Case Study

Siaron Medical was contracted by a large OEM in November of 2010. The OEM had won the replacement of the Angio system at the Alaska Regional Hospital in Anchorage, Alaska. Upon contracting for the...
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Pre-Project Evaluation Questionnaire

Dear Customer

This questionnaire provides us with important information about your site & any site-specific requirements. The questionnaire also serves as a reminder to all stakeholders to provide this important information to ensure that everyone is prepared for the start of the project and the arrival of our team.

The form includes important information about patient data removal, exit routes, infection control procedures and site orientation.
Please fill out and submit this questionnaire no later than 7 days before project start date so that we can internally evaluate, prepare and provide a risk analysis. Failure to complete and submit the questionnaire may result in the project being delayed or unnecessary disruptions on site.

There are 2 options to complete, the online version below, or the printable version which can be downloaded by clicking here

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The system must be fully functional after patient data removal, and a test scan will be required on the day of removal to confirm functionality. (test scan only required for systems purchased or to be re-used)

YesNoNA
Hospital Facilities/Security Aware of Our Arrival?
Site Orientation Required? (if "yes" provide details below)
Will the System Be De-Contaminated Before Our Arrival?
Is there Infection Control Procedures? (if "yes" provide details below)
Has and Electrician Been Booked To Lock Out And Disconnect Power?
Has a Plumber Been Booked To Disconnect From Water Supply?
Is Access Required To Other Rooms to Access Conduits? (if "yes" provide details below)
Are there Working Time Restrictions? (if "yes" provide details below)
Loading Dock Available to Use?
Any Truck/Parking Restrictions? (if "yes" provide details below)
Will We Need Elevator Access? (if "yes" provide details below)

Please provide further details if elevator use is required.

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