IO Field Service Repair Traveler

Version and Life Clock Information
Repair performed by (Name):*
Date*
MM slash DD slash YYYY
Company*
Concentrator*
- G1
- G2
- G3
Concentrator serial number*
Hours displayed at receipt*
Under warranty*
- Yes
- No
Reported error and notes*
Details
Catalog Number/Description
Detail of Components
Serial/Lot Number
Replaced
- Yes
Notes
ASTERISKED ITEMS BELOW MUST BE RETURNED TO INOGEN

Part Catalog Number / Description Detail of Components Serial/Lot Number Replaced Notes
Details
Concentrator Test Data

Incoming Test (A/R)

Item	1st Pass	2nd Pass	3rd Pass

Final Test

Item	1st Pass	2nd Pass	3rd Pass

Concentrator Burn In Data

Final Test

Step	Item	1st Pass	2nd Pass	3rd Pass

Additional Information
Comments (optional)

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The Inogen^® portable oxygen concentrators are available by prescription only. For safe and proper use of the Inogen^® devices, please refer to https://www.inogen.com/support/inogen-manuals/

Inogen, Inc.
859 Ward Drive, Suite 200, Goleta, CA 93111

IO Field Service Repair Traveler

Version and Life Clock Information

Details

ASTERISKED ITEMS BELOW MUST BE RETURNED TO INOGEN

Concentrator Test Data

Concentrator Burn In Data

Additional Information

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Company

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