SAFETY FORM 5802b - Preventive Maintenance Log - BC 20s

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BC 20s PREVENTIVE MAINTENANCE LOG

Month/Year: ___________________________

Day of Use 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Check waste container
Check tubing
Check Recorder paper
Instrument
background pass?
Initials

AS NEEDED Date Performed Performed by


WBC bath
RBC bath
Overall Soak
Clear aperture
WBC bath cleaning
RBC bath cleaning
Fluidics reset
Fluidics pack-up

Write below any issue/s with the equipment and corrective action taken
Date Issue Correction Documented by

Reviewed By/Date: __________________________________________________________________________

SAFETY FORM 5802b Preventive Maintenance Log – BC-20s

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