WHEEL-E usage instructions
33
31 Appendix: Medical product passport/record of training
Product specifications:
Serial number:
Key number/s:
Customer data:
Surname, forename:
Street:
Postcode, city:
Phone:
Paying organisation:
Training
carried out by:
Rehabilitation specialist
dealer
PRO ACTIV Field
Representative/
Product adviser
Record of training
I /we have been instructed in accordance with the associated hand-over certificate about the operation
of the product listed and informed about possible operator errors. I /we have also been advised about
situations where the assistance of another person is required. The usage instructions were handed to
me/us.
Instructor
Name, date, signature
1. Person being trained
Name, date, signature
2. Person being trained
Name, date, signature
3. Person being trained
Name, date, signature
For minors, or persons who are not responsible for their actions, legal guardians/supervisors/responsible persons are to be
trained in the use. This is confirmed by their signature. The data are recorded in the feedback system of PRO ACTIV Reha-
Technik GmbH as the manufacturer of the above named product. It is managed in accordance with § 16 BDSG (German Data
Protection Law).
Stamp / Date / Rehabilitation specialist dealer's signature
