Facility description

General reason for visit:

Current Linac:

Photo of current linac

Current top energy:

Proposed replacement System:

General discussion:

Customer expectations:

Follow ups:

Vault Parameters

Vault door width and height:

ISO to back wall:

ISO to patient foot:

ISO to A-side:

ISO to B-side

Quick drawing of vault:
Photo of existing vault

Ceiling height:

Control room location:

Control room width:

Control room depth

Photo of control room
Control room drawing


Current chilled water supply:

City water backup?

Current electrical supply? Include location, ampacity, voltage.


General description of path. General length, hall width, door width & height.

General description of staging area:

Photo of staging area:

Standard delivery?

Does this delivery fall under standard delivery?

Dock or ground delivery?

Explain why rigging does not fall under standard rigging.

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.