D现场检验调查表(Xray).doc

辽宁省医疗器械检验所现场检验条件调查表Questionnaire on Testing Spot1. 基本情况（Basic Condition）制造商名称：Manufacturer:生产厂地址：Address:产品名称：Name:型号规格：Model:商标名称：Trade mark:真实性承诺：我们承诺现场检验条件调查表中填写内容真实无误，若有不符，承担由此而产生的一切责任和后果。Authenticity Promise:We promise that “Questionnaire on Testing”we filled in is truly and inerrable. If it does not truly with the form, we will take the responsibility for all the legal issue occurred.填表人签字： 印刷体：Filled by: Print :批准人签字： 印刷体：Approved by: Print : (公章) 年 月 日 (Seal) date:V5.3 LMTI-QSD-D222A-S02. 试验现场条件（Testing Spot Condition）要求：现场试验的场地及相关的电源、通风、照明、电离辐射防护等条件应满足X射线机（CT机）试验的要求。Requirement: The conditions of testing spot on the site, supply, ventilate, lighting, ionization radiation protection should meet the testing requirements of X-ray equipment C T. 试验场地名称及地点：The name and addressof testing site:工作面积： m2 状态：独立 局部Working area State Independence Part环境温度：相对湿度：空调自然状态Environment temperature Relative humidity Conditioner Nature condition通风状况： 空调 自然通风Ventilated condition Conditioner Nature照明状况： 人工采光 自然采光Lighting condition Supplying light Nature light电源条件： 相数： 单相 三相 电源电阻：Supply condition Phase single phase Triphase Power resistance 电压：V 频率：Hz 容量：kWVoltage Frequency Electrical capacity电磁干扰的防止： 无干扰源 有干扰源Electromagnetic interference prevention No-interference Interference 有干扰源，但有防止措施 Interference, but has prevention method振动噪音的防止： 无噪声源 有噪声源Vibration noise prevention No-noise Noise 有噪声源、但有改善措施 Noise, but has improvable method保护接地的条件： 有专用接地系统 有临时接地系统 Protective earthing condition Special earthing systemTemporary earthing system无接地系统No- earthing system电离辐射的防护： 永久性防护（隔室操作）临时防护（防护屏）Ionization radiation protectionPermanenceprotection Temporary protection 无辐射防护No-radiation protectionV5.3 LMTI-QSD-D222B-S03. 试验辅助人员（Testing Assistant）要求：应有熟悉标准、检验操作的专业技术人员协助工作。Requirement: Technical staffs who are familiar with the standard and test should assist with the work .名称Name性别Sex 职务/职称Title专业Major从事专业年限Years at this field4. 试验仪器设备（Testing Instruments）要求：应提供试验所需要的仪器设备。Requirement: The instrument should be supplied for testing requirement.仪器设备名称Name of instrument要求Requirement型号Model量程及准确度Measuring range and accuracy计量有效期Calibration Period of Validity温度计Thermometer用于环境温度监测湿度计Hygrometer用于环境湿度监测频率计Frequency meter用于网电源监测电源电阻表Resistance meterGB9706.3(IEC 601-2-7)1.4b)电压表、电流表Voltmeter、current-meterGB9706.1(IEC 601-1)7.1潮湿预处理设备Instrument for humidity preconditioning treatmentGB9706.1(IEC 601-1)4.10剩余电压测量仪器Instrument for measuring residual voltageGB9706.1(IEC 601-1)15剩余能量测量仪器Instrument for measuring residual energyGB9706.1(IEC 601-1)15接地电阻测量用仪器Instrument for measuring earthing resistanceGB9706.1(IEC 601-1)18漏电流测量用仪表Instrument for measuring leakage currentGB9706.1(IEC 601-1)19漏电流测量用隔离变压器Isolate transformer for measuring leakage currentGB9706.1(IEC 601-1)19电介质强度测量设备Instrument for measuring Dielectric strengthGB9706.1(IEC 601-1)20测量用压板（625mm2）Measuring board（625mm2）GB9706.1(IEC 601-1)21a)测量用压板（0.1m2）Measuring board（0.1m2）GB9706.1(IEC 601-1)21.3硬木板HardwoodGB9706.1(IEC 601-1)21.65和10斜面5and 10inklined planeGB9706.1(IEC 601-1)24GB9706.14(IEC 601-2-32)24.104扭矩试验装置Torque test apparatusGB9706.1(IEC 601-1)56.10b)标准试验指Standard test fingerGB9706.1(IEC 601-1)16(图7)试验针Test pinGB9706.1(IEC 601-1)16(图8)试验钩Test hookGB9706.1(IEC 601-1)16(图9)试验棒Test rodGB9706.1(IEC 601-1)16b)冲击试验装置Impact test apparatusGB9706.1(IEC 601-1)21(图G1)X射线剂量仪（测试半价层 、线性、重复性、稳定性）X-ray dosimeterGB9706.12（IEC601-1-3）29.201.2GB9706.3(IEC 601-2-7)50.102标准铝板Standard Aluminium layerGB9706.12（IEC601-1-3）29.201.2X射线剂量仪（测试漏射线）X-ray dosimeterGB9706.12（IEC601-1-3） 29.204X射线管电压表X-ray tube kV-meterGB9706.3(IEC 601-2-7) 50.103.1X射线管电流表X-ray tube mA-meterGB9706.3(IEC 601-2-7) 50.103.2加载时间表Loading timerGB9706.3(IEC 601-2-7) 50.103.3电流时间积表Current time product meterGB9706.3(IEC 601-2-7) 50.103.4纯铝板Aluminium layerGB9706.3(IEC 601-2-7) 50.105.2存储型示波器Memory oscillograph秒表Stop watchGB9706.3(IEC 601-2-7)29.1.104GB9706.11(IEC 601-2-28)42.101推拉式弹簧测力计Push and pull spring dynamometerGB9706.1(IEC 601-1)21a)GB9706.14(IEC 601-2-32)22.4.3、24.101 角度仪AnguloometerGB9706.1(IEC 601-1)24长度尺Length rulerGB9706.11(IEC 601-2-28)16铝箔mental foilGB9706.1(IEC 601-1)19重物massGB9706.1(IEC 601-1)21.3试验角test cornerGB9706.1(IEC 601-1)42.3测温装置measuring temperature apparatusGB9706.1(IEC 601-1)42.3 4)弯曲试验装置 flexing cord apparatusGB9706.1(IEC 601-1)57.4b)电源变压器试验装置supply transformer test apparatusGB9706.1(IEC 601-1)57.9.1电源变压器电介质强度试验装置dielectric strength of supply transformer test apparatusGB9706.1(IEC 601-1)57.9.2球压试验装置Ball-pressure test apparatusGB9706.1(IEC 601-1)59.2 1)高温箱high-temperature cabinetGB9706.1(IEC 601-1)59.2 1)高压电路电介质强度试验装置dielectric strength test apparatus(high-voltage circuit)GB9706.3(IEC 601-2-7)20三种水模（自动曝光控制的稳定性）provision of phantoms of three different thicknessesGB9706.3(IEC 601-2-7) 50.102.2b)密度计d