Done Date to be completed

FACILITIES:

HMSA must have 24 hour access to facility Chairs and a restroom must be available in the work area Convenient storage area is available for miscellaneous equipment A dumpster will be available for disposal of packing debris Delivery path is accessible and free of obstructions (minimum clearance ?”) Area for parking delivery truck and off loading identified and arrangements made to keep it clear for delivery date All of these items have been checked and are complete. All of these items have been checked and exceptions with completion dates noted. Customer has completed all applicable Federal, State and Local registrations and met all applicable requirements to allow for the delivery, installation and service of the equipment in conformance with those regulations. Date__________ HMSA FSE Signature_______________________________ Name printed__________________________ Date___________ Contractor/Customer Signature________________________ Name printed__________________________ E-Mail to #InstallChecklistGroup@HITACHIMED.COM SCENARIA PRE-DELIVERY/INSTALLATION SITE CHECKLIST (REV 10/8/12) DM# 98489 v1 Pg. 2 of 2

SCENARIA PRE-DELIVERY/INSTALLATION SITE CHECKLIST The following checklist notes items that must be completed prior to the delivery and installation of the SCENARIA CT system. “Per site drawing” on this checklist refers to the HMSA final site specific drawing provided to the customer and their contractor. It is the customer’s/contractor’s responsibility to provide masonite or other protective covering for the floors to prevent damage during the delivery and placement of the equipment. THIS CHECKLIST MUST BE COMPLETED AND RETURNED TO HMSA TWINSBURG PRIOR TO DELIVERY

Done Date to be completed

GENERAL CONSTRUCTION: All room dimensions verified against the final HMSA site drawing and Site Planning notified of any discrepancies Scan room ceiling height is 8’-0” or greater Counter for Operator Workstation installed in control room if applicable All other casework and sink installed and complete Scan and Control room construction complete All rooms free of dust and debris Protective floor covering (masonite or equal) in place or available for delivery

ELECTRICAL:

Disconnect installed at Image Processor location and ready to be energized: 480V, 150A, 3 phase, 4 wire Emergency stop buttons (Shunt trip) installed and functional “X-Ray On” warning lights installed at scan room doors and location in scan room visible from anywhere in room Door interlock switches (optional) installed Wiring for “X-Ray On” and door interlocks w/ 12’ pigtails run to junction box @ Image Processor per site drawing Wall mounted wireway with 2 equal compartments and removable cover per site drawing (divider open @ vertical transition) On-floor/ in-floor wireway with 2 equal compartments and removable cover per site drawing Standard service outlets (120V) throughout suite (minimum 1 per wall) and required outlets (120V) per site drawing Telephone in control room for Technician and Service Engineer use Network (DICOM) drops located per site drawing Lights with adjustable brightness levels installed and functional in scan and control rooms Electrician scheduled for the morning after delivery to connect power and provide wireway access openings per installer ENVIRONMENTAL: HVAC system with separate thermostatic zones for scan and control rooms operational

SCENARIA PRE-DELIVERY/INSTALLATION SITE CHECKLIST (REV 10/8/12) DM# 98489 v1 Pg. 1 of 2