Contract Att02 - BLS - CEIA EMA-MS Decommission Checklist.pdf

Section Yes No

Please check one

(1) box:

Past/Current

Day

Past 3 Days Past Week Past Month More than a month

Unknown

The comments/concerns section may be used to provide further detail concerning unit quality, quantity, or general notes on unit/part condition

Decommission Checklist For the CEIA EMA-MS

Bottled Liquid Scanner (BLS)

Operation Test Kit (OTK)?

Take a photo of the MAKE/MODEL of the unit and document any damage or concerns.

Take a photo of the SERIAL NUMBER and BARCODE on the unit and document any damage or concerns.

BLS S/N: TSA/FAA Bar Code Number:

Airport Code: Terminal: Date of Test: Time:

Did the system pass the System Operational Check (NO

PASS) Successfully?

When time frame was the system last used?

Please mark one (1) box.

Did the system pass the System Operational Check (PASS)

Successfully?

Comments/Concerns

V is u a l

V er if ic a ti o n

U n it

C o n d it io n

Is the labeling correct on the packaging?

"Abnormal Object" Test Sample with Red Label?

(NO PASS)

System Keys?

Does the unit have any Exterior Damage?

(i.e. broken pieces, dents, paint chipping, locally added stickers)

Does the unit have Interior Damage?

(i.e. broken pieces, dust, locally added stickers)

T es ti n g

Does the system turn on?

Does the system allow users to Log On?

Evaluation Criteria

Take photo of the unit PACKAGED for shipping and document any damage or concerns.

U n it

P a ck a g in g

Take a photo of the unit while OPERATIONAL and document any damage or concerns. (screen included)

Take a photo of the FRONT of the unit and document any damage or concerns.

Take a photo of the SIDES of the unit and document any damage or concerns.

Take a photo of the BACK of the unit and document any damage or concerns.

In v en to ry

EMA-MS BLS System?

Power Supply?

Probe Complete with control unit?

(BLS main component)

"Normal Object" Test Sample with Green Label?

(NO PASS)

In case of liquid spill in the AC, tilt unit forward and wipe AC with a dry non-abrasive clothC le an in g Wipe the analysis compartment (AC) clean, using a slightly moist (water only), non-abrasive cloth.

Yes No

DateSignature

Federal Employee Comments/Concerns

Federal Employee Verification

As a witness, sign and date this Decommission Checklist to confirm the document was completed on-site.

Confirmed By:

Printed Name

Email Address Phone Number

Signature DateCompany Name

Systems Integrator Contact Information and Verification

Sign and date this Decommission Checklist and leave a copy with the unit.

Reviewed By:

Printed Name Email Address Phone Number

Company Name Signature Date

Subcontractor Contact Information and Verification

Evaluation Criteria Comments/Concerns

System Integrator Section (This section should be filled in by the System Integrator ONLY)

Has all damage been documented? If NO, please specify in the comments section.

Printed Name

Sign and date this Decommission Checklist and leave a copy with the unit.

Systems Integrator Additional Comments

Performed By:

Are there any components missing? If YES, please specify in the comments section.

Is a Verification Kit being returned with this unit? If YES, please note it in the comments section.