Site Specifications

Site specification

Hospital Name:

Hospital Address:
Date of inspection:

Reason for inspection:

Customer Representative Signature:
Elekta Representative Signature:

Pre-Installation Administration

Pre-Installation Administration

Have all parties agreed on the delivery and loading date for the unit?

What is the date?

Has the rigging firm been hired and reviewed the delivery route?

Contact name & phone:

Name of rigging firm:

Have the owner and rigging firm discussed and agreed on the space needed for staging of equipment during deliveries?

Will a lockable area be available for the storage of delivered equipment and tools?

Has the radioactive materials license been received by the user and a copy sent to Elekta Project Manager?

What type of license is on hand?

Is the Radiation Safety Officer, or Authorized person, available to receive the radioactive material on the selected date as per the license conditions?

RSO Name:

RSO Contact #:

Have the Scanner Interface Forms and Adapter Information been complete and returned to Elekta Project Manager?

If project is an upgrade to Perfexion, has the "Back to Factory" kit been ordered?

Additional comments:

Access to Site / offloading area

Access to site / offloading area

Has the rigger reviewed the area designated for delivery and will that area be clean and unoccupied at delivery time?

Is the off loading area flat and at the same height as the entrance to the hospital building?

If not, who is responsible for preparing the equipment landing area for the off loading?

Name:

Contact number:

Date this will be done:

Has security been notified of the area needed, the timing and extent of the rigging operations of the equipment deliveries and pickup?

Has the radiation safety officer reviewed the delivery route for the cobalt, both outside and inside the building?

Has it been determined that the minimum dimensions of 72" x 80"h (clear opening) of the delivery route have been met?

If not, have arrangements been made to ensure that the minimum dimensions are met throughout th delivery route?

Has it been determined that the delivery route can support the 40,000 lbs of the radiation unit, rigging equipment and personnel necessary to move the unit?

Is there finished flooring in the delivery route and if so, has the rigger been advised and agreed on flooring protection that will be used?

NOTE: It is recommended that the finished flooring be in place in the loading are before the delivery of he radiation unit. ( except Terrazzo or Clay Tile)

Has the delivery route for the reminder of the system components been determined and will it be clean and clear of obstructions on the delivery date?

i.e. patient couch, covers, electrical cabinets, etc

Is there a gradient in he delivery route?

Has the rigger reviewed it and made arrangements for equipment necessary to affect delivery?

Has security been informed and have a plan in place if parking/blocking roadways are involved?

NOTE: On new construction sites the entire delivery route must be clean and clear of all obstructions the day before delivery.

NOTE: On existing building sites, hospital personnel must be clear of the delivery route during equipment movements and any obstructions must be removed.

Additional comments:

Treatment Room

Treatment Room

Has the ECU floor box for the radiation unit been checked for correct position?

Has all new concrete work been complete?

Has the floor been checked for levelness spec of 1/8" in 10'?

Have the door(s) been hung and checked operational with locks to secure the radioactive material once it is on site?

Who will have the keys for access?

Contact number?

Are the final lighting and controls installed and operational?

Is HVAC system installed and operational with ducts cleaned to ensure controllable temperature = 50 - 80 deg & humidity = 30-75% (min/maxi) 24/7?

Elekta recommends 72-79 deg for patient comfort & 30-50% humidity for optimum equipment operation.

Are the 120vac power outlets operational in the vault?

Is the ceiling height at 9'-6" (min) to allow loading to occur inside the treatment room?

Are the pull strings been installed in the conduits for Elekta supplied cables?

If in-line pull boxes have been installed, the electrical contractor needs to have personnel standing by to assist in the pulling of the Elekta supplied cables.

Has the contractor been advised if applicable?

Contractor name:

Contact number:

Is all the work completed in the treatment room, control room, and planning room to allow installation to take place without interruption?

This includes all flooring, ceiling work, cabinetry, conduits, contractor wiring, user supplied cameras, door switches, e-stops, in-room radiation monitor, data link cabling, and phone lines, etc.

Has the installation been discussed with the site physicist and is he/she available for acceptance testing as needed?

Are all electrical box covers mounted and all conduits labelled as to destination?

Have final floor finishes (except Terrazzo & Clay tile) been installed?

Have all Pause, Emergency, Stop, and Door Switches been installed with 8' tails pulled to the ECU box?

Additional comments:

Control Area

Control Area

Is all millwork installed and cable passages drilled in counter tops with grommets installed?

NOTE: the cable passages can be drilled while the installers are on site to determine best location if the contractor will be on site during the installation.

Are the conduits and cable ducts installed?

NOTE: all conduits and cable ducts must be grounded.

Are the conduits and cable ducts clean and clear?

Do he cable duct covers fit correctly?

Are pull strings installed in the conduits that will be used for Elekta supplied cables?

Are the 120vac power outlets operational and in the control room?

Are the final floor finishes installed?

If not, when will this be done?

Are the ceiling grid and all ceiling tiles installed?

Is the control room dust free and cleared of debris?

Is HVAC system installed and operational with ducts cleaned to ensure controllable temperature = 50 - 80 deg & humidity = 30-75% (min/maxi) 24/7?

Elekta recommends 72-79 deg for patient comfort & 30-50% humidity for optimum equipment operation.

Are the final lighting and controls installed and operational?

Are the hospital network drops installed and operational?

If not, when will they be installed?
When will they be operational?

Is the "Room in Use" light installed and operational with wires pulled to the ECU box with 8' pigtails?

Is there a working telephone in the control area?

What is the phone number:

Additional Comments:

Treatment Planning Area

Treatment Planning Area

Is all millwork installed and cable passages drilled in counter tops with grommets installed?

NOTE: the cable passages can be drilled while the installers are on site to determine best location if the contractor will be on site during the installation.

Are the hospital network drops installed and operational?

If not, when will they be installed?
When will they be operational?

Are the 120vac power outlets operational and in the control room?

Are the door(s) installed and lockable?

Who will have the keys for access?

Are the final floor finishes installed?

Are the ceiling grid and all ceiling tiles installed?

Is HVAC system installed and operational with ducts cleaned to ensure controllable temperature = 50 - 80 deg & humidity = 30-75% (min/maxi) 24/7?

Elekta recommends 72-79 deg for patient comfort & 30-50% humidity for optimum equipment operation.

Are the final lighting and controls installed and operational?

Is there a working telephone in the control area?

What is the phone number?

Additional Comments:

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.