made to construct a ramp or platform?

  • Does the site require any floor protection for manhole covers or ducts?

  • Have provisions been made to protect the hazards?

  • Is there a minimum clear height of 2100mm along the path?

  • Is there a minimum clear width of 1200mm along the path?

  • Is the route flat and free from any gradients on the route to the treatment room?

  • Have provisions been made to correct?

  • Has the access route been cleared and swept clean?

  • When will this be completed?

  • Is there a lockable storage space of approximately 25 square meters nearby?

  • Additional notes for STANDARD equipment delivery:

Administrative

  • Has the Project Plan been circulated to all parties?

  • Have delivery sequence and dates been confirmed with the customer?

  • Has a 3D scan been conducted?

  • When is this anticipated to be completed?

  • When was this conducted?

  • Have the delivery surveys been completed?

  • Have the drawings been approved by the sites Radiation Protection Officer?

  • Has the Control Room Cable Kit been ordered?

Slab inspection

  • Is the site ready for a Slab Inspection?

  • Has the Feasibility Survey been completed?

  • Have the permanent isocenter references been marked/mounted to the walls?

  • Does the site meet the minimum vault dimensions? (6704mm x 6735mm)

  • Are the crane and Raised Access Floor being mounted to the structural concrete wall?

  • Has an approved structure been constructed that meets the specifications?

  • To confirm a structure is suitable, measure the location of the fixing holes, and obtain documentation from the structural engineer to confirm the loading requirements.
    To confirm the crane mounting structure is suitable, a copy of the structural design drawings should be sent to Elekta for review and attached with this report.

  • Has the bunker burst panel been formed into the bunker?

  • What is the proposed solution if this is a required item?:

  • Have the Gantry, Machine Room & PSS pits constructed within the required tolerances?

  • Proposed Solution:

  • Is the floor level and flatness is within the required tolerances?

  • Has the floor level and flatness form been completed and attached?

  • Floor level and flatness form:

  • Has the bunker measurement form been completed?

  • Does the bunker have a clear height of 3250mm to allow for the installation of the Gantry and construction of the RF cage?

  • Is the concrete certification specifications available?

  • Attach screen shot or photo of the concrete report:

  • Has the aperture for the Helium vent pipe been formed?

  • What is the length of the cable run from the control room to the technical room?

  • Additional information/observations from 1st site inspection:

  • Slab Inspection Completed By:

Electrical & Mechanical Inspection

  • Is the site ready for the Electrical & Mechanical Inspection?

  • Treatment Room Items:

  • Are the cable ducts complete between the technical room and the machine room?

  • Are the chilled-water pipes for the heat exchanger in the correct position, orientation and labeled?

  • Do the chilled-water pipes have gauges and isolation valves above 3050mm, and terminated at 2500mm with 32mm female BSP/NPT?

  • Is there water flow through the pipes ready for installation?

  • Is there a pipe to connect the heat exchanger to the condensate drain?

  • Is the condensate pipe terminated with ribbed hose barb suitable for 12mm hose?

  • Are the flow and return for the HVAC correct to the drawings?

  • Are the following Isolators (switches) an the machine room wall above the RF cage for the following supplies?

  • Control Room Items:

  • Are there cable ducts between the control and machine room?

  • Are these required?

  • Is there cable containment between the Ferroguard control and sensor locations?

  • Technical Room Items:

  • Have the cable trays/ladders been installed and grounded?

  • Are the chilled water pipes for the LCC in position and labeled?

  • Do the chilled water pipes have gauges, isolation valves and terminated above 2350mm with 1 male and 1 female 32mm BSP flat seal?

  • Is there water flow available through the pipes ready for installation?

  • Is there a backup water supply available?

  • Is the 3 phase isolator (Breaker) present for the treatment delivery system supply?

  • Is the 3 phase isolator (Breaker) present for the MR supply?

  • Is the 3 phase isolator (Breaker) present for the service supply?

  • Has the location been determined for securing the SF6 bottle with the SF6 pipe in the proper location?

  • Is a small bottle of SF6 available?

  • Is a double stage 0-5bar SF6 regulator available?

  • Additional information/observations from 2nd inspection:

  • 2nd Survey Conducted By:

Final Inspection

  • Is the site ready for the Final Inspection?

  • Treatment Room Requirements

  • Are the air conditioning ducts available and ready to be connected to the plenums?

  • Are they in the correct locations?

  • Is there air supply to the machine room?

  • Has the air conditioning duct work been cleaned and removed of dust?

  • Is the air conditioner functional and controlling the air from 19-22 degrees Celsius? (66.2 - 71.6 degrees Fahrenheit)

  • Is the Helium vent pipe (Quench) in place, insulated and ready to be connected?

  • Has a date for the final connection been determined and added to the Project Plan?

  • Is there a 12mm pipe ready to connect the SF6 filling station to the SF6 bottle, terminated with lossless couplings and a valve that converts the pipe from 12mm to 6mm?

  • Has the SF6 pipe been tested with pressure up to 4bar?

  • Have there been provisions made to bring medical gasses into the machine room if required?

  • Are the fixings present for mounting the panel above the heat exchanger?

  • Is the required lighting in the machine room?

  • Is there 430mm of clearance before the crane location to allow the carriage to be installed?

  • Is there temporary lighting in the treatment room?

  • Is there single phase power outlets in the machine room with power supplied to them?

  • Is the EPO switch installed in the machine room near the location of the door?

  • Is the EPO switch wired to remove power from the Linac, MR, and Service Isolators?

  • Is the EPO switch functional and tested?

  • Is the treatment room door installed with interlock switches wired back to the CITB location?

  • Who is constructing the Machine Room door?

  • Has it been installed with interlock wires going to the CITB location?

  • When will this be completed?

  • Has it been added to the project plan?

  • Is the a radiation warning light installed in the machine room with the wires going back to the CITB location?

  • Is this item required?

  • Is a fire detection system installed in the machine room?

  • Are provisions in place to install a fire detection system in the plenum RF cage?

  • Are the bunker walls clear of switches, cable containment or other obstructions that will interfere with the RF cage?

  • Are the cable ladders present in the machine room to the location of the filter panel?

  • Has the area been cleared of debris and swept clean?

  • When will this be completed?

  • Have the floors been painted in accordance with the floor plan?

  • Has the concrete been sealed in accordance to the plans?

  • Is the residual and surface moisture of the floor finish less than 3%?

  • Control room requirements.

  • Is the control desk in position and finished?

  • Has the final floor been laid?

  • Has the ceiling grid and tiles installed?

  • Does the control room have lighting?

  • Are the cable ducts installed between the control and technical room with draw strings?

  • Are there cable trays under the control desk and are they grounded?

  • Is the air conditioning system operational and tested?

  • Has the air conditioning ducting been cleaned and removed of dust?

  • Are there single phase outlets installed and is power supplied?

  • Is there an EPO switch in the control room?

  • Has the EPO switch been tested and operational?

  • Is there a 13amp circuit available for the Ferroguard control unit?

  • Is there 2 meters or less between the Ferroguard sensors?

  • Is there a radiation warning light with wires going back to the CITB location?

  • Is the fire detection system installed in the control area?

  • Has the control room been cleared of debris and swept clean?

  • When will this be completed?

  • Technical Room Requirements

  • Has the final floor been installed?

  • If required, has the ceiling grid and tiles been installed?

  • Does the technical room have lighting?

  • Is the air conditioning system functional and tested?

  • Has the air conditioning duct been cleaned and removed of dust?

  • Are there single phase outlets with power supplied?

  • Is there an EPO switch in the technical room?

  • Is the EPO switch functional and tested?

  • Is there a network connection available to the hospital network?

  • Is the fire detection system installed in the technical room?

  • Has the technical room been cleared of debris and swept clean?

  • When will this be completed?

  • Additional information/observations from 3rd inspection:

  • Survey completed by:

Final Review

  • Staging Area Photos: Truck parking, equipment off-load area.

  • Rig Path and Obstacles:

  • Bunker Photos: Pits, walls, ceiling, large equipment access cut-out.

  • Control Room Photos:

  • Technical Room Photos:

  • Additional information and observations:

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