Monthly Monitor Worksheet - Radiation Services, Inc. 2026

1. Click ‘Get Form’ to open the Monthly Monitor Worksheet in the editor.
2. Begin by filling in the facility name, room number, and unit at the top of the form. This information is crucial for identifying where the evaluation is taking place.
3. Enter the year and month for which you are conducting the evaluation. Use the provided fields to mark each day of the month along with technologist's initials.
4. For the SMPTE Pattern Check section, assess each gray level step and indicate if they are distinguishable from adjacent steps. Mark 'Pass' or 'Fail' as appropriate.
5. Evaluate alphanumeric characters and high-contrast line-pair images for clarity and sharpness, marking your findings accordingly.
6. In the Analysis of Glass and Screen Defects section, check for visible scratches, black points, or non-uniformities. Document your observations using Pass = √ ; Fail = F; Does not apply = NA.
7. Fill in window width and level values as per manufacturer recommendations or use standard values provided in the form.
8. Finally, have a qualified medical physicist review and sign off on the document by entering their name and date of review.

Start using our platform today to streamline your document editing process for free!