Contract Att04 - BLS - Responder Decomm Checklist.pdf

Section Yes No

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

RespondeR BLS System?

Power Supply with AC Adapter?

Safety Enclosure?

(Should be attached to the RespondeR BLS)

Clear Sticker Dispenser?

(Should be attached to the Safety Enclosure)

Subcontractor Contact Information and Verification

Printed Name

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

Performed By:

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?

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)

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 Smiths RespondeR

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 Detection Verification Check Successfully?

Does the system calibrate correctly?

Comments/ConcernsEvaluation Criteria

Email Address Phone Number

Signature DateCompany Name

C le an in g Using a cotton tip applicator, gently clean the lens area to remove any dust or debris.

Using no chemicals, wipe off any dust or debris from the viewing windows.

Yes No

Signature Date

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.

Systems Integrator Additional Comments

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.

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

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