Fax +49(0)30 75791199
Tel49(0)30 7579110
Record of installation and setting up
Please send to MELAG.
Dear Madam/Sir,
MELAG Medical Technology
Geneststraße 7 - 10
10829 Berlin
within the scope of Quality Assurance we are oblig-
ated, in cooperation with you, the responsible spe-
cialist MELAG dealer, to install this MELAG auto-
clave at the operator's in accordance with good en-
gineering practice and provide instructions in its
use.
Please copy, fill out and sign this form and send it
to us after the autoclave has been successfully in-
stalled.
The returned form is prerequisite for the
MELAG factory warranty.
Device and installation data
We, hereinafter referred to as specialist MELAG dealer, have today installed, instructed the personnel and
performed the initial start-up of the autoclave Vacuklav
®
41-B/43-B as described below:
Specialist dealer (name, address, stamp)
……………………………………………………………….
Operator (name, address/ stamp)
……………………………………………………………….
E-mail-address for software update
……………………………………………………………….
E-mail-address for software update
……………………………………………………………….
Serial No. Vacuklav
®
41-B/43-B
……………………………………………………………….
Remarks
………………………………………………………………
Please place checkmark where applicable
Date
………………………………………………………………
O
First installation
O
Subsequent
installation
The following persons were present during the instructions for use:
Name, first name (please print in block letters)
Signature
From the practice/ clinic:
………………………………………………………...... …………………………………….
………………………………………………………….. …………………………………….
………………………………………………………….. …………………………………….
………………………………………………………….. …………………………………….
Name, first name (please print in block letters)
Signature
Instructing technician
………………………………………………………….. …………………………………….
From the company:
………………………………………………………….. …………………………………….
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