Get Example Form Equipment Performance Evaluation ... - Dshs State Tx

This guide provides a comprehensive overview of how to accurately complete the EXAMPLE FORM EQUIPMENT PERFORMANCE EVALUATION from the Dshs State Tx. By following these instructions, you will ensure that all necessary components are properly filled out for effective equipment performance evaluation.

Follow the steps to complete the equipment performance evaluation form online.

1. Click the ‘Get Form’ button to access the form. This action will open the document in your online editor.
2. Begin by filling in the facility name in the designated space. Ensure the information is accurate and clearly written, as this identifies the location of the equipment being evaluated.
3. Proceed to enter the registration number, the date of the equipment performance evaluation, and the survey instrument used along with its calibration date.
4. Select whether the survey instrument is an exposed sensor/detector or an enclosed sensor/detector by marking the appropriate box.
5. In the X-ray unit identification section, fill out the manufacturer's name and location or room of the X-ray unit, followed by the model and serial numbers of the equipment.
6. Move on to the timer accuracy section and select the testing method used for the evaluation. Document the time for testing in milliseconds or pulses and indicate whether the pass/fail criteria are met.
7. For the exposure reproducibility section, record the technique factors selected and perform four measurements. Then, calculate the coefficient of variation as instructed and document the results.
8. Proceed to the linearity section, where you will select the mA station, determine the mAs, and complete the exposures. Make sure to check if the criteria are met.
9. In the kVp section, specify the method for testing, document the indicated kVp, measured kVp, and calculate the deviation. Indicate whether the test passes or fails as appropriate.
10. Complete the entrance exposure limits section by filling out the examination types, patient thickness, exposure limits, and actual exposures measured, circling the pass or fail for each test.
11. In the tube stability section, confirm the physical stability of the tube during exposure and whether it has free movement.
12. Next, for the collimation section, fill in the required measurements and check for misalignment as needed. Indicate if the equipment passes or fails the test.
13. Finally, have the technician and licensed medical physicist's signatures along with their registration numbers and license details provided at the end of the form.
14. After completing all sections, save your changes, and download or print the form as required for submission or record-keeping.

Complete your equipment performance evaluation form online today to ensure compliance and effective documentation.