Information
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Client / Site
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Location
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Conducted on
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Main contact
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Phone
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Clinical contact
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Phone
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Prepared by
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ASM
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Sales
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First contact
Backgrounds
Customer background
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Number of vaults in center
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Total patients for center
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Patients treated per day in vault
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Percent IMRT for vault
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R&V
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Version
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TPS
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Version
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As built provided while on site
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Digital or hard copy
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4SITC
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Version
Equipment background
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Linac model
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Linac serial number
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Linac energies
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Linac software version
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Linac manufacture date
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MLC model
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Couch model
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Couch serial number
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Couch Baseframe
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Portal imaging
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Model
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Accessories type
Measurements
Elevations
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Elevation diagram
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Distance from floor to isocenter (A)
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Add media
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Distance from isocenter to false ceiling (B)
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Add media
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If applicable, @IR camera (C)
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Add media
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Distance from false ceiling to concrete (D)
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Add media
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If applicable, @IR camera (E)
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Add media
Plan
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Plan diagram
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Distance between lateral laser walls (A)
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Add media
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Distance from back wall to front wall (B)
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Add media
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If applicable, service area (F)
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Add media
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Distance from back wall from iso (C)
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Add media
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Length of maze (D)
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Add media
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Width of maze (E)
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Add media
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Maze wall width
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Add media
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Width of opening clearance
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Add media
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Height of opening clearance
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Add media
Vault Characteristics
Vault and console characteristics
Contractor specifics
Comments / Pictures
Comment section
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Comments
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Additional photos
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Additional drawings
