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Acceptance Format2

This document is an acceptance testing form for new medical equipment being delivered to Wolkite University Specialized Hospital. It includes sections to record information about the delivered equipment like the inventory number, type of equipment, and warranty details. The form then has sections to document the acceptance checks done upon delivery, unpacking, assembly, installation, commissioning/testing, and training. The checks ensure the equipment was received intact and in working order, all necessary parts and manuals were included, and staff were trained to operate it correctly. Upon completing all acceptance checks, the head of equipment maintenance will certify if the equipment is accepted.

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239 views4 pages

Acceptance Format2

This document is an acceptance testing form for new medical equipment being delivered to Wolkite University Specialized Hospital. It includes sections to record information about the delivered equipment like the inventory number, type of equipment, and warranty details. The form then has sections to document the acceptance checks done upon delivery, unpacking, assembly, installation, commissioning/testing, and training. The checks ensure the equipment was received intact and in working order, all necessary parts and manuals were included, and staff were trained to operate it correctly. Upon completing all acceptance checks, the head of equipment maintenance will certify if the equipment is accepted.

Uploaded by

Ezana
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Wolkite university Specialized Hospital

Acceptance testing Form

REGISTIRATION BOX
Allocated inventory number_______________________________________
Equipment type_________________________________________________
Destination location______________________________________________
Accepted date___________________________________________________
Warranty expiry date_____________________________________________
Maintenance contract with_________________________________________

Name of Equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . .
Type/Model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . ..
Order Number . . . . .. . . . . . . . . . . . . . . . . . Serial Number . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ………
Cost . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Date Received . . . . . . . . . . . . . . . . . . . . . . . . . .. . . …...
Manufacturer . . . . . . . . . . . . . . . . . . . . . . Supplier/Agent . . . . . . . . . . . . . . . .. . . . . . .. . .. . . . ………….
Address . . . . . . . . . . . . . . . . . . . . . . . .. . . . . Phone . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . .. . . .

ACCEPTANCE CHECKS

1. Delivery.

Yes / done No/ not done Corrected if


applicable
Representative of supplier present?
Correct number of boxes received?
After unloading, are boxes intact?
If damaged, has this been stated on
the delivery
Note and senior management
informed?

Undertaken by: ……………………………………………………………


Witnessed by: name……………………. position………………….. Date…………………
2. UNPACKING

Yes / done No/ not done Corrected if


applicable
Is the equipment intact and
undamaged?
Equipment complete as ordered?
User/operator manual as ordered?
Service/technical manual as
ordered?
Accessories as ordered?
Consumables as ordered?
Spare parts as ordered?

Undertaken by: ……………………………………………………………


Witnessed by: name……………………. position………………….. Date…………………
3. Assembly
Yes / done No/ not done Corrected if
applicable
Are all parts available?
Do they fit together?
Do all the accessories fit?
Are markings and labels ok?
Any damage?

Undertaken by: ……………………………………………………………


Witnessed by: name……………………. position………………….. Date…………………
4. Installation

Yes / done No/ not done Corrected if


applicable
Was installation carried out
satisfactorily?
Were all parts present and
correctly fitted?
Were technical staff present as
learners?
Was the equipment demonstrated
as fully working?
Were staff trained in operation of
the equipment?
Undertaken by: ……………………………………………………………
Witnessed by: name……………………. position………………….. Date…………………
5. Commissioning/testing
Yes / done No/ not done Corrected if
applicable
Were electrical, mechanical, gas,
radiation safety tests and
performance check carried out in
accordance test sheet?
Was work carried out
satisfactorily?
Were technical staff present as
learners?
Were operators present as
learners?
Undertaken by: ……………………………………………………………
Witnessed by: name……………………. position………………….. Date…………………

6. Acceptance – to be certified by head of equipment maintenance


Yes / done No/ not done Corrected if
applicable
Is equipment accepted?

If rejected, have the short coming


been summarized on page?
If so, has a report gone to senior
management?
Should payment be withheld
pending correction?
Is payment approved?

Undertaken by: ……………………………………………………………


Witnessed by: name……………………. position………………….. Date…………………

7. Training
Yes / done No/ not done Corrected if
applicable
Were the expected training courses
given?
Were suitable operator present?
Were suitable technical staff
present?
Undertaken by: ……………………………………………………………
Witnessed by: name……………………. position………………….. Date…………………
Describe and quantify all items received

accessories consumebles Spare parts manuals

Undertaken by: ……………………………………………………………


Witnessed by: name……………………. position………………….. Date…………………

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