Página de Título

  • Tittle:

  • Client/ Site:

  • Address:
  • Brachytherapy model:

  • Project Number:

  • Date of inspection:

  • SIR prepared by:

  • Is the site new or existent?

Hospital Contact:

  • Main hospital contact:

  • Constructor:

  • Electrician:

  • IT responsible:

  • Physicist:

Information:

  • Has the hospital been notified about the delivery of equipment?

  • Date:

  • What is the estimation date to finalize the site?

  • Date:

Access to the site

  • Is the area free of any building worker?

  • Is the Bunker and the control area free of any building worker?

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

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

Major system & options:

  • TDU (Treatment Delivery Unit)?

  • TCP (Treatment control panel)?

  • TCC (Treatment communication control)?

  • Source Emergency Container?

  • System Box?

  • Door interlock?

  • Emergency button?

  • Junction box?

  • *CFTV locally system?

  • *CCTV remote camera system?

  • *Treatment status indicator?

  • *Source verification system?

  • *Room radiation monitor?

  • *Start enable interlook?

  • *Oncentra Brachy planning software?

Consctruction requirements Treatment Room

  • Is the shielding project been approved by locally nuclear agency?

  • Is the bunker been constructed by shielding project specifications?

  • Is the shielding door fitted?

  • Is a minimum space from the treatment area 2 x 3 m?

  • Is the false ceiling installed?

  • Is the final light fitted and functional?

  • Have the room fittings been completed?

  • Is the cable ducts installed according to the Flexitron site speciation?

  • Are pull strings available in the cable ducts between treatment and control area?

Construction requirements Control Room

  • Is the control area available as per the Flexitron site specification?

  • Is the control desk in position and finished?

  • Are the cable ducts installed under the desk according to the Flexitron site specification?

  • Have cable passages cut in the control desk?

  • Is the final lighting fitted and operational?

  • Is there a internet connection on the control desk available during the installation?

Electrical requirements

  • Mains site Voltage:

  • What is the type of the power outlets?

  • Is a power outlet available for the TDU in the treatment room?

  • Is 4 units of power outlet available for the control area devices?

  • In a Oncentra Prostate to be implemented on site?

  • Is the power outlet installed at treatment room and functional?

Networking requirements

  • In the customer planning to connect the TCC to an external computer system or network?

  • Is the network available and function?

  • Are the 4 units of RJ45 CAT6 1Gigabit data connection fitted under the control desk and functional?

  • In a Oncentra Prostate to be implemented on site?

  • Is the RJ45 CAT6 1Gigabit data connection installed at treatment room and functional?

  • IP TCC:

  • IP Oncentra:

  • IP Mosaiq:

Enviromental

  • Is the air conditioning installed and operational?

  • Is the humidity range about 30-70%?

  • Is the temperature range about 17 - 24°C?

Final Confirmaton - Sign-off

  • Is the site ready for installation to start?

  • Responsible to complete the SIR:

  • Date of SIR:

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. Any ratings or scores displayed in our Public Library have not been verified by SafetyCulture for accuracy. Users of our platform may provide a rating or score that is incorrect or misleading. You should independently determine whether the template is suitable for your circumstances. You can use our Public Library to search based on criteria such as industry and subject matter. Search results are based on their relevance to your search and other criteria. We may feature checklists based on subject matters we think may be of interest to our customers.