Installation Oxygen Concentrator

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INSTALLATION/SERVICE REPORT

HOSPITAL/CLINIC: ____________________________________ DATE: ____________________


ADDRESS: ____________________________________________ DEVICE TYPE: ____________________
LOCATION OF DEVICE: _______________________ MODEL/SERIAL#: ____________________
MANUFACTURER: ___________________________

Date responded: ________________

Testing/checked Flowrate Control Indicator light/LED, Control buttons

Testing/checked Pressure Safety Valve Performed Alarm Test

Testing/checked Overload Protection Checked All the Sensors/Detectors

LCD, Filter, Accessories Cleaning, disinfection, and sterilization


(power cord cable & fuse.

The Oxygen concentrator is in good working condition: YES __ N0__


Follow-up work necessary : YES __ N0__

Follow-up action/Recommendation________________________________________________
_____________________________________________________________________________

Performed by: Noted by:


____________________________ ____________________________
Service Engineer End use

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