Breast Pumps Technical Report Date Received Company Name Hospital Name Complainant's Name and Surname Complainant's Contact Number Pump Model Serial Number Warranty In WarrantyOut of Warranty Please Describe The Problem With The Breast Pump: Internal Use Only Date Received Technician Name & Surname Accessories Received with the Machine Breast ShieldDust CoverDiaphragm CapSilicone DiaphragmBreast KitsMilk BottleBottle StandBottle LidStandard Neck ConnectorsTubing with Connecter Technical Evaluation Testing Device Testing Altitude Measured Stimulation Vacuum - PRE Single Speed Setting 1 Speed Setting 2 Speed Setting 3 Stimulation Speed T/min Measured Stimulation Vacuum - POST Double Speed Setting 1 Speed Setting 2 Speed Setting 3 Stimulation Speed T/min Expression Vacuum - PRE Single Speed Setting 1 Speed Setting 2 Speed Setting 3 Speed Setting 4 Speed Setting 5 Speed Setting 6 Stimulation Speed T/min Expression Vacuum - POST Double Speed Setting 1 Speed Setting 2 Speed Setting 3 Speed Setting 4 Speed Setting 5 Speed Setting 6 Stimulation Speed T/min Repairs Done Quality Test Done: YesNo Quality Checklist Is the Machine Clean? YesNo Are the Covers in a Good Condition? YesNo Is the Outer Cover Discoloured? YesNo Any Damage to the Breast Pump? YesNo If YES, Please Note The Damages Spare Parts Used Date Return To Customer: Courier Used: Waybill Number:
