Request: 420283 Preventive - Asset

Orig. Date: 8/29/2011 WR Status: Completed (9/23/2011 3:07:00 PM)

Shop: Priority: Routine
Employee: Due Date: 9/30/2011
Cost Center: Contact:
Location: Floor: 2nd Room: Room 3 Reference:
Problem: Tier: 2
Description
System-Generated Preventive Maintenance This Asset is on a Reduced Schedule. This is the only Work Request
that will be generated this year.
System: LIGHTS/LIGHT SOURCES
Class: LIGHT SOURCE, F-O, FLEX. ENDOSCOPIC-12-343A
Object: EXERA II CLV180
Manufacturer: OLYMPUS CORP

*%BT14679%*
Asset ID: 12764
Serial Number: 7901???
Common Name: Light Source Warranty End: 10/1/2010
Cost Center: ENDOSCOPY Indicators Previous Current
Building: W B1 - The W illiamsport Hospita
Floor: 2nd
Area: Endoscopy
Room: Room 3
Risk Factors: Disruption of Patient Service (4) /Ancillary - Diagnostic (3) /0 - 1 (1) Total = 8
Problem Text:
Status History
Status Date Employee Shift Repair Regular Time Travel Time Over Time
Repair Description
Completed 9/23/2011 0NPF-No 0 Hrs 0 Min 0 Hrs 0 Min 0 Hrs 0 Min
Problem
Found

Totals: 0 Hrs 40 Min 0 Hrs 0 Min 0 Hrs 0 Min

Procedures
CLEAN AND INSPECT ALL EXTERNAL SURFACES, HARDWARE AND CONNECTORS FOR PHYSICAL DAMAGE. Annually

CLEAN AND INSPECT ALL EXTERNAL SURFACES, HARDWARE AND CONNECTORS FOR PHYSICAL DAMAGE. Every 0 days

1. POWER CORD/PLUG CONDITION N/A

2. CHASSIS TO GROUND IMPEDANCE (0.5 OHMS MAX) _________ OHM

3. CHASSIS LEAKAGE CURRENT IN MICROAMPS (300 UA MAX) _________ UA

CHECK ALL SWITCHES, KNOBS, CONTROLS AND INDICATORS FOR PROPER RANGE AND MECHANICAL
OPERATION.

(RECORD THE HIGHEST OBSERVED VALUE ONLY)

INSPECT POWER CORD, STRAIN RELIEF AND PLUG FOR DAMAGE OR DETERIORATION.

CHECK ALL LAMPS AND PILOT LIGHTS. VERIFY CORRECT FUSE SIZE.

**PERFORMANCE DATA**
INDICATED VS. ACTUAL
________ - _________
________ - _________
________ - _________
________ - _________

VERIFY CORRECT LAMP SIZE AND RATING. CHECK OUTPUT AND INTENSITY.

DISASSEMBLE AND REMOVE ALL DUST AND FOREIGN MATERIAL. Every 0 days

VISUALLY INSPECT ALL INTERNAL PARTS FOR SIGNS OF WEAR, DETERIORATION, CORROSION, BREAKAGE,
Request: 420283 Preventive - Asset Page 2
Orig. Date: 8/29/2011 WR Status: Completed (9/23/2011 3:07:00 PM)

CLEAN AND CHECK ALIGNMENT OF LAMP AND FIBER BUNDLE ASSEMBLY OR FIBER BUNDLE ASSEMBLY SOCKET.
1. POWER CORD/PLUG CONDITION N/A Annually
DISASSEMBLE AND REMOVE ALL DUST AND FOREIGN MATERIAL. Annually
2. CHASSIS TO GROUND IMPEDANCE (0.5 OHMS MAX) _________ OHM Annually
CHECK ALL SWITCHES, KNOBS, CONTROLS AND INDICATORS FOR PROPER RANGE AND MECHANICAL Annually
OPERATION.
3. CHASSIS LEAKAGE CURRENT IN MICROAMPS (300 UA MAX) _________ UA Annually
VISUALLY INSPECT ALL INTERNAL PARTS FOR SIGNS OF WEAR, DETERIORATION, CORROSION, BREAKAGE, Annually
ABUSE OR OVERHEATING.
(RECORD THE HIGHEST OBSERVED VALUE ONLY) Annually
INSPECT POWER CORD, STRAIN RELIEF AND PLUG FOR DAMAGE OR DETERIORATION. Annually
CHECK ALL LAMPS AND PILOT LIGHTS. VERIFY CORRECT FUSE SIZE. Annually
**PERFORMANCE DATA** Annually
INDICATED VS. ACTUAL
-
-
-
-
-
-
VERIFY CORRECT LAMP SIZE AND RATING. CHECK OUTPUT AND INTENSITY. Annually
CLEAN AND CHECK ALIGNMENT OF LAMP AND FIBER BUNDLE ASSEMBLY OR FIBER BUNDLE ASSEMBLY SOCKET. Annually

New Materials: Qty Cost Total Cost

Completed Sign Off
By: By:
Response Completed
Date: / / Date: / /
Response : Completed :
Time: Time:
Duration: Rpr Code:

Misc.