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Check List/Test Reports Of Syringe Pump

Merk

No.Order

Type

Ruang Alat

S/N

Tempat PPM

A. Main Unit
No

Descriptions

Results

1.

Chasis/Housing

Pass

Fail

NA

2.

Mount/Fasteners

Pass

Fail

NA

3.

Circuit Breakers/Fuse

Pass

Fail

NA

4.

Fittings/Connectors

Pass

Fail

NA

5.

Controls/Switches

Pass

Fail

NA

6.

Indicators/Displays

Pass

Fail

NA

7.

Audiable Signals

Pass

Fail

NA

8.

Alarms

Pass

Fail

NA

9.

Charging Systems

Pass

Fail

NA

10. Back Up Battery Powered

Pass

Fail

NA

11. Flow Stop Mechanism

Pass

Fail

NA

12. Occlusion

Pass

Fail

NA

13. Plungger Mechanism/Misloaded Syringe Set

Pass

Fail

NA

14. Labeling

Pass

Fail

NA

B. Accessories
No

Descriptions

Results

Quantity

1.

Power Cable

Pass

Fail

NA

pc

2.

Clamp Hanger

Pass

Fail

NA

pc

3.

S O P /Manual Book

Pass

Fail

NA

pc

4.

Pass

Fail

NA

pc

5.

Pass

Fail

NA

pc

Date
Start Time
End Time

Customer

create by sigit trijananto

CL/V-02/IV/14.Rev.1

Checked By,

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