Site Specifications

Pre Delivery Site Info:

Hospital Name:

Hospital Address:
Delivery Address if Different:

Radiation Safety Officer info:

RSO Name:

RSO Contact #:

Elekta is responsible for rigging if considered "Standard Rigging"

Does Delivery area and rigging path meet Elekta Standard Rigging Parameters?

Description of non-standard rigging parameters:

Pictures of rigging concerns:

Has the rigging been arranged?

Name of rigging firm:

Contact name & phone:

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

Agreed on the delivery of Upgrade items:

Hospital's main contact info for deliveries:

Elekta's Riggers contact info:

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

Schedule date of Acceptance:
Customer Representative Signature:
Elekta Representative Signature:

Additional comments:

Access to Site / offloading area

Equipment Delivery Information

Description of offloading / staging area:

Pictures of offloading / rigging area:

Has it been determined that the minimum dimensions of 40"w 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 the delivery route?

Description of rigging path including door sizes:

Pictures of rigging path:

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?

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

Additional comments:

Treatment Room

Treatment Room Inspection

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.

Is the the site using the Nova Solutions Disconnect Panel?

Has a separate 3 phase and single phase disconnects been installed in the treatment room?

Has a 50amp contactor been installed with helper relay?

Record the voltage & current specs of the helper relay coil?

Record the 3 phase voltage.

Record the single phase voltage:

Does the shunt trip button trip both breakers?

Is the new electrical floor box in the correct location with respect to RU isocenter per the Elekta Reference Drawings?

Have the 3 phase wires been installed with 8' tails pulled to the Floor box?

Has the electrician installed signals wires from helper relay to floor box with 6' pigtails?

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

(CAM1) Is there enough cable to move camera max 18" horizontal from isocenter if needed?

Are the 120vac power outlets operational in the vault?

Additional comments:

Control Area

Control Area Inspection:

Is there enough room on control counter for an additional workstation?

Are the 120vac power outlets open for additional workstation monitor?

Is the control room dust free and cleared of debris?

Are the final lighting and controls installed and operational?

Are the additional 2 hospital network drops installed and operational?

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

Has Network information been provided by hospital & forwarded to Project Manager?

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.