Kodak 8000 Site Survey Form 12.02.04.pdf - VirTech - Virtua ...

PracticeWorks, Inc.
A Subsidiary of Eastman Kodak Company
1765 The Exchange
Atlanta, GA 30339
Site Survey Checklist
KODAK 8000 Digital Panoramic System
This checklist is a tool to be used by a representative of Kodak’s dental systems group and PracticeWorks, Inc. or its
affiliates, or a representative of a Certified Network Solution Provider (“NSP”) and a representative of any practice preparing
to purchase a Kodak 8000 system. It is meant to improve the customer’s understanding of some of the spatial and installation
requirements of the product they are about to purchase and ensure that the installation site meets these requirements. This
document should be discussed thoroughly, filled out, and signed by both the customer and a representative of Kodak’s
dental systems group.
Customer Information
Practice or Doctor’s Name (not both)
Address City State Zip
Phone Number
Contact
Fax Backline #
E-mail
Web Site
Specialty: Dental □ Orthodontics □ Oral Surgery □ Other_______________ □
Network Solution Provider Information
Company Name _____________
Location
Phone Number
Contact Cell/Alternate #
E-mail
Web Site
Computer Hardware Vendor Information
(If not utilizing NSP for PC’s, network, etc.)
Company Name _____________
Address City State Zip
Phone Number
Contact
Fax Cell/Alternate #
E-mail
Web Site
Information Concerning Your Facilities
Construction:
Structure: Existing □ New Construction □
Type of flooring: Wood □ Cement □ Carpet □ Tile □
Is a base plate required for proper installation? Yes □ No □
(Required for floors that are not level, floors that have water pipes below, wood floors not installed over concrete, etc.)
Type of wall: Wood Studs □ Metal Studs □ Concrete □ Cinder Block □
Kodak is a trademark of Eastman Kodak Company.

If metal studs is there rear access to the wall? Yes □ No □
(Metal studs require additional mounting brackets that should be bolted through the wall)
Electrical:
Are studs 16” on center? Yes □ No □ If no, please describe:__________________________
Do studs run continuously from floor to ceiling? Yes □ No □ If no, please describe:__________________________
Dedicated 220 Volt / 16 amp circuit: Present □ Installation required □
(Please have electrician provide male plug for 220 volt outlet on site)
110 Volt Outlet available for PC: Present □ Installation required □
Please Note:
Any electrical work required to allow the installation of the Kodak 8000 or 8000C system is the responsibility of the customer.
Storage & Delivery:
Crate Size: (1) 4’x4’x2’ approx. 260 lbs
(1) 7’x2’x2’ approx. 170 lbs
(1) 40”x28”x7” approx. 150 lbs (If base plate is required)
Reviewed size of crates: Yes □ No □
Does the practice have room to store the crates? Yes □ No □
Distance between storage area and installation area:
_________ Feet
Are all doors between the storage area and installation area a minimum of 31.5” wide? Yes □ No □
(Smaller doors require alternate assembly procedure)
Are there any steps or elevators? Steps □ Elevators □ None □
If there is an elevator, can it be used to deliver the crates? Yes □ No □ NA □
Requested delivery/installation time frame? Immediate □ Deliver On: ____________
Office hours for delivery and installation: ______________________________________________________________________
Space Requirements:
Is it likely that the customer will upgrade to the Kodak 8000C system in the future? Yes □ No □
If answer to upgrade question above is “yes”:
Room size required:
Actual Kodak 8000C system dimensions:
76.75”Deep, 110 1/4” Wide, and 94.5” High
49. 5”Deep, 97” Wide, 91.75”High
Kodak 8000C system orientation desired: Left □ Right □
(See attached diagrams)
If answer to upgrade question above is “no”:
Room size required:
76.75”Deep, 59 Wide, and 94.5” High
Actual Kodak 8000 unit dimensions: 46”Deep, 35” Wide, 90.5”High
Kodak 8000 system orientation desired: Left Entry □ Right Entry □
(See attached diagrams)
Reviewed room size requirements: Yes □ No □
Kodak is a trademark of Eastman Kodak Company.

Technology
Operating System/Dedicated PC:
Does the practice have a dedicated PC for the Kodak 8000 system? Yes □ No □
(If no, a dedicated PC that meets the minimum system requirements must be purchased)
Will the dedicated PC be stand alone or networked? Stand Alone □ Networked □
Does the practice have a Microsoft Windows or Apple Macintosh network? Windows □ Macintosh □
(If a Macintosh network is indicated,, a Windows PC must be provided for use with the Kodak 8000 system)
PC Operating System: Microsoft Windows 2000 Pro □ Microsoft Windows XP Pro □
Does the dedicated PC meet the 1 GB RAM recommendation? Yes □ No □
(512 MB Minimum Required)
System Integration:
Does the practice currently own or plan to purchase a practice management software product?
Yes □
No □
If yes, which product?
_________________________________ (Please provide product name and version number)
Does the practice currently own and use an imaging software product?
Yes □
No □
If yes, which product?
_________________________________ (Please provide product name and version number)
How many PC’s will utilize the imaging software product being purchased with the Kodak 8000 system?
________
Do all the PC’s that will be used for viewing purposes meet the minimum 512 MB RAM requirement? Yes □ No □
(1 GB Recommended)
Has all network cabling been completed in the practice? Yes □ No □
Services
Will the removal and disposal of shipping crates be handled by the NSP? Yes □ No □
Does the practice require removal of an existing pan or ceph? Yes □ No □
(If yes, please obtain quote from NSP)
Is the customer aware that initial training will be provided by the NSP? Yes □ No □
Acknowledgments
Customer Initial
System requirements were provided to and reviewed with customer? Yes □ No □ _____
On-site measurements reviewed and approved by customer? Yes □ No □ _____
Drawing of room layout, dimensions, and additional notes complete? Yes □ No □ _____
Reviewed that installation and initial training to be provided by NSP? Yes □ No □ _____
Kodak is a trademark of Eastman Kodak Company.

SIGNATURES REQUIRED PRIOR TO INSTALLATION:
PRACTICEWORKS or NSP:
Date:
Authorized Signature
I have read and fully understand the System Site Requirements and Practice Responsibilities set forth on this Site Survey Checklist and
acknowledge that I have reviewed each one of them with a representative of Kodak’s dental systems group; or one of the Certified
Network Solutions Providers.
PRACTICE AUTHORIZATION:
Authorized Signature
Date:
“Our Vision” is to develop, provide, and support information and practice management systems for dental
professionals so they can better focus on what they do best: care for their patients.
Kodak is a trademark of Eastman Kodak Company.

ROOM LAYOUT AND DIMENSIONS
Please be precise
Additional notes and comments:
Client Confirm (initials) ___________