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Inspection/Preventive Maintenance / Calibration Report

of Cardiac Monitor

Department: _____________________________ Equipment Name:


__________________________

Supplier: ________________________________ Make________________ Model


No_____________

Serial No/ ID No.__________________________ Date of


installation__________________________

Marked
to:_____________________________Signature:____________________________________

Description Y/N Remarks

1. Power Circuits and Start-up


1.1 Power ON/OFF
1.2 Power-Up Sequence
1.3 Monitor Powered From External Source
2. Rotary Knob
3. LCD Display
4. Fixed Keys
4.1 ON/OFF Key
4.2 Main Screen Key
4.3 Alarm Silence Key
4.4 Alarm Limits Key
4.5 All Alarms Off Key
4.6.Code Key
4.7 Record Key
4.8 Print Screen Key
4.9 NBP Start/Stop Key
4.10 Zoom Key
4.11 Help Key
4.12 Mark Key
5. ECG/RESP Functions
5.1 ECG/RESP Test Setup
5.2 Waveforms/Digital Readouts/Tones
5.3 Pacer Detection
5.4 Lead-Off Indicators
5.5 Alarm Function
5.6 Asystole
6. SpO2 Function
6.1 SpO2 Test Setup
6.2 Waveforms/Digital Readouts/Tones
6.3 Pulse Tone Generator
6.4 SpO2 Limits Alarms
Description Y/N Remarks

7. Temperature Function
7.1 Temperature Test Setup
7.2 Digital Readout
7.3 Temperature Calibration Check (see
attached table 4.2.1)
8. Non-Invasive Blood Pressure Function
NBP Calibration check (see attached table
8.1.1)
8.1 System Setup and Pneumatics Leakage Test
8.2 Calibration Check
8.3 NBP calibration procedure
8.4 Hardware Overpressure
8.5 Pump
8.6 Interval Mode
8.7 Safety Timer
9. IBP Test
10. C.O Test (BT and TI, G-40 only)
11. etCO2 Function
12. Memory Backup Function
13. CPS/IDS Mode
14. Direct Net Mode (requires
VC2-level installed software)
15. Networking Test
16. Electrical safety test
16.1 system enclosure leakage
16.2. protective earth continuity
16.3 patient leakage current with mains voltage
17. Battery Charger Circuit
18. Recorder Function
19. Speaker Test

Biomedical Technician:
_______________________________________________________________

User Name: ________________User Remarks: ________________________ Signature:


__________

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