1. Pre-Installation Admin

Facility Name:

Actual Project Address:

Additional Directions if needed:

Machine Type:

Optional items:

Machine S/N:

Project Number:

Inspection W/O #:

Date of Inspection:

Inspection type:

Site Status:

Has the hospital administration been notified of the proposed date of the equipment delivery?

Have the authorities been informed where public areas may be used for equipment delivery / access?

(All Elekta staffed installations are started on a Wednesday unless otherwise agreed with Elekta)

What proposed delivery date has been arranged with the hospital?

Elekta Installation Engineer:

Any other considerations or comments on the above?

2. Access to site / Off-loading

Is the off loading area clear?

Will it be clear on the date of delivery?

What size is the off loading area?

Attach diagram if necessary.
Picture of staging area if applicable:

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

Will arrangements be made for a shallow gradient ramp or leveled area to allow easier access of the equipment?

When will it be ready?

What is being used to offload truck?

Has Riggers visited site for evaluation?

Does the forklift have enough space to maneuver, allowing for the area that crates will take up when unloaded? (Approx 3,800 sq. ft)

Does the above have a SWL of 11,000 lbs?

Is there enough truck parking space?

Any obstacle in rigging or staging path require protection?

Are there any gradients on the access route into the hospital building?

What is the gradient of the slope?

Have arrangements been made for a rigging company to be available for the first two days of the installation?

How many people?

Have they had experience installing Linacs in the past year?

Does the delivery meet guidelines for a "Standard Delivery"?

Has rigging company site visit been scheduled?

What date will rigging company site visit take place?

Any other considerations or comments on the above?

3. Access to Treatment Room

All floors must support a load of 4,850 lbs. (a point load of 1,323 lbs) Can the floor withstand this load?

Have arrangements been made to correct this?

Is the minimum clear height on the access route to the treatment room higher than 80"? (2015mm)

Have arrangements been made for this to be altered?

Is the minimum clear width on the access route to the treatment room wider than 45-1/4"? (1150mm)

Have arrangements been made for this to be altered?

Are there any tight corners to be negotiated?

Can the beam arm and gantry drum make the turn around the corner?

Is it necessary to remove any door frames?

Have arrangements been made for this work to be done?

Do any floor ducts or floor finishes require protection?

Have arrangements been made for this work to be done?

Are there any gradients on the route to, or inside the treatment room?

What are the gradients?

Is the ceiling height behind the fascia wall > 9' to allow for Linac assembly? (This includes sprinkler heads, vents, lights, etc)

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

Any other considerations or comments on the above?

4. Precise Table Pit

Has the Precise Table Pit been constructed?

Does it meet the specifications on Elekta drawings sheet S1 thru S3?

Has figure 1 been filled out completely?

Floor Duct:

no label

Pit depth from finished floor: (235mm +/-2mm)

Pit diagonal dimensions: A / B

A - 66-1/2" (1716mm or E2):

B - 85-1/2" (2176mm or E2):

C - 109.5" (2781mm or E2):

D - 124-1/2" (2879mm or E2):

E - 43-3/4" ( 1111mm or E2):

F - 72" ( 1829mm or E2):

G - 18-11/16" (475mm)

H - floor duct width x depth:

Add media

Do floor raceway cutouts meet Elekta specs?

Are the mild steel angle frames (pit edging) that surround the Precise Table Pit 2" x 2" x 1/4" in size and anchored into the concrete?

Has the pit edging been held above concrete floor whatever thickness final floor will be per Pit Edge detail on sheet S2 of Elekta drawings?

Any other considerations or comments on the above?

5. Treatment Room

Has the treatment room been cleared of debris and swept clean?

When will this be done?

Is the room clear of workers?

Has the concrete been poured?

All new concrete must have test cylinders poured and tested. Elekta requires copies of the test cylinder reports confirming concrete meets or exceeds our min. spec of 4500 psi compressive strength. If existing concrete to be used for any anchors, a core sample must be taken and tested confirming existing concrete meets or exceeds our min. spec of 4500psi comps dive strength. This report must be received by Elekta by the final site inspection date.

Has a copy of the concrete test results been received by Elekta?

What was the break test value shown on test results?

Was the concrete poured monolithic with no topping leveling layer?

How thick is the concrete slab under the accelerator and table pit?

Signature of General Contractor Representative affirming constructed I/A/W Elekta requirements:

Does the concrete floor below the Linac, around the table pit, and in the floor of the table pit meet levelness spec as indicated on sheet S1 of Elekta drawings?

Has the final floor been laid?

When will this be done?

If the final floor finish is not laid then the concrete floor must be sealed to reduce dust, has this been done?

When will this be done?

Have arrangements been made to protect the floor?

Has the wall covering been added?

Is ceiling finished?

When will this be done?
What lifting facilities are available ?

Is the long axis of the beam parallel and vertically above the front/rear axis (G-T axis) of the table pit?

What is the distance between the floor level and the highest point that the hook can be raised when using the I-Beam? (Min 94-1/2" (2400mm)

Have all parts of the lifting system been load tested to 7000 lbs Safe Working Load?

Has a copy of the certificate been sent to Elekta?

When will this be done?

Is a one ton chain hoist and trolley available?

Are the cable ducts finished?

Are they clear of debris and clean?

What size is the duct / conduits between the treatment room and the control room?

What is the measured distance from control room floor box to Linac equip rm floor box?

Does the ducting meet the requirements on Elekta drawing sheet E2?

Are the ducts / conduits between the treatment room and the control room dry and clear for pulling cables?

Are pull strings installed in the duct / conduits between the treatment room and the control area?

Is the treatment room fascia wall constructed?

What is the height of the opening? (2540mm)

What is the width of the opening? (4000mm)

Distance of fascia wall from isocenter? A/B (1220mm)

Is the opening of the fascia wall centered on the G-T line of isocenter?

Has a space been left to allow the chain hoist on the I-Beam to pass?

How wide is it?

Is wood blocking in header of fascia for goal post anchors? (Wood 2x4 typ.)

When will this be done?

Is the 3-phase circuit breaker in position?

Is power supplied to the above circuit breaker(s)?

Has the 3-phase cable been supplied from the primary circuit breaker to FB2? (via PCDU if applicable)

Are all ion pump wires (#10 conductors) pulled from PCDU to FB2?

Has the electrician checked for proper phase rotation? (CW)

What are the following voltage measurements? (Required at time of final site verification)

Phase 1 voltage - maximum:

Phase 2 voltage - maximum:

Phase 3 voltage - maximum:

Single Phase voltage - maximum:

Is the Client Interface Terminal Box in position?

Has time delay been tested and passed?

Has the radiation door been tested and passes?

Has the Neutron Door been tested and passes?

Has the Laser Alignment System been tested and passes?

Has the Motion Stop Switches been tested and passes?

Has the Treatment Room Lights (both dimmed & fluorescent) been tested and passes?

Has the Radiation Warning Light(s) been tested and passes?

Has the Fascia Door Switch(es) been tested and passes?

Has the Shut Off Solenoids been tested and passes?

Has the Water Chiller Start Circuit been tested and passes?

Have all the interlocks been tested?

When will this be done?

Is voltage present on the Emergency Off and/or Door Switch Circuit? (Should not be present)

Have all low voltage inputs into CITB been checked for short to ground?

State the resistance of the Emergency Off Switch circuit: (spec is <1 ohm)

Is the air conditioning system functional?

Tested ?

Is filtration to 90-95% efficiency?

Ductwork cleaned to remove the dust?

When will this be done?

State the humidity of the air in the treatment room:

State the temperature in the treatment room:

Is the final lighting installed?

Is the final lighting operational?

When will this be done?

Have all cabinets and countertops in treatment room been installed?

Will this be done?

Has the Applicator Storage cabinet been check for proper dimensions?

Have the laser recesses (side & sagittal) been constructed to correct size and location in reference to isocenter? (L x W x AFF)

When will this be done?

Have aluminum plates been rigid mounted to concrete on 1/2" standoffs? (Side and sagittal lasers)

Has aluminum plate been mounted on a rigid structure for overhead laser to proper height above finished ceiling?

When will this be done?

Have the false ceiling tiles been installed?

When will this be done?

If there is a ceiling mounted I-Beam, have any struts or panels in the false ceiling been mounted across the path of the chain hoist and trolley?

When will they be removed?

Is a fire detection system installed in the treatment room? (In both the patient area or gantry areas)

Cat cables, & outlets for CCTV and Intercom system installed?

When will they be complete?

Have the cables been verified to be shielded cables and terminated properly?

Is the XVI Circuit breaker (SDX) installed? (480v/70a)

What is the power output of the XVI circuit breaker?

Are the power conductors pulled from SDX to the Generator location?

Does the Shunt Trip Circuit Breaker for SD & SDX operate correctly?

Is a functional sink with water and drain in the treatment room?

Will the contractor provide a 3/4" water hose to the room for use with a core drill?

Have all camera mounting plates been checked for proper locations?

Is the 3 Point to Point CAT5 cables in place and in the appropriate locations?

Any other considerations or comments on the above?

6. Control Room

Is the control desk in position?

When will this be done?

Will a chair that meets IEC regulations for computer work be available at the start of the installation? ( i.e. height, back tilt adjustment, etc.)

Are the cable ducts finished?

When will they be done?

Are the cable ducts grounded?

When will this be done?

Are the single phase outlets installed?

When will they be?

Is single phase power supplied to them?

When is this expected to be complete?

Who is responsible for installing CCTV & Intercom systems

Operational?

When will they be completed?

Are the cable ducts clean and clear?

Are the cable ducts?

Do the cable ducts meet the requirements on Elekta drawings sheet E2

Do the cable duct covers fit correctly?

Are all removable panels below the control desk accessible?

Can they be removed easily?

Has the final floor been laid?

When will this be done?

Have the ceiling grid and ceiling tiles been installed?

When will this be done?

Is the air conditioning system functional, tested , and cleaned to remove dust?

When will this be done?

Is the final lighting installed?

Is the final lighting operational?

When will this be done?

Is the Control Cabinet position clear?

Is site implementing a systems computer closet?

Does closet have adequate air flow?

Does closet have pullout shelving?

Have 3" grommeted cable passages been cut in the control desk counter top?

When will this be done?

Is a telephone, with the ability to phone internationally and be direct dialed, located in the control area?

What is the telephone number?

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

When will this be done?

Any other considerations or comments on the above?

7. Chilled Water Supply

Is the Chilled water being supplied from:

Chiller Manufacturer:

Chiller Operation?

Has Chiller start-up been scheduled?

Date scheduled?

Is the temperature gauges in place?

Is both supply and return line pressure gauges installed?

Is the flow gauge that can read 4-16 gpm installed?

Has a water filter been installed?

Are the three external Solenoids in place?

Have these Solenoids been tested & operate correctly?

Are the manual shut off valves in position?

Are the 1" hose barbs installed and in proper location?

Is the chilled water system fully operational?

State the chilled supply water pressure:

State the chilled supply water temperature:

State the return chilled water pressure:

State the chilled water flow rate:

Is site using city water as a back up?

City water temperature:

City water supply pressure:

City water return pressure:

City water flow rate:

City water filtration:

Any other considerations or comments on the above?

8. Radiation Protection

Has the hospital provided a State-Approved Shielding Plan to allow start of equipment installation?

Has a copy of this shielding plan been sent to the Installation Manager?

Has the radiation door been approved by the customer's Physicist of Record?

Name of Customer's Physicist of Record?

Physicist contact number:

Is the Photon energy 10Mv or higher?

Is Physicist prepared to perform a leakage test using a Neutron meter to confirm any leakage is within safe working levels before installation can continue?

Is the Main Vault Entrance Door installed and operational?

When will this be done?

Is the treatment room within 50 ft of a MRI or located in a room that was once occupied by a MRI?

Does the treatment room meet the following guidelines? The composite (victor - summed) magnetic flux denisity within the Linac's swept volume is LESS than 100 microtesla. The variation of the composite magnetic flux density is over 0.5m in any direction within the Linac's swept volume shall be less than 20 microtesla.

Are there any other Linac treatment rooms built onto the sides of this treatment room?

What Photon energies are adjacent Linac(s)?

What is the instantaneous dose in the treatment room if adjacent Linacs are radiating directly at treatment room walls specific to this installation?

State equipment make and model that was used to achieve this reading?

When was the equipment last calibrated?

Any other considerations or comments on the above?

9. Networking

An IP Address is required for installation of your machine. You must provide the correct IP Address(es) within the first three (3) days of the system delivery. This Note is to inform you that failure to provide the IP Address(es) could result in an additional charge to the customer from Elekta.

Is the client planning to connect the Control Cabinet to an external computer system or customer network?

What are the network addresses?

I.P. Address - LCS Cabinet:

I.P. Address - Secondary Impac Computer (Scheduler) :

I.P. Address - Network Printer:

Subnet Mask:

Default Gateway:

WINS/DNS Primary:

WINS/DNS Secondary:

What are the nodes names?

Is network available?

When will this be done?

Has the network been tested as functional?

When will this be done?

Any other considerations or comments on the above?

10. Information for Elekta

Are 10 gallons of distilled water available? (De-mineralized water is not acceptable)

When will water be available?

Is a cylinder of Dry Nitrogen available? ( size "C" is acceptable, min 99.9% purity required)

Who is providing Dry Nitrogen

When will it arrive to site?

Expected day gases are to be on site?

Is a cylinder of SF6 available? ( size "B" or "C" is acceptable, min 99% purity required)

Who is providing SF6?

When will it arrive to site?

Expected day gases are to be on site?

Has provisions been made for disposing of, or recycling all packaging and crates?

It the site a new or existing building?

Has all building work been completed?

Is any hospital staff working on the access route?

Have arrangements been made for the area to be clear on the delivery day and the following day?

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

How wide is the doorway?

What are the dimensions of the space?

Enter all facility contacts for Elekta Installation Engineers

Installers Contacts

Contact Name:

Contact Title:

Contact Phone:

List any individuals that will be working with the Elekta Engineers:

Contacts:

Name:

Title / Company:

Phone:

NOTE: The installation Engineer has no authority to change the set-up, configuration, or add a special requirement unless he has approval from Elekta's development department that it is safe to do so.

Give details of any locally agreed specials or changes to the end set-up, configuration of the Linac, or its options that are not mentioned on the order or approved by Elekta.

Any political issues or problems to be aware of?

State the communication arrangements with regards to the ordering and delivery of spare parts from Elekta to the hospital during installation.

This report was completed by:

Signature:

Additional comments:

Inspection notes

Inspection Notes:

Site Pictures:

Truck Parking and Staging Area:
Rigging Path:
Vault: include each wall, pit, floor raceway, back wall layout, and ceiling.
Control Room: include under countertop, computer closet/Cabinet:
Applicator Storage:
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.