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Preventative Maintenance Inspection Form
12.0 Preventative Maintenance Document (Optional)
Technician: _________________________________ Date: _____________________________
Facility: ______________________________________________________________________
Department: __________________________________________________________________
Serial number: _____________________ Model Number: __________________________
Software Version Level: __________________________
: __________________________
Each step must be performed in the order provided on this form. Sign off each step as it
is performed, prior to the next step. ** NOTE: The Synergy
annual calibration or preventative maintenance. Performing a preventative maintenance
inspection is at the discretion of the healthcare facility to verify electrosurgical unit
performance.
Front Panel Console
Number Front Panel Elements
1
On/ Off Power Switch
2
Power Switch IEC 60417-5010 symbol (On/Off)
3
Footswitch Symbol
4
Footswitch Connector
5
Touch Screen Display
6
Hand-piece Symbol
7
Hand-piece Connector
8
Type CF Symbols (Electric Shock Protection)
DFU-0276-4r0_fmt_en-US
AR-9800 Arthrex Synergy
RF™
Console
: _____________________________
RF™
console does NOT require
PM – 1/8
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