Xenex Incident Report
Call Type
(Choose call type)
Choose Model and Call Type
LS6 - Repair
LS6 - Inspection (PM)
LS6 - Swap
LS6 - Upgrade
X4/X5 - Repair
X4/X5 - Inspection (PM)
X4/X5 - Swap
X4/X5 - Upgrade
Choose Model and Call Type
Service Call Details
MCM Ticket #
Serial Number of
Robot
LS6 - Serial Number of Robot Being Returned to Xenex
X4/X5 - Serial Number of Robot Being Returned to Xenex
LS6 - Serial Number for new lamp
(PM)
LS6 - Serial Number for new lamp
(Repair)
LS6 - Serial Number for new lamp
(Upgrade)
X4/X5 - Serial Number for new lamp
(PM)
X4/X5 - Serial Number for new lamp
(Repair)
X4/X5 - Serial Number for new lamp
(Upgrade)
Provide the number of LS6 Pulse Cycles before replacing lamp
Provide the number of X4/X5 Pulse Cycles before replacing lamp
LS6 - Repair Checklist
Confirm with the on-site customer contact that the symptom they are experiencing with the robot is correctly listed on the service request
If the on-site customer describes any other issues, make sure all these symptoms are addressed before leaving the site
Correct any issue(s) they are experiencing trouble with and document the repairs you made to the Xenex system
Test for proper operation by running the Xenex disinfection system through 5 disinfection cycles to verify its proper operation
Check the Motion Sensor Cone for proper operation
Check the Door (orange) Cone for proper operation
If necessary order any additional parts to restore the robot to proper operation if you do not have these parts with you. Inform the On-site customer contact that these parts are on order and give them and ETA of the parts arrival and your ETA return time to correct the issue
If Xenex robot is repaired, inform the on-site customer contact the robot is back in operation and fully tested and have them sign and date this form
X4/X5 - Repair Checklist
Confirm with the on-site customer contact that the symptom they are experiencing with the robot is correctly listed on the service request
If the on-site customer describes any other issues, make sure all these symptoms are addressed before leaving the site
Correct any issue(s) they are experiencing trouble with and document the repairs you made to the Xenex system
Test for proper operation by running the Xenex disinfection system through 5 disinfection cycles to verify its proper operation
Check the Motion Sensor Cone for proper operation
Check the Remote Cone for proper operation
If necessary order any additional parts to restore the robot to proper operation if you do not have these parts with you. Inform the On-site customer contact that these parts are on order and give them and ETA of the parts arrival and your ETA return time to correct the issue
If Xenex robot is repaired, inform the on-site customer contact the unit is back in operation and fully tested and have them sign and date this form
LS6 - Swap Out Checklist
Unpack the replacement Xenex robot (Save Packing Material for the returning Xenex robot)
Move the replacement Xenex robot to the appropriate location for customer usage
On the LS6 you will need to contact Xenex to obtain the unique Username and Password for this robot
Raise the Dome (Dome tab in Settings menu) and Install the UVC lamp (Use Cotton or Rubber Gloves to handle the UVC lamp and VLA Glass lenses)
On the LS6 you will need to enter the Lamp Serial Number in the touchscreen (Lamp Tab in Settings Menu)
Install the VLA Glass lenses and clean if necessary
X4/X5 Swap Out Checklist
Unpack the replacement Xenex robot (Save Packing Material for the returning Xenex robot)
Move the replacement Xenex robot to the appropriate location for customer usage
On the X4/X5 you will need to contact Xenex to obtain the unique Username and Password for this robot
Raise the VLA Assembly (Hardware Status Menu) and Install the UVC lamp (Use Cotton or Rubber Gloves to handle the UVC lamp and VLA Glass lenses)
On the X4/X5 you will need to enter the Lamp Serial Number in the touchscreen (Hardware Status Menu)
Install the VLA Glass lenses and clean if necessary
LS6 Robot Swap Setup and Test
Preform robot test by running the robot for 5 disinfection cycles
Verify that the Motion Sensor is functioning properly on the Tethered/Black Cone
Verify the Door (orange) Cone is functioning properly and test the Remote Stop Button
X4/X5 Robot Swap Setup and Test
Preform robot test by running the robot for 5 disinfection cycles
Verify that the Motion Sensor is functioning properly on the Tethered/Black Cone
Verify the Remote Cone is functioning properly and test the Remote Stop Button
Prepare LS6 faulty Robot for return
Unplug the faulty robot and move the unit close to the return crate for shipment
Power robot up and Remove the VLA Glass lenses
Confirm the voltage on the UVC lamp connection is 0.0v
Remove UVC lamp and place into the box provided
Place the VLA Glass lenses into box provided
Make sure the dome is returned to the bottom position or damage will occur in shipping
Turn off the touchscreen
Place proper packing material on the Xenex robot and insert into the crate
Place the UVC bulb box in the appropriate place in the crate
Pack the VLA Glass lense Box in the appropriate place in the crate
Insure everything is packed correctly to survive the return shipment before closing the create.
Prepare X4/X5 faulty system for return
Unplug the faulty robot and move the robot close to the return crate for shipment
Power robot up and Remove the dome and VLA Glass lenses
Test the voltage on the UVC lamp connection with the high voltage probe for 0.0v
Remove UVC lamp and place into the box provided
Place the VLA Glass lenses into box provided
Make sure the dome is returned to the bottom position or damage will occur in shipping
On the X4/X5 robot you need to deactivate the robot in the Diagnostic setup screen
On the X4/X5 robot press the Red Button on bottom of display to turn off the tablet
Place proper packing material on the Xenex robot and insert into the crate
Place the UVC lamp box in the appropriate place in the crate
Pack the VLA Glass lense Box in the appropriate place in the crate
Place the dome in the appropriate package in the appropriate space.
Insure everything is packed correctly to survive the return shipment before closing the create.
Inspection Checklist for LS6
VLF glass panes: Remove, Inspect and Clean if necessary (gloves and alcohol wipes required)
UVC Lamp replaced (cotton or latex gloves required)
New Lamp serial # entered in Lamp tab on touchscreen. (new serial # is on banana jack of lamp)
Pulse count of old lamp and robot ID recorded on Xenex incident report. (Pulse count found in lamp tab)
Cleaned Air Intake Screen and Static Drag Under Robot
Ozone filter replaced (if required)
Inspect reflective surface of reflector assembly for damage
Clean reflective surface of reflector assembly
Verify plenum fan operation during full range of lift
Verity dome has normal rotation
Performed PM hardware check list
Verify casters are not loose or worn
Verify locks on all 4 casters functional
Disconnect tethered cord, unravel and inspect for damage
Inspect tethered cone for damage and verify operational
Inspect door (orange) cone for damage and verify operational.
Door cone stop button works and green LED light at end of cycle
Verify door cone charging when docked on robot
Inspect extension cords for wear or damage
5 consecutive 5 minute cycles ran on robot with no errors
Take pictures of any damage to robot or cones and forward to Xenex
TAKE A PICTURE CONFIRMING DMS IS CONNECTED
Inspection Checklist for X4/X5
Quartz panes: Remove, inspect and clean if necessary (gloves and alcohol wipes required)
UVC Lamp replaced (Replaced every 800 rooms disinfected) (cotton or latex gloves required)
New Lamp serial # entered in hardware status screen. (new serial # is on banana jack of wire)
Pulse count of old lamp recorded on Xenex incident report
Cleaned Air Intake Screen and Static Drag Under Robot
Ozone filter replaced (if required)
Inspect reflective surface of reflector assembly for damage
Clean reflective surface of reflector assembly
Verify plenum fan operation during full range of lift
Performed PM hardware check list
Verify casters are not loose or worn
Verify locks on rear casters functional
Disconnect tethered cord, unravel and inspect for damage
Inspect tethered cone for damage and verify operational
Inspect remote cone for damage and verify operational
Remote cone stop button works and green LED lights at end of cycle
Verify remote cone charger output (4.2 Vdc pulsing)
Verify back up battery charging
Inspect extension cords and power pigtail for wear or damage
5 consecutive 5 minute cycles ran on robot with no errors
Take pictures of any damage to robot or cones and forward to Xenex
TAKE A PICTURE SHOWING DMS IS CONNECTED
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Notes Section (Provide DETAILED notes about what you did onsite)
Was job completed and job area cleaned?
Yes
No
Technician Name
Technician email
Technician Branch ID
Time technician arrived
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MM
AM
Time technician departed
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MM
AM
Technician Signature
Clear
Customer Contact Name
Customer email
Customer Signature
Clear
Service Date
MM
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YYYY
Time Signed
HH
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AM
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