ALLEGATO 2_Questionario Tecnico-Tavoli Operatori

SERVIZIO SANITARIO REGIONE SARDEGNA
AZIENDA SANITARIA LOCALE N.5 ORISTANO
Capitolato Speciale
per l'acquisto di tre tavoli operatori
polifunzionali da destinare alle sale
operatorie del P.O. “Delogu” di
Ghilarza e del P.O. “Mastino di Bosa
ALLEGATO 2:
Questionario Tecnico
Timbro e Firma:
SERVIZIO SANITARIO REGIONE SARDEGNA
AZIENDA SANITARIA LOCALE N.5 ORISTANO
QUESTIONARIO TECNICO
INFORMAZIONI GENERALI
DITTA PRODUTTRICE ___________________________________________________________
DITTA DISTRIBUTRICE __________________________________________________________
MODELLO _____________________________________________________________________
ANNO DI IMMISSIONE SUL MERCATO DELL’ULTIMA VERSIONE ________________________
APPLICAZIONI _________________________________________________________________
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BASE
TIPO DI BASE DEL TAVOLO (fissa, mobile, ...) ________________________________________
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CARATTERISTICHE COSTRUTTIVE COLONNA
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LARGHEZZA (cm) _________________________________________________________
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LUNGHEZZA (cm) _________________________________________________________
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ALTEZZA (cm) ____________________________________________________________
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PESO (Kg) _______________________________________________________________
TIPO MOVIMENTAZIONE _________________________________________________________
CARATTERISTICHE COSTRUTTIVE
DI SICUREZZA, MOVIMENTAZIONE, PRECISIONE,
STABILITA’, PULIZIA, ERGONOMIA (descrivere) _______________________________________
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Timbro e Firma:
1
SERVIZIO SANITARIO REGIONE SARDEGNA
AZIENDA SANITARIA LOCALE N.5 ORISTANO
MATERIALE COSTRUTTIVO (descrivere le caratteristiche) _______________________________
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SISTEMA DI MOVIMENTAZIONE E BLOCCAGGIO (n° ruote, sistema di bloccaggio, ecc.) ______
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POSIZIONAMENTO DEL PIANO (indicare le modalità di posizionamento) ____________________
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SISTEMA DI AZIONAMENTO (descrivere)
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PORTATA MASSIMA PAZIENTE (Kg) _______________________________________________
DISPOSITIVO DI ALLINEAMENTO AUTOMATICO [si, no]
ESECUZIONE IN EMERGENZA DI TUTTI I MOVIMENTI AUTOMATICI [si, no]
CARATTERISTICHE ALIMENTAZIONE ELETTRICA:
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TENSIONE (V) ____________________________________________________________
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FREQUENZA (Hz) _________________________________________________________
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POTENZA ASSORBITA _____________________________________________________
ALIMENTAZIONE A BATTERIA [si, no] ______________________________________________
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TIPO BATTERIE __________________________________________________________
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AUTONOMIA OPERATIVA __________________________________________________
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TEMPO DI RICARICA ______________________________________________________
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INDICATORE LIVELLO BATTERIE [si, no] ______________________________________
Timbro e Firma:
2
SERVIZIO SANITARIO REGIONE SARDEGNA
AZIENDA SANITARIA LOCALE N.5 ORISTANO
PIANO
TIPO DI PIANO PORTA-PAZIENTE (fisso, removibile, ...) ________________________________
CARATTERISTICHE COSTRUTTIVE PIANO
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LARGHEZZA (cm) _________________________________________________________
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LUNGHEZZA (cm) _________________________________________________________
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PESO (Kg) _______________________________________________________________
CARATTERISTICHE DI FUNZIONALITA’ , SICUREZZA, PRECISIONE, STABILITA’, PULIZIA,
ERGONOMIA (descrivere) _________________________________________________________
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PIANO RADIOTRASPARENTE [si, no] (descrivere materiale costruttivo ecc.) _________________
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CUSCINI (descrivere lo spessore, il materiale costruttivo, l’asportabilità, ecc.) _________________
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NUMERO DI SEZIONI DEL PIANO (descrivere il numero di sezioni e le motorizzazioni) ________
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Timbro e Firma:
3
SERVIZIO SANITARIO REGIONE SARDEGNA
AZIENDA SANITARIA LOCALE N.5 ORISTANO
REGOLAZIONE PIANO E SEGMENTI:
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POSIZIONE TRENDELENBURG RISPETTO ALL’ORIZONTALE (°) __________________
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POSIZIONE ANTITRENDELENBURG RISPETTO ALL’ORIZONTALE (°) ______________
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INCLINAZIONE LATERALE (+° / -°) ___________________________________________
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MOVIMENTAZIONE IN ALTEZZA DELLA BASE SENZA PIANO (min cm, max cm) ______
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MOVIMENTAZIONE IN DEL PIANO (min cm, max cm) ____________________________
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TRASLAZIONE PIANO (cm) _________________________________________________
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MOVIMENTO SEGMENTO TESTA RISPETTO ALL’ORIZONTALE (+° / -°) ____________
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MOVIMENTO SEGMENTO SHIENA RISPETTO ALL’ORIZONTALE (+° / -°) ___________
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MOVIMENTO SEGMENTO GAMBE RISPETTO ALL’ORIZONTALE (+° / -°) ____________
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DIVARICAZIONE GAMBE [si,no] ______________________________________________
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SOLLEVAMENTO ZONA RENALE [si, no] ______________________________________
DISPOSITIVO PORTALASTRE INCORPORATO [si, no] _________________________________
CONTROLLO DEI MOVIMENTI DEL PIANO:
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TIPO (manuale, elettrico, idraulico, ...) __________________________________________
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COMANDO (pulsantiera, pedaliera, ...) _________________________________________
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MEMORIZZAZIONE POSIZIONI ______________________________________________
SISTEMA DI COMANDO DI EMERGENZA ____________________________________________
CARRELLO TRASPORTATORE PER IL PIANO
CARATTERISTICHE COSTRUTTIVE
DI SICUREZZA, MOVIMENTAZIONE, PRECISIONE,
STABILITA’, PULIZIA, ERGONOMIA (descrivere) _______________________________________
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REGOLABILE IN ALTEZZA [si, no] ___________________________________________
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PERMETTE LE POSIZIONI DI TRENDELENBURG E ANTITRENDELENBURG [si, no] __
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LATI DI ACCESSO AL PIANO ________________________________________________
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RUOTE FRENATE [si, no] ___________________________________________________
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SISTEMA DI CONTENIMENTO PAZIENTE [si, no] ________________________________
Timbro e Firma:
4
SERVIZIO SANITARIO REGIONE SARDEGNA
AZIENDA SANITARIA LOCALE N.5 ORISTANO
NORMATIVE
CONFORMITA’ ALLA DIRETTIVA 93/42 CEE (D.lgs 46/97):
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CLASSIFICAZIONE [I, IIa, IIb, III] _____________________________________________
CONFORMITA’ ALLE NORME DI SICUREZZA:
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CEI EN 60601-1 (CEI 62-5) [si, no] ____________________________________________
Classe elettrica [I, II, AI] __________________________________________________
Tipo parti applicate [B, BF, CF] ____________________________________________
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CONFORMITA’ AD ALTRE NORME (specificare) _________________________________
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ACCESSORI
TUTTI GLI ACCESSORI INDICATI NEL CAPITOLATO SPECIALE DEVONO ESSERE OFFERTI
NELLA CONFIGURAZIONE BASE (specificare, eventualmente allegare documentazione) ______
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Timbro e Firma:
5
SERVIZIO SANITARIO REGIONE SARDEGNA
AZIENDA SANITARIA LOCALE N.5 ORISTANO
ACCESSORI OPZIONALI (specificare, eventualmente allegare documentazione) _____________
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ASSISTENZA IN GARANZIA
GARANZIA (Specificare il tipo e la durata) ____________________________________________
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TEMPO DI INTERVENTO MASSIMO (ore solari) _______________________________________
TEMPO DI RIPRISTINO MASSIMO (ore solari) _________________________________________
DISPONIBILITA’ MULETTO [si, no] __________________________________________________
SEDE DI ASSISTENZA TECNICA PIU’ VICINA ________________________________________
N° VISITE PROGRAMMATE ANNUE ________________________________________________
ASSISTENZA TECNICA POST GARANZIA
TEMPO DI INTERVENTO MASSIMO (ore solari) _______________________________________
TEMPO DI RIPRISTINO MASSIMO (ore solari) _________________________________________
DISPONIBILITA’ MULETTO [si, no] __________________________________________________
SEDE DI ASSISTENZA TECNICA PIU’ VICINA ________________________________________
N° VISITE PROGRAMMATE ANNUE ________________________________________________
ALTRO
MATERIALI DI CONSUMO NECESSARI (Specificare) ___________________________________
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Timbro e Firma:
6
SERVIZIO SANITARIO REGIONE SARDEGNA
AZIENDA SANITARIA LOCALE N.5 ORISTANO
ALTRE INFORMAZIONI __________________________________________________________
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DATA __________________
TIMBRO E FIRMA
Timbro e Firma:
7