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:

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.