Installation Report Microlab Series

Dealer Customer

Name: ........................... Name: ...............................

Contact person: ............................ Contact person: .................................
Telephone nr: ............................ Telephone nr: .................................

Type of instrument: ..................................

Serial nr. .......................... Installation date: .................................

Transport damage

Package damaged: Yes No

Parts damaged Yes No

If yes, please specify:

Initial check-out
Parts missing? Part number Part description
(Check against packing list)
___________ ________________________
Yes  Please specify parts ___________ ________________________
___________ ________________________
No
___________ ________________________
___________ ________________________

Installation

Did any failure occur during installation and / or first run?

Yes  Please fill out “Malfunction Report”

No

Please fax or e-mail this report to:

ELITechGroup B.V. Copy 1 customer
Van Rensselaerweg 4 Copy 2 distributer
6956 AV Spankeren Copy 3 ELITechGroup B.V.
The Netherlands
E-mail: service.ecsnl@elitechgroup.com

Document 3085-042-02 1/2

Serial number: ………………

Chemical Installation

Run Reagent Blank.

Run Calibrations.

Run QC material for several clinical chemistry applications.

(A few enzymes, a few substrate tests using customer’s reagent)

Test QC range level 1 Test result QC range level 2 Test result

Remarks:

Technical acceptance

Date (ddmmyyyy):………………

Service Engineer:………….. Customer:……………………….

Name:……………………….. Name:……………………………

Signature:…………………… Signature:……………………….

Please fax or mail this report to:

ELITechGroup B.V. Copy 1 customer

Van Rensselaerweg 4 Copy 2 Distributer
6956 AV Spankeren Copy 3 ELITechGroup B.V.
The Netherlands
Email: service.ecsnl@elitechgroup.com
Fax no. +31-313-427807

Document 3085-042-02 2/2