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Common CT
CT

Installation Protocol
System

Mechanical installation certificate

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© Siemens AG 2005
The reproduction, transmission or use
of this document or its contents is not
permitted without express written
authority. Offenders will be liable for
damages. All rights, including rights
created by patent grant or registration
of a utility model or design, are
reserved.

Print No.: CT00-000.813.02.02.02 English

Replaces: CT00-000.813.02.01.02 Doc. Gen. Date: 10.07
2 Revision / Disclaimer
1Revision / Disclaimer

Document revision level

The document corresponds to the version/revision level effective at the time of system
delivery. Revisions to hardcopy documentation are not automatically distributed.
Please contact your local Siemens office to order current revision levels.

Disclaimer
The installation and service of equipment described herein is to be performed by qualified
personnel who are employed by Siemens or one of its affiliates or who are otherwise
authorized by Siemens or one of its affiliates to provide such services.
Assemblers and other persons who are not employed by or otherwise directly affiliated
with or authorized by Siemens or one of its affiliates are directed to contact one of the
local offices of Siemens or one of its affiliates before attempting installation or service pro-
cedures.

Common CT CT00-000.813.02.02.02 Page 2 of 10 Siemens AG

10.07 CTLPQ Medical Solutions
Table of Contents 3
0Table of Contents

1 _______ Mechanical installation certificate __________________________________ 4

Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Certificate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
System and installation team data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Measurement tools . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Mechanical installation checklist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

2 _______ Changes to previous version ______________________________________ 9

Siemens AG CT00-000.813.02.02.02 Page 3 of 10 Common CT

Medical Solutions 10.07 CTLPQ
4 Mechanical installation certificate
1-
Introduction
1Mechanical installation certificate

This certificate checks all components necessary for the mechanical installation of a
SOMATOM system.

NOTE This document has to be filled out, if the mechanical installation

will be performed by a Siemens-authorized vendor.

The mechanical installation work steps have to performed in accordance with the installa-
tion instructions delivered with the system in the blue Siemens “Technical Documents”
binder.
The mechanical installation certificate has to be filled out by the mechanical installation
team authorized by Siemens.
The signed certificate has to be handed over to the local Siemens installer or left in the
blue Siemens “Technical Documents” binder.

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10.07 CTLPQ Medical Solutions
Mechanical installation certificate 5

Certificate 1.1

System and installation team data 0

CT system model: ...........................................................................................................

Serial number: ...........................................................................................................

Order number: ...........................................................................................................

Customer: ...........................................................................................................

Installation site: ...........................................................................................................

Installation team: ...........................................................................................................

Start of installation: ...........................................................................................................

End of installation: ...........................................................................................................

Remark: please mark as n.a., if not applicable

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Medical Solutions 10.07 CTLPQ
6 Mechanical installation certificate

Measurement tools 0

Protective conductor meter:

Type: ......................................................... Serial no.: ....................................................

Torque wrench:

Type: ......................................................... Serial no.: ....................................................

Type: ......................................................... Serial no.: ....................................................

Type: ......................................................... Serial no.: ....................................................

Type: ......................................................... Serial no.: ....................................................

Multimeter:

Type: ......................................................... Serial no.: ....................................................

Other:

Type: ......................................................... Serial no.: ....................................................

Type: ......................................................... Serial no.: ....................................................

Type: ......................................................... Serial no.: ....................................................

Type: ......................................................... Serial no.: ....................................................

Remark: please mark as n.a., if not applicable

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10.07 CTLPQ Medical Solutions
Mechanical installation certificate 7

Mechanical installation checklist 0

NOTE The mechanical installation work steps have to be performed in

accordance with the installation instructions delivered with the
system in the blue Siemens “Technical Documents” binder.

Mechanical installation
completed
Yes No* n.a.
Gantry ❒ ❒ ❒
Patient table ❒ ❒ ❒
Power distribution cabinet(s) ❒ ❒ ❒
Computer cabinet ❒ ❒ ❒
Cooling unit cabinet ❒ ❒ ❒
Computer tower(s) in the control room ❒ ❒ ❒
Monitor(s) ❒ ❒ ❒
Ceiling support ❒ ❒ ❒
Monitor cart ❒ ❒ ❒
CT furniture ❒ ❒ ❒
System cabling completed and tightened with correct
❒ ❒ ❒
torque wrench
Emergency stop switch (on site) connected ❒ ❒ ❒
Water connection performed and filled with correct pres-
❒ ❒ ❒
sure
Seismic anchoring completed in response of the local
❒ ❒ ❒
project manager according to local regulations
Protective conductor measurement completed; all values
❒ ❒ ❒
are within tolerance.

Remark: please mark as n.a., if not applicable

*in case of “no,” a statement is necessary.

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Medical Solutions 10.07 CTLPQ
8 Mechanical installation certificate

The CT system was installed by the installation team in accordance with the installation
instructions delivered with the system.
All safety-relevant work steps were performed, as required.

Statement (necessary if “no” has been checked): (reason including name, date, and
signature)

.......................................................................................................................................

.......................................................................................................................................

.......................................................................................................................................

.......................................................................................................................................

.......................................................................................................................................

.......................................................................................................................................

Location .................................................................... Date ...........................................

Responsible sub-contractor ....................................... Name* ........................................

Responsible sub-contractor ....................................... Name* ........................................

Responsible sub-contractor ....................................... Name* ........................................

Responsible sub-contractor ....................................... Name* ........................................

Siemens representative ............................................ Name* ........................................

* in block letters

Remark: please mark as n.a., if not applicable

NOTE The certificate, signed by the authorized installation team, has to

be left in the blue Siemens “Technical Documents” binder.
The certificate has to signed by the local Siemens installer and
left on-site in the “System Owners manual”, “Protocols” register.

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10.07 CTLPQ Medical Solutions
Changes to previous version 9
2Changes to previous version 2-

Page Changes Reason

6 Measurement tools detailed. Comment in review meeting
7 Emergency shutdown button added. Change number: 168669
Remark added “in case of “no,” a state-
7 Comment in review meeting
ment is necessary."
Sentence “Reason why, if “no” has been
8 checked” changed into “Statement (nec- Comment in review meeting
essary....):”
8 More lines for sub-contractors added. Comment in review meeting

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Medical Solutions 10.07 CTLPQ
10 Changes to previous version

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10.07 CTLPQ Medical Solutions