Service Report

• Site conducted

  Select

• Conducted on

  Date

• Account

• Contact

• Email

• Prepared By

Scope of Work

• Work to be performed

  Repair

  Maintenance

  Installation

  Delivery

  Other

• Please specify work to be performed

• Description of work

• Take a photo of the problems identified

  Media

• Have you completed work?

  No

  Yes

Follow Up Action Items

• Proposed timeline for completion of work

Report

Device

• Model

  Select UV7002 UV182 2800 Innovation Pro UV1000L 2800 Innovation HF-216 TP-4 UV109B UV5002 UV1002 Medisun 250 Illuco IDS-1100

  • UV7002
  • UV182
  • 2800 Innovation Pro
  • UV1000L
  • 2800 Innovation
  • HF-216
  • TP-4
  • UV109B
  • UV5002
  • UV1002
  • Medisun 250
  • Illuco IDS-1100

• Serial number

• Lamp hours

• Intensity Old (mW/cm^2)

• Intensity New (mW/cm^2)

• Parts Replaced

  No

  Yes

• Part

• Covered under warranty?

  No

  Yes

• Service Performed

  No

  Yes

Entire Unit

• General condition of device

  Good

  Fair

  Poor

  N/A

• No damage on modules and doors

  Good

  Fair

  Poor

  N/A

• No damage on T-profile

  Good

  Fair

  Poor

  N/A

• No condensation or water on device

  Good

  Fair

  Poor

  N/A

• No damage on lamps and reflectors

  Good

  Fair

  Poor

  N/A

Doors

• Door allignment

  Good

  Fair

  Poor

  N/A

• Door sesnor allignment

  Good

  Fair

  Poor

  N/A

• No damage on plastic hose inside door fold

  Good

  Fair

  Poor

  N/A

• Door suspension

  Good

  Fair

  Poor

  N/A

Interior

• Panels clean

  Good

  Fair

  Poor

  N/A

• No damage on acrylic handles

  Good

  Fair

  Poor

  N/A

• No damage on foam landing

  Good

  Fair

  Poor

  N/A

• No damage on interior control panel

  Good

  Fair

  Poor

  N/A

• Filters replaced

  Yes

  No

  N/A

Electrical

• No damage on power plug

  Pass

  Fail

  N/A

• Interior lighting function

  Pass

  Fail

  N/A

• Patient cooling function

  Pass

  Fail

  N/A

• Device cooling function

  Pass

  Fail

  N/A

• Power board connections

  Pass

  Fail

  N/A

• Contactor connections

  Pass

  Fail

  N/A

• Touch Screen Condition

  Good

  Fair

  Poor

  N/A

UV Sensor System

• No damage on UV sensor cover

  Good

  Fair

  Poor

  N/A

• Sensors clean

  Good

  Fair

  Poor

  N/A

Functional test

• Functional test successful

  Yes

  No

  N/A

• Serial number

• Modules Calibrated

  Yes

  No

  N/A

Module 1

• Lamp hours Module 1

• Intensity Module 1 Old (mW/cm^2)

• Intensity Module 1 New (mW/cm^2)

Module 2

• Lamp hours Module 2

• Intensity Module 2 Old (mW/cm^2)

• Intensity Module 2 New (mW/cm^2)

Module 3

• Lamp hours Module 3

• Intensity Module 3 Old (mW/cm^2)

• Intensity Module 3 New (mW/cm^2)

Module 4

• Lamp hours Module 4

• Intensity Module 4 New (mW/cm^2)

• Intensity Module 4 Old (mW/cm^2)

• Parts Replaced

  No

  Yes

• Part

• Covered under warranty?

  No

  Yes

• Service Performed

  No

  Yes

Entire Unit

• General condition of device

  Good

  Fair

  Poor

  N/A

• No damage on modules and doors

  Good

  Fair

  Poor

  N/A

• No damage on T-profile

  Good

  Fair

  Poor

  N/A

• No condensation or water on device

  Good

  Fair

  Poor

  N/A

• No damage on lamps and reflectors

  Good

  Fair

  Poor

  N/A

Interior

• Panels clean

  Good

  Fair

  Poor

  N/A

Electrical

• No damage on power plug

  Pass

  Fail

  N/A

• Device cooling function

  Pass

  Fail

  N/A

• Power board connections

  Pass

  Fail

  N/A

• Contactor connections

  Pass

  Fail

  N/A

• Touch Screen Condition

  Good

  Fair

  Poor

  N/A

Functional test

• Functional test successful

  Yes

  No

  N/A

• Serial number

• Lamp hours

• Intensity Old (mW/cm^2)

• Intensity New (mW/cm^2)

• Parts Replaced

  No

  Yes

• Part

• Covered under warranty?

  No

  Yes

• Service Performed

  No

  Yes

Entire Unit

• General condition of device

  Good

  Fair

  Poor

  N/A

• No damage on modules and doors

  Good

  Fair

  Poor

  N/A

• No damage on T-profile

  Good

  Fair

  Poor

  N/A

• No condensation or water on device

  Good

  Fair

  Poor

  N/A

• No damage on lamps and reflectors

  Good

  Fair

  Poor

  N/A

Doors

• Door allignment

  Good

  Fair

  Poor

  N/A

• Door sesnor allignment

  Good

  Fair

  Poor

  N/A

• No damage on plastic hose inside door fold

  Good

  Fair

  Poor

  N/A

• Door suspension

  Good

  Fair

  Poor

  N/A

Interior

• Panels clean

  Good

  Fair

  Poor

  N/A

• No damage on foam landing

  Good

  Fair

  Poor

  N/A

• No damage on interior control panel

  Good

  Fair

  Poor

  N/A

Electrical

• No damage on power plug

  Pass

  Fail

  N/A

• Interior lighting function

  Pass

  Fail

  N/A

• Patient cooling function

  Pass

  Fail

  N/A

• Device cooling function

  Pass

  Fail

  N/A

• Power board connections

  Pass

  Fail

  N/A

• Contactor connections

  Pass

  Fail

  N/A

• Touch Screen Condition

  Good

  Fair

  Poor

  N/A

UV Sensor System

• No damage on UV sensor cover

  Good

  Fair

  Poor

  N/A

• Sensors clean

  Good

  Fair

  Poor

  N/A

Functional test

• Functional test successful

  Yes

  No

  N/A

• Serial number

• Lamp hours

• Intensity Old (mW/cm^2)

• Intensity New (mW/cm^2)

• Parts Replaced

  No

  Yes

• Part

• Covered under warranty?

  No

  Yes

• Service Performed

  No

  Yes

Entire Unit

• General condition of device

  Good

  Fair

  Poor

  N/A

• No damage on modules and doors

  Good

  Fair

  Poor

  N/A

• No condensation or water on device

  Good

  Fair

  Poor

  N/A

• No damage on lamps and reflectors

  Good

  Fair

  Poor

  N/A

Doors

• Door allignment

  Good

  Fair

  Poor

  N/A

Interior

• Panels clean

  Good

  Fair

  Poor

  N/A

• No damage on foam landing

  Good

  Fair

  Poor

  N/A

Electrical

• No damage on power plug

  Pass

  Fail

  N/A

• Patient cooling function

  Pass

  Fail

  N/A

• Power board connections

  Pass

  Fail

  N/A

• Contactor connections

  Pass

  Fail

  N/A

• LCD Display Condition

  Good

  Fair

  Poor

  N/A

Functional test

• Functional test successful

  Yes

  No

  N/A

• Serial number

• Lamp hours

• Intensity Old (mW/cm^2)

• Intensity New (mW/cm^2)

• Parts Replaced

  No

  Yes

• Part

• Covered under warranty?

  No

  Yes

• Service Performed

  No

  Yes

Entire Unit

• General condition of device

  Good

  Fair

  Poor

  N/A

• No damage on modules and door

  Good

  Fair

  Poor

  N/A

• No damage on T-profile

  Good

  Fair

  Poor

  N/A

• No condensation or water on device

  Good

  Fair

  Poor

  N/A

• No damage on lamps and reflectors

  Good

  Fair

  Poor

  N/A

Doors

• Door allignment

  Good

  Fair

  Poor

  N/A

• Door sesnor allignment

  Good

  Fair

  Poor

  N/A

• No damage on plastic hose inside door fold

  Good

  Fair

  Poor

  N/A

• Door suspension

  Good

  Fair

  Poor

  N/A

Interior

• Panels clean

  Good

  Fair

  Poor

  N/A

• No damage on foam landing

  Good

  Fair

  Poor

  N/A

• No damage on interior control panel

  Good

  Fair

  Poor

  N/A

• Filters replaced

  Yes

  No

  N/A

Electrical

• No damage on power plug

  Pass

  Fail

  N/A

• Interior lighting function

  Pass

  Fail

  N/A

• Patient cooling function

  Pass

  Fail

  N/A

• Device cooling function

  Pass

  Fail

  N/A

• Power board connections

  Pass

  Fail

  N/A

• Contactor connections

  Pass

  Fail

  N/A

• Touch Screen Condition

  Good

  Fair

  Poor

  N/A

UV Sensor System

• No damage on UV sensor cover

  Good

  Fair

  Poor

  N/A

• Sensors clean

  Good

  Fair

  Poor

  N/A

Functional test

• Functional test successful

  Yes

  No

  N/A

• Serial number

• Modules Calibrated

  Yes

  No

  N/A

• Lamp hours Module 1

• Lamp hours Module 2

• Lamp hours Module 3

• Lamp hours Module 4

• Intensity Module 1 (mW/cm^2)

• Intensity Module 2 (mW/cm^2)

• Intensity Module 3 (mW/cm^2)

• Intensity Module 4 (mW/cm^2)

• Parts Replaced

  No

  Yes

• Part

• Covered under warranty?

  No

  Yes

• Service Performed

  No

  Yes

Entire Unit

• General condition of device

  Good

  Fair

  Poor

  N/A

• No damage on modules

  Good

  Fair

  Poor

  N/A

• No condensation or water on device

  Good

  Fair

  Poor

  N/A

• No damage on lamps and reflectors

  Good

  Fair

  Poor

  N/A

Interior

• Panels clean

  Good

  Fair

  Poor

  N/A

Electrical

• No damage on power plug

  Pass

  Fail

  N/A

• Device cooling function

  Pass

  Fail

  N/A

• Power board connections

  Pass

  Fail

  N/A

• Contactor connections

  Pass

  Fail

  N/A

• LCD display condition

  Good

  Fair

  Poor

  N/A

Functional test

• Functional test successful

  Yes

  No

  N/A

• Serial number

• Lamp hours

• Intensity Old (mW/cm^2)

• Intensity New (mW/cm^2)

• Parts Replaced

  No

  Yes

• Part

• Covered under warranty?

  No

  Yes

• Service Performed

  No

  Yes

Entire Unit

• General condition of device

  Good

  Fair

  Poor

  N/A

• No damage on modules and doors

  Good

  Fair

  Poor

  N/A

• No condensation or water on device

  Good

  Fair

  Poor

  N/A

• No damage on lamp casing

  Good

  Fair

  Poor

  N/A

• No damage on lamp and reflector

  Good

  Fair

  Poor

  N/A

Electrical

• No damage on power plug

  Pass

  Fail

  N/A

Functional test

• Functional test successful

  Yes

  No

  N/A

• Serial number

• Lamp hours

• Intensity Old (mW/cm^2)

• Intensity New (mW/cm^2)

• Parts Replaced

  No

  Yes

• Part

• Covered under warranty?

  No

  Yes

• Service Performed

  No

  Yes

Entire Unit

• General condition of device

  Good

  Fair

  Poor

  N/A

• No damage on modules and doors

  Good

  Fair

  Poor

  N/A

• No damage on T-profile

  Good

  Fair

  Poor

  N/A

• No condensation or water on device

  Good

  Fair

  Poor

  N/A

• No damage on lamps and reflectors

  Good

  Fair

  Poor

  N/A

Doors

• Door allignment

  Good

  Fair

  Poor

  N/A

• Door sesnor allignment

  Good

  Fair

  Poor

  N/A

• No damage on plastic hose inside door fold

  Good

  Fair

  Poor

  N/A

• Door suspension

  Good

  Fair

  Poor

  N/A

Interior

• Panels clean

  Good

  Fair

  Poor

  N/A

• No damage on acrylic handles

  Good

  Fair

  Poor

  N/A

• No damage on foam landing

  Good

  Fair

  Poor

  N/A

• Filters replaced

  Yes

  No

  N/A

Electrical

• No damage on power plug

  Pass

  Fail

  N/A

• Interior lighting function

  Pass

  Fail

  N/A

• Patient cooling function

  Pass

  Fail

  N/A

• Device cooling function

  Pass

  Fail

  N/A

• Power board connections

  Pass

  Fail

  N/A

• Contactor connections

  Pass

  Fail

  N/A

• Touch Screen Condition

  Good

  Fair

  Poor

  N/A

UV Sensor System

• No damage on UV sensor cover

  Good

  Fair

  Poor

  N/A

• Sensors clean

  Good

  Fair

  Poor

  N/A

Functional test

• Functional test successful

  Yes

  No

  N/A

• Serial number

• Lamp hours

• Intensity Old (mW/cm^2)

• Intensity New (mW/cm^2)

• Parts Replaced

  No

  Yes

• Part

• Covered under warranty?

  No

  Yes

• Service Performed

  No

  Yes

Entire Unit

• General condition of device

  Good

  Fair

  Poor

  N/A

• No damage on modules and doors

  Good

  Fair

  Poor

  N/A

• No damage on T-profile

  Good

  Fair

  Poor

  N/A

• No condensation or water on device

  Good

  Fair

  Poor

  N/A

• No damage on lamps and reflectors

  Good

  Fair

  Poor

  N/A

Doors

• Door allignment

  Good

  Fair

  Poor

  N/A

• Door sesnor allignment

  Good

  Fair

  Poor

  N/A

• No damage on plastic hose inside door fold

  Good

  Fair

  Poor

  N/A

• Door suspension

  Good

  Fair

  Poor

  N/A

Interior

• Panels clean

  Good

  Fair

  Poor

  N/A

• No damage on foam landing

  Good

  Fair

  Poor

  N/A

• Filters replaced

  Yes

  No

  N/A

Electrical

• No damage on power plug

  Pass

  Fail

  N/A

• Interior lighting function

  Pass

  Fail

  N/A

• Patient cooling function

  Pass

  Fail

  N/A

• Device cooling function

  Pass

  Fail

  N/A

• Power board connections

  Pass

  Fail

  N/A

• Contactor connections

  Pass

  Fail

  N/A

• LCD display condition

  Good

  Fair

  Poor

  N/A

Functional test

• Functional test successful

  Yes

  No

  N/A

• Serial number

• Modules Calibrated

  Yes

  No

  N/A

Module 1

• Lamp hours Module 1

• Intensity Module 1 Old (mW/cm^2)

• Intensity Module 1 New (mW/cm^2)

Module 2

• Lamp hours Module 2

• Intensity Module 2 Old (mW/cm^2)

• Intensity Module 2 New (mW/cm^2)

Module 3

• Lamp hours Module 3

• Intensity Module 3 Old (mW/cm^2)

• Intensity Module 3 New (mW/cm^2)

Module 4

• Lamp hours Module 4

• Intensity Module 4 New (mW/cm^2)

• Intensity Module 4 Old (mW/cm^2)

• Parts Replaced

  No

  Yes

• Part

• Covered under warranty?

  No

  Yes

• Service Performed

  No

  Yes

Entire Unit

• General condition of device

  Good

  Fair

  Poor

  N/A

• No damage on modules and doors

  Good

  Fair

  Poor

  N/A

• No damage on T-profile

  Good

  Fair

  Poor

  N/A

• No condensation or water on device

  Good

  Fair

  Poor

  N/A

• No damage on lamps and reflectors

  Good

  Fair

  Poor

  N/A

Interior

• Panels clean

  Good

  Fair

  Poor

  N/A

Electrical

• No damage on power plug

  Pass

  Fail

  N/A

• Device cooling function

  Pass

  Fail

  N/A

• Power board connections

  Pass

  Fail

  N/A

• Contactor connections

  Pass

  Fail

  N/A

• Touch Screen Condition

  Good

  Fair

  Poor

  N/A

Functional test

• Functional test successful

  Yes

  No

  N/A

• Serial number

• Lamp hours

• Intensity Module Old (mW/cm^2)

• Intensity Module New (mW/cm^2)

• Parts Replaced

  No

  Yes

• Part

• Covered under warranty?

  No

  Yes

• Service Performed

  No

  Yes

Entire Unit

• General condition of device

  Good

  Fair

  Poor

  N/A

• No condensation or water on device

  Good

  Fair

  Poor

  N/A

• No damage on lamps and reflectors

  Good

  Fair

  Poor

  N/A

Interior

• Panels clean

  Good

  Fair

  Poor

  N/A

Electrical

• No damage on power plug

  Pass

  Fail

  N/A

• Device cooling function

  Pass

  Fail

  N/A

• LCD display Condition

  Good

  Fair

  Poor

  N/A

Functional test

• Functional test successful

  Yes

  No

  N/A

• Serial number

• Parts Replaced

  No

  Yes

• Part

• Covered under warranty?

  No

  Yes

Charge

• Cost of goods and services

• Total

Completion

• I confirm that the performed work, issues encountered, corrective actions, and follow up action items as stated in this report are accurate.
  
  If the required work is completed and that all issues were resolved; I confirm that system functionality, and any applicable system integration meets the design specifications.
  
  If follow up action items are required; I confirm that I will perform all of the necessary steps to complete all of the follow-up action items that are of my responsibility as stated in this report.

• Technician/Service Practicioner Full Name and Signature

  Sign

• End User / Owner Name and Signature

  Sign