Inspection of equipment and data form submission are both critical components of the quality control process for the Connecticut Department of Motor Vehicles (DMV). The DMV requires that all equipment be inspected regularly to ensure accuracy and completeness of data. In addition, data form submissions must be carefully reviewed to verify that all necessary information has been included. These processes help to ensure that the DMV is able to accurately and efficiently administer its programs.
| Question | Answer |
|---|---|
| Form Name | Data Form Ct Equipment Quality Control |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | daily ct equipment form template, ct daily form, daily ct quality control form, ct daily quality control |
A. DATA FORM FOR DAILY CT EQUIPMENT QUALITY CONTROL
CT Facility Name:__________________
CT Scanner Identifier:_____________________
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Date |
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Water HU |
Limit |
Water SD |
Limit |
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Axial Artifacts |
Notes |
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Axial |
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Y/N |
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Y/N |
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Y/N |
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Helical |
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Y/N |
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Y/N |
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Y/N |
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Axial |
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Y/N |
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Y/N |
|
Y/N |
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Helical |
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Y/N |
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Y/N |
|
Y/N |
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Axial |
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Y/N |
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Y/N |
|
Y/N |
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Helical |
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Y/N |
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Y/N |
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Y/N |
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Axial |
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Y/N |
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Y/N |
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Y/N |
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Helical |
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Y/N |
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Y/N |
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Y/N |
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Axial |
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Y/N |
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Y/N |
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Y/N |
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Helical |
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Y/N |
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Y/N |
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Y/N |
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Axial |
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Y/N |
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Y/N |
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Y/N |
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Helical |
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Y/N |
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Y/N |
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Y/N |
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Axial |
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Y/N |
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Y/N |
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Y/N |
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Helical |
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Y/N |
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Y/N |
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Y/N |
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Axial |
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Y/N |
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Y/N |
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Y/N |
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Helical |
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Y/N |
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Y/N |
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Y/N |
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Axial |
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Y/N |
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Y/N |
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Y/N |
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Helical |
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Y/N |
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Y/N |
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Y/N |
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Axial |
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Y/N |
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Y/N |
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Y/N |
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Helical |
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Y/N |
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Y/N |
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Y/N |
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Axial |
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Y/N |
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Y/N |
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Y/N |
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Helical |
|
Y/N |
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Y/N |
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Y/N |
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Axial |
|
Y/N |
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Y/N |
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Y/N |
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Helical |
|
Y/N |
|
Y/N |
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Y/N |
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Axial |
|
Y/N |
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Y/N |
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Y/N |
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Helical |
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Y/N |
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Y/N |
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Y/N |
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Axial |
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Y/N |
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Y/N |
|
Y/N |
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Helical |
|
Y/N |
|
Y/N |
|
Y/N |
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Axial |
|
Y/N |
|
Y/N |
|
Y/N |
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|
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Helical |
|
Y/N |
|
Y/N |
|
Y/N |
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Axial |
|
Y/N |
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Y/N |
|
Y/N |
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Helical |
|
Y/N |
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Y/N |
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Y/N |
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Axial |
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Y/N |
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Y/N |
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Y/N |
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Helical |
|
Y/N |
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Y/N |
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Y/N |
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CT |
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Axial |
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Y/N |
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Y/N |
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Y/N |
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Quality |
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||||
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Helical |
|
Y/N |
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Y/N |
|
Y/N |
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|
Control |
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Axial |
|
Y/N |
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Y/N |
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Y/N |
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Axial |
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Y/N |
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Y/N |
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Y/N |
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Helical |
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Y/N |
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Y/N |
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Y/N |
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Manual |
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Axial |
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Y/N |
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Y/N |
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Y/N |
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||
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Helical |
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Y/N |
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Y/N |
|
Y/N |
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Helical |
|
Y/N |
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Y/N |
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Y/N |
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Axial |
|
Y/N |
|
Y/N |
|
Y/N |
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Helical |
|
Y/N |
|
Y/N |
|
Y/N |
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Reviewed by: _____________________________ |
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__________________________________ |
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|
Qualified Medical Physicist |
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Date of Review |
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