CHECK SHEET
(Q) Name and signature of the per-
son responsible for checking.
(R) Notes (defects found, repairs perfor-
med or other relevant information)
- 23 / 24 -
(S) Check results.
O
Device fit for use.
O
Device unfit for use.
O
Device to be checked.
O
Device fit for use.
O
Device unfit for use.
O
Device to be checked.
O
Device fit for use.
O
Device unfit for use.
O
Device to be checked.
O
Device fit for use.
O
Device unfit for use.
O
Device to be checked.
O
Device fit for use.
O
Device unfit for use.
O
Device to be checked.
O
Device fit for use.
O
Device unfit for use.
O
Device to be checked.
O
Device fit for use.
O
Device unfit for use.
O
Device to be checked.
O
Device fit for use.
O
Device unfit for use.
O
Device to be checked.
O
Device fit for use.
O
Device unfit for use.
O
Device to be checked.
O
Device fit for use.
O
Device unfit for use.
O
Device to be checked.
(T) Date of
next check.