User's Manual

BODYGUARDIAN CONTROL UNIT – BASE KIT Operator Manual
20
Enclosure 1.7
PRODUCT TRACEABILITY FORM
To: PREVENTICE
1652 Greenview Drive SW
Rochester, MN 55092
c.a. Quality Assurance Department
System/device name……….................................................................................................
Device code / reference number (REF) ............................................................................
Device serial (SN) / lot number (LOT) .................................................................................
Name and address of the former owner .................................................................……....
.............................................................................................................................................
.............................................................................................................................................
.............................................................................................................................................
Name and address of the present owner .................................................................….......
....................................................................................................................................….....
................................................................................................................….........................
...............................................................................................................…..........…............
Date:...........................
Signature
...............................................
(please name in full)