RSUD MUNYANG KUTE

IPS-RS CHECK LIST PREVENTIVE REDELONG

RSUD MKR MAINTENANCE KABUPATEN BENER MERIAH

Equipment : Autoclave N. Invent :

Sub-Unit :
Brand : Building :
Model /Type : Room :
Serial N. : Interval Maint :
Year : 2019
CHECK LIST MAINTENANCE
1 2
OK Not OK OK Not OK

SAFETY CHECK
1 Cek Tahanan Ground **)  
2 Cek Kebocoran Arus Ground Pada Kondisi Normal **)  
MAINTENANCE
1 Periksa Tegangan Listrik  
2 Periksa Kabel Kelistrikan  
3. Periksa Dan Ukur Heather Pemanas  
4 Periksa Fungsi Parameter Pada Autoclave  
5 Periksa Tutup Autoclave  
6 Periksa Pembuangan Air  
7 Periksa Selang Pembuangan Air, Ganti Bila Perlu  
8 Periksa Kebersihan Alat  
9 Uji Kinerja Alat  
 
 
 
 
 

PERFORM DATE (Tanggal Melakukan)

EXECUTION TIME (Waktu Eksekusi)
(PPM STANDARD TIME Hrs.)
TECHNICIAN NAME AND SIGNATURE
(Nama dan Tanda Tangan Teknisi)
USER NAME AND SIGNATURE
(Nama Pengguna dan Tanda Tangan)
OBSERVATIONS (Pengamatan) :
1. ...............................................................................................................................................................
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2. ...............................................................................................................................................................
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3. ...............................................................................................................................................................
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 ELECTRICAL SAFETY EVALUATION
(For equipment class I)

No Measure
Measure step Norm unity 1 2
MONITOR
1 Mains Voltage 22010% Volts
2 Power -----* VA
3 Ground Leakage Current ≤ 500 µA
3.1 Single fault condition (Open feed line) ≤ 1000 µA
4 Insulated Resistance between line conductors to ground 2 M
5 Ground Resistance ≤ 0.2 

Changeable Material Minimum Spare parts Tools and Measuring Equipments

Surface cleaner, Lens cleaner Fuse Multimeter

Contact cleaner, Grease Standard Service Tools
Flannel / tissue, Brush Electrical Safety Analyzer/
Portable Vacuum Cleaner

OBSERVATIONS

1.

2.

RECOMMENDATION 1 2
The equipment has no problems. Result of safety test showed no deviation from the required
reference values  
The equipment has minor problems that do restrict its use. However they should be corrected as the
preventive measure. Result of safety test showed no deviation from the required reference values  
The equipment has major problems. For safety reasons, the equipment may not be used until the
problem has been resolved.  

* In the equipment evaluation it must not exceed a consume power of 3.5KW.