INSTITUTE OF HEALTH OF THE STATE OF

MEXICO

PREVENTIVE MAINTENANCE LOG/DIAGNOSTIC CASE NON-INVENTORY:

Head of the Medical Unit :________________________________________________________________
Health Jurisdiction:_____________________________________________________ Medical unit:

OTOSCOPE OPHTHALMOSCOPE PHARYNGOSCOPE

Q either
2 >
WORKS WORKS WORKS AND and you
DATE BATTERY CHANGE NAME AND SIGNATURE OF WHO VERIFIES
YEAH NO YEAH NO 22 5n

OBSERVATIONS:

GRADES:
or
PREVENTIVE AND CORRECTIVE MAINTENANCE WILL BE COMPLETED:

YES: IF IT WAS DONE IF YOU REQUIRE CORRECTIVENESS: NOTE THE REPORT NUMBER ACCORDING TO YOUR RECORD
NO: NOT REQUIRED
NA.: NOT APPLICABLE
 INSTITUTE OF HEALTH OF THE STATE OF
PREVENTIVE MAINTENANCE LOG / CHICOTE LAMP MEXICO

NON-INVENTORY:

Health Jurisdiction: Medical unit:

Head of the Medical Unit: Mont

h:

HELLO GOOD
WORKS CONDITIONS

DATE YEAH NO YEAH NO NAME AND SIGNATURE OF THE PERSON NAME AND SIGNATURE OF WHO VERIFIES
PERFORMING

OBSERVATIONS:

GRADES:
or
THE PREVENTIVE AND CORRECTIVE MAINTENANCE FILLING WILL BE FILLED:
IF YOU REQUIRE CORRECTIVENESS: NOTE THE REPORT NUMBER ACCORDING TO YOUR RECORD

YES: IF IT WAS DONE

NO: NOT REQUIRED
NA.: NOT APPLICABLE
 INSTITUTE OF HEALTH OF THE STATE OF
MEXICO

PREVENTIVE MAINTENANCE LOG/SPHIGMOMANOMETER NON-INVENTORY:

Health Jurisdiction: Medical unit:_________________________________

Head of the Medical Unit: Mont

h:
either either
2 2
either 2EE
HELLO GOOD “ 2 AND 2
GUY WORKS CONDITIONS 4 5 9 2 AND
• EITHER Yes 8 K 9
523 $ 8 8°
DATE YEAH NO YEAH NO YEAH NO Yes Yes AND 2 Yes 2 AND NAME AND SIGNATURE OF THE NAME AND SIGNATURE OF WHO
PERSON PERFORMING VERIFIES

OBSERVATIONS:

GRADES:
or
THE PREVENTIVE AND CORRECTIVE MAINTENANCE FILLING WILL BE FILLED:
YES: IF IT WAS DONE IF CORRECTIVE IS REQUIRED: NOTE REPORT NUMBER ACCORDING TO YOUR RECORD
NO: NOT REQUIRED
 INSTITUTE OF HEALTH OF THE STATE OF
NA.: NOT APPLICABLE PREVENTIVE MAINTENANCE LOG / AUTOCLAVE MEXICO
 INSTITUTE OF HEALTH OF THE STATE OF
MEXICO
NON-
INVENTORY:
Health Jurisdiction: Medical unit:

HERMETIC SEALING
Head of the Medical Unit: Month:

EX Qe
either either
WORKS GOOD PEGS CLEAN
E
Z
X
A
TE
I
R
N
N
TE
A
RNA Y
$89 2 >
3Q z 5
2 #€
to It
DATE YEAH NO YEAH NO YEAH NO YEAH NO YEAH NO g“ 8°

OBSERVATIONS:

GRADES:

THE PREVENTIVE AND CORRECTIVE MAINTENANCE FILLING WILL BE FILLED:

YES: IF IT WAS DONE IF YOU REQUIRE CORRECTIVENESS: NOTE THE REPORT NUMBER ACCORDING TO YOUR RECORD
NO: NOT REQUIRED
NA.: NOT APPLICABLE
 INSTITUTE OF HEALTH OF THE STATE OF
PREVENTIVE MAINTENANCE LOG / AUTOCLAVE MEXICO

PREVENTIVE MAINTENANCE LOG /PHONE DETECTOR NON-

INVENTORY:
Health Jurisdiction: Medical unit:

Head of the Medical Unit: Month:

tn or >
28 z
WORKS 20 D 2
•m2 g or 2
z
8 or EIT
<q eith 5
2
•L
HER 0 <z
er
LU E & a:
E or
<a • cc OH either 5 • • to
DATE
• < 2CL
EITHER YEAH NO YEAH NO $<
<• <H e□i-• 2 • • 5 F NAME AND SIGNATURE OF THE PERSON NAME AND SIGNATURE OF WHO VERIFIES
PERFORMING
OBSERVATIONS:

GRADES:
or
THE PREVENTIVE AND CORRECTIVE MAINTENANCE FILLING WILL BE FILLED:

IF YOU REQUIRE CORRECTIVENESS: NOTE THE REPORT NUMBER ACCORDING TO YOUR RECORD
YES: IF IT WAS DONE
NO: NOT REQUIRED
NA.: NOT APPLICABLE
 INSTITUTE OF HEALTH OF THE STATE OF
PREVENTIVE MAINTENANCE LOG / DOUBLE CAPSULE STETHOSCOPE MEXICO NON-INVENTORY:

Health Jurisdiction: Medical unit:__________________________________

Head of the Medical Unit: Mont

h:

NAME AND SIGNATURE OF THE NAME AND SIGNATURE OF WHO

PERSON PERFORMING VERIFIES

OBSERVATIONS:

GRADE
S:

THE PREVENTIVE AND CORRECTIVE MAINTENANCE FILLING WILL BE

FILLED:
YES: IF IT WAS DONE IF YOU REQUIRE CORRECTIVENESS: NOTE THE REPORT NUMBER ACCORDING TO YOUR
NO: NOT REQUIRED RECORD
NA.: NOT APPLICABLE
 INSTITUTE OF HEALTH OF THE STATE OF
PREVENTIVE MAINTENANCE LOG / WATER DISTILLER MEXICO NON-INVENTORY:
Health Jurisdiction: Medical unit:

Head of the Medical Unit: Month:

either either
B U E N A S
WORKS CO N D IC I O NES CLEANING
§ w§
M l
either
l .n =u
8 EITHER 3 NAME AND SIGNATURE OF THE PERSON PERFORMING NAME AND SIGNATURE OF WHO VERIFIES
DATE YEAH NO YEAH NO YEAH NO S2E
OBSERVATIONS:

GRADES:
or
THE PREVENTIVE AND CORRECTIVE MAINTENANCE FILLING WILL BE FILLED:

YES: IF IT WAS DONE IF CORRECTIVE IS REQUIRED: NOTE THE REPORT NUMBER ACCORDING TO YOUR RECORD
NO: NOT REQUIRED
NA.: NOT APPLICABLE
 FROM MEXICO INSTITUTE OF HEALTH OF THE STATE OF MEXICO EDDAEX
PREVENTIVE MAINTENANCE LOG / NON-INVENTORY NEGATOSCOPE :
Health Jurisdiction: Medical unit:
Head of the Medical Unit: Month:

CORRECTIVE
WORKS GOOD CONDITION CLEANING 2

REQUIRES
AND
either
YEAH NO YEAH NO YEAH NO LLI 5
m NAME AND SIGNATURE OF THE PERSON
DATE Yes PERFORMING NAME AND SIGNATURE OF WHO VERIFIES

OBSERVATIONS:

GRADES:
or
THE PREVENTIVE AND CORRECTIVE MAINTENANCE FILLING WILL BE FILLED:
YES: IF IT WAS DONE IF CORRECTIVE IS REQUIRED: NOTE THE REPORT NUMBER ACCORDING TO YOUR RECORD
NO: NOT REQUIRED
NA.: NOT APPLICABLE
 INSTITUTE OF HEALTH OF THE STATE OF
PREVENTIVE MAINTENANCE LOG / 2 M FLEXIBLE TAPE MEASURE. MEXICO
NON-INVENTORY:

Health Jurisdiction: Medical unit:

Head of the Medical Unit: Mont

h:

1
B U E N A S
WORKS CO N D IC I O NES CLEANING
Yes

DATE YEAH NO YEAH NO YEAH NO 8 NAME AND SIGNATURE OF THE PERSON NAME AND SIGNATURE OF WHO VERIFIES
PERFORMING

OBSERVATIONS:

GRADES:
or
THE PREVENTIVE AND CORRECTIVE MAINTENANCE FILLING WILL BE FILLED:

YES: IF IT WAS DONE IF CORRECTIVE IS REQUIRED: NOTE REPORT NUMBER ACCORDING TO YOUR RECORD
NO: NOT REQUIRED
NA.: NOT APPLICABLE
 INSTITUTE OF HEALTH OF THE STATE OF MEXICO EDOAEX
PREVENTIVE MAINTENANCE LOG / GLUCOMETER
NON-INVENTORY:
Health Jurisdiction: Medical unit:
Head of the Medical Unit: Month:

CORRECTIVE
GOOD CONDITION
2

REQUIRES
BATTERY
WORKS CLEANING g
YEAH NO either
5
NAME AND SIGNATURE OF THE PERSON
DATE YEAH NO YEAH NO PERFORMING NAME AND SIGNATURE OF WHO VERIFIES

OBSERVATIONS:

GRADES:
or
THE PREVENTIVE AND CORRECTIVE MAINTENANCE FILLING WILL BE FILLED:
YES: IF IT WAS DONE IF CORRECTIVE IS REQUIRED: NOTE REPORT NUMBER ACCORDING TO YOUR RECORD
NO: NOT REQUIRED
NA.: NOT APPLICABLE
 Health Jurisdiction: Medical unit:
INSTITUTE OF HEALTH OF THE STATE OF
Head of the Medical Unit: MEXICO
PREVENTIVE MAINTENANCE LOG / THERMOMETER Month:

>>
B U E N AS
WORKS CO N D IC IO NES CLEANING
> LU E
LU g eg
DATE YEAH NO YEAH NO YEAH NO R E or
8 2 7
5 AND NAME AND SIGNATURE OF THE PERSON PERFORMING NAME AND SIGNATURE OF WHO VERIFIES

OBSERVATIONS:

NON-INVENTORY:

GRADES:
or
THE PREVENTIVE AND CORRECTIVE MAINTENANCE FILLING WILL BE FILLED:

YES: IF IT WAS DONE IF CORRECTIVE IS REQUIRED: NOTE THE REPORT NUMBER ACCORDING TO YOUR RECORD
NO: NOT REQUIRED
NA.: NOT APPLICABLE
 PREVENTIVE MAINTENANCE ITACORA / SCALE WITH NON-INVENTORY STATIMETER :
INSTITUTE OF HEALTH OF THE STATE OF
Health Jurisdiction: MEXICO
Head of the MedicalPREVENTIVE
Unit: MAINTENANCE LOG / THERMOMETER Medical unit:
Month:
9 §
2 UJ
HELLO GOOD 5 YOU
WORKS CONDITIONS CLEANING
g eg
CT UJ O
YEAH NO YEAH NO YEAH NO 8 EITHER'
DATE 5 8 NAMEANDSIGNATURE OF WHO MAKESNAMEANDSIGNATURE OF
WHO VERIFY

OBSERVATIONS:

GRADES:
or
THE PREVENTIVE AND CORRECTIVE MAINTENANCE FILLING WILL BE FILLED:

YES: IF IT WAS DONE IF CORRECTIVE IS REQUIRED: NOTE REPORT NUMBER ACCORDING TO YOUR RECORD
NO: NOT REQUIRED
NA.: NOT APPLICABLE
 INSTITUTE OF HEALTH OF THE STATE OF
PREVENTIVE MAINTENANCE LOG / BABY WEIGHT SCALE MEXICO

NON-INVENTORY:
Health Jurisdiction: Medical unit:
Head of the Medical Unit: Mont
h:
GOOD
WORKS CONDITION CLEANING

DATE NAME AND SIGNATURE OF THE NAME AND SIGNATURE OF WHO

PERSON PERFORMING VERIFIES

OBSERVATIONS:

GRADES:
or
THE PREVENTIVE AND CORRECTIVE MAINTENANCE FILLING WILL BE FILLED:

YES: IF IT WAS DONE IF CORRECTIVE IS REQUIRED: NOTE REPORT NUMBER ACCORDING TO YOUR RECORD
NO: NOT REQUIRED
NA.: NOT APPLICABLE
 HEALTH INSTITUTE OF THE STATE OF MEXICO

—m A i" and
. ESRADODE MEXICO CISTERN AND TANK
MAINTENANCE LOG
MEXICO STATE
/L7-7. E—-A*h
Jurisdiction: Medical unit
Year:
JANUARY FEBRUARY MARCH APRIL MAY JUNE JULY AUGUST SEPTEMBER OCTOBER NOVEMBER DECEMBER

and

the

filling
urge,

b b
Observations:
Mark with an X the actions carried out each month
pH: _______________________ Record pH level:
ppm Cl: ___________________ Record chlorine concentration
__________________________ NA : Register in case this action does not apply:
JURISDICTION: MEDICAL UNIT:
LOGGING OF LIGHTS, CONTACTS AND SWITCHES (15 DAYS)
DATE:
No. DATE ACTIVITY STATE OUT OF SIGNATURE
SERVICE

AREA
1 VISUAL EXAM
2 SWITCH OFF CHECK
3 CONNECTION SOCKET CHECK
4 VOLTAGE CHECK
NUMBER OF SPOTLIGHTS
AREA
1 VISUAL EXAM
2 SWITCH OFF CHECK
3 CONNECTION SOCKET CHECK
4 VOLTAGE CHECK

AREA
1 VISUAL EXAM
2 BOARD AMPERAGE CHECK
3 BOARD VOLTAGE CHECK
4 CIRCUIT REVIEW

AREA
1 VISUAL EXAM
2 BOARD AMPERAGE CHECK
3 BOARD VOLTAGE CHECK
4 CIRCUIT REVIEW
5 POWER CABLES

AREA
1 VISUAL EXAM
2 BOARD AMPERAGE CHECK
3 BOARD VOLTAGE CHECK
4 CIRCUIT REVIEW
5 POWER CABLES
Made______________________________ verified_____________________________
 Corrective Maintenance Log
1/ JURISDICTION : 2/
MONTH
3/ MEDICAL UNIT/ HOSPITAL: 4/ DATE :

6/ EQUIPMENT FAULT REPORT : 5/ No. REPORTING :

NAME AND INVENTORY NUMBER OF THE BREAKDOWN
EQUIPMENT

FAULT DESCRIPTION

NAME OF THE PERSON TO WHOM THE FAILURE IS

REPORTED

7/ DATE OF REPAIR:
EQUIPMENT MAINTENANCE REPORT:

COMPANY NAME

NAME OF THE PERSON RESPONSIBLE FOR THE REPAIR

DESCRIPTION OF THE REPAIR PERFORMED

OBSERVATIONS (INDICATE IF IT WAS COMPLETELY

REPAIRED)

NOTE : IF THE EQUIPMENT HAS LEFT THE UNIT, PLEASE ATTACH RECORD OR REPORT FROM THE COMPANY
RESPONSIBLE DENTISTRY STAFF RESPONSIBLE PERSONNEL OF THE APPLICATION UNIT
8/ NAME AND SIGNATURE 9/ NAME AND
208C0101100000L-450-20 SIGNATURE
INSTRUCTIONS TO FILL OUT THE FORM : CORRECTIVE MAINTENANCE LOG

Aim:
Attend and correct unexpected equipment stoppages and failures efficiently and promptly to minimize unproductive time. Verify repairs
scheduled in advance and leave a record of the activities carried out by specialized technicians.

Distribution and Recipient:

Dentistry regulatory area responsible for the concentration of information.

No. CONCEPT DESCRIPTION

1 NAME OF THE JURISDICTION Write down the name of the jurisdiction to which the medical unit in which the form is prepared
corresponds.
2 MONTH Write down the month it belongs to.
3 MEDICAL UNIT / HOSPITAL Register the name of the Health Unit.
4 DATE Record the day, month and year in which the equipment failure report is made.
5 REPORT NUMBER Enter the consecutive number of the report prepared in the year.
Name and Inventory Number of the Broken Equipment: Record the name of the equipment and
the Number with which it is inventoried.
Fault Description: Brief description and what the fault consists of.
Name of the Person to whom the Failure is Reported: Write down the Full Name, Paternal and
FAULT REPORT IN Maternal Surname, as well as the position of the person to whom the failure is reported and submit a
6 copy of this form.
EQUIPMENT
Repair Date: Record the day, month and year in which the equipment repair was carried out.

EQUIPMENT CORRECTIVE
7 equipment should leave the Application Unit, Health Center, CEAPS, Hospital, etc., if a receipt and
MAINTENANCE REPORT
Company Name: Register the name of the company that carries out the repair. (Business name).
Name of the Person Responsible for the Repair: Register Full name of the Technician who
repaired the failure.
Description of the Repair Made: Brief description and what the repair consists of.
Observations Indicate if it was repaired in its entirety: It will be noted whether the equipment
was repaired in its entirety or if it is a partial repair and why.
NOTE: If the equipment has left the Unit, please attach a receipt and report from the company (No
report are not prepared. the company correctly requested).

NAME AND SIGNATURE OF THE Write down the Full Name, Paternal Surname and Maternal Surname of the Head of Dentistry.
8 RESPONSIBLE DENTISTRY STAFF

NAME AND SIGNATURE OF THE

PERSONNEL RESPONSIBLE FOR THE
9 Write down the Full Name of the person responsible for the Application Unit.
APPLICATION UNIT
 GOVERNMENT OF THE STATE OF
EXICO
1/ JURISDICTION: 2/
Log of Preventive Maintenance Activities of the Dental Office MONT
3/ MEDICAL UNIT / HOSPITAL:
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
Autoclave/sterilizer

CLEANING STERILIZER (INTERIOR)

CLEAN THE INTERNAL PARTS OF THE AUTOCLAVE
CLEAN THE EXTERNAL PARTS OF THE AUTOCLAVE
SIGNATURE OF THE SERVICE
RESPONSIBLE

CLEANING AND LUBRICATING HIGH SPEED HAND PIECE

CLEANING AND LUBRICATION OF LOW SPEED HANDPIECE
TRIPLE SYRINGE CLEANING
DENTAL LIGHT LAMP CLEANING
SPOTTOON CLEANING
CLEANING AND PURGE OF THE EJECTOR
DENTAL CHAIR CLEANING
ELECTRICAL INSTALLATION REVIEW
REVIEW OF WATER AND AIR INSTALLATIONS
AMALGAMADOR CLEANING
SIGNATURE OF THE SERVICE
RESPONSIBLE
7/ X-RAYS
CLEANING THE X-RAY DEVICE
CLEANING THE DEVELOPMENT BOX
CHECK PLUG, CABLE AND CONNECTIONS OF THE RAY DEVICE
SIGNATURE OF THE
RESPONSIBLE
8/ COMPRESSOR

CHECK CLEANLINESS OF THE COMPRESSOR AREA

PURGE COMPRESSOR
CHECK DOOR AND LOCK OF THE NICHE
CHECK PLUG, CONNECTION CABLE
SIGNATURE OF THE SERVICE
RESPONSIBLE
SIGNATURE OF THE HEAD OF THE UNIT
DENTIST RESPONSIBLE FOR THE SERVICE UNIT MANAGER
9/ NAME AND SIGNATURE NAME AND SIGNATURE

208C0101100000L-448-20
INSTRUCTIONS TO FILL OUT THE FORM:
LOG OF PREVENTIVE MAINTENANCE ACTIVITIES OF THE DENTAL OFFICE
Aim:
Carrying out the actions implicit in the log helps us prevent premature wear of vital parts in the unit's dental equipment. Ensuring a long useful
life of the installation as a whole.
Meet a certain reliability value.

Distribution and Recipient:

Dentistry regulatory area responsible for the concentration of information.

No. CONCEPT DESCRIPTION

1 NAME OF THE Write down the name of the jurisdiction to which the medical unit in which the form is prepared corresponds.
JURISDICTION
2 MONTH Note the month in which the format is generated.
NAME OF
3 MEDICAL UNIT / Write down the name of the medical unit in which the form is prepared.
HOSPITAL
4 MAINTENANCE Mark with a ( ) the activities carried out during the day, and those that are not carried out place an (
Sterilizer Cleaning (Interior): Clean with a clean damp cloth at the end of the work day.
Cleaning the Internal Parts of the Autoclave: Clean with a clean damp cloth, at the end of the working day,
wash the trays as well as the tray holder with soap and water and dry them with a clean dry cloth. Cleaning the
AUTOCLAVE OR external parts of the autoclave: Clean with a clean damp cloth at the end of the working day.
5 Signature of the person responsible: Write down the Signature of the Person Responsible for the Activity.
STERILIZER

1 .-Cleaning and Lubrication of Low and High Speed Handpiece (Autoclavable):

a) Flush the Handpiece with running water for 20 to 30 seconds in a container, spittoon, sink, or absorbent
material.
b) Clean the surface of visible dirt.
c) Sterilize following the manufacturer's instructions.
d) Lubricate after the sterilization and cooling process, with a specific lubricant for sterilized handpieces, wipe
off excess oil.
e) After purging the water line, place the high speed piece and bleed the excess air for 20 to 30 seconds.
2 .- Triple Syringe Cleaning: Purge before directing it to the patient's mouth, activating the water and
air.
3 .- Cleaning the Photocuring Dental Light Lamp and its Fiber Optic: Insulate (vinyl-type plastic,
PVC, aluminum foil) to the handle of the lamp, apply an intermediate level disinfectant (70% ethyl alcohol,
phenols, products containing chlorine).
4.- Spittoon Cleaning: Disinfect at the beginning of the day and after each patient, clean with water and
detergent, eliminate all types of waste that may accumulate and use chemical disinfectants such as 1% sodium
hypochlorite by running water.
5 .- Cleaning and Purge of the Ejector: Washing the internal filters, using disinfectant solution, daily
EQUIPMENT AND and after blood suction, removing the cover and the filter with the help of tweezers, wash the filters with
6
DENTAL OFFICE running water, replace them , carry out disinfection through aspiration of disinfectant chemicals.
6.- Cleaning the Dental Chair: Insulate (vinyl-type plastic, PVC, aluminum foil) at the headboard, armrests, or
apply an intermediate level disinfectant (70% ethyl alcohol, phenols, products containing chlorine).
7 .- Electrical Installation Review: Do not use electrical extensions or multiple contacts in a single
contact.
8.- Review of Water and Air Installations: The hydraulic installation must be complemented with a flush system
for that used in the triple syringe and in the handpieces, the compressor must be free of oil, purged daily at the
end of the workday, through the equipment's sediment depressurization valve.
Signature of the Person Responsible: Write down the Signature of the Person Responsible for the Activity.

1.- Cleaning the chlorine).

2.- Cleaning the Development Box: Apply an intermediate level disinfectant (70% ethyl alcohol, phenols,
products containing chlorine).
3.- Check Plug, Cable and Connection of the X-ray Device: Do not use electrical extensions or multiple contacts
in a single contact.
7 X-RAYS Signature of the Person Responsible: Write down the Signature of the Person Responsible for the Activity.

1.- Check Cleaning of the Compressor Area: Sweep the Niche every three days to eliminate the accumulation of
dust and garbage.
2.- Purge Compressor: Purge at the end of each work day.
3.- Check Niche Door and Lock: The door has ventilation to avoid overheating of the motor, the lock is in good
condition to protect the equipment.
4.- Check Plug, Cable and Connection: Do not use electrical extensions or multiple contacts in a single contact.
8 COMPRESSOR
The air compressor must be oil-free with filters and condensate drain for basic dentistry unit, with automatic
start and stop.
Signature of the Person Responsible: Write down the Signature of the Person Responsible for the Activity.

DENTIST
9 RESPONSIBLE FOR Write down the full name and signature of the Dentistry staff responsible for the Service.
THE SERVICE
MONITORING FORMAT (FIELD SHEET) STATE K
OF MEXICO
MEXICO STATE

MEDICAL UNIT DATE:

LOCATION:
OPERATING AGENCY:
MONITORING SITE FREE RESIDUAL CHLORINE mg/l
0 < 0.2 0.2 TO 1.5 > 1.5 OUT OF
CHLORINE WITHIN STANDARD WITHOUT
No. LOCATION HOUR
FREE STANDARD WATER

TOTAL:
OBSERVATION
=f-----------------------------------------------------------------------------------------------------------------------------------------------------------------
NAME AND SIGNATURE OF THE MONITOR
217B40000-004-07
 JURISDICTION: MEDICAL UNIT:
HYDROSANITARY SYSTEMS LOG (15 DAYS)
DATE:
No. DATE ACTIVITY STATE PROBLEMS OF OUT OF SIGNATU
FUNCTIONING SERVICE RE

AREA
1 REVIEW OF LEAKS IN TOILET
HARDWARE
2 REVIEW OF CORRECT TOILET
FLUSH

3 CHECK FOR LEAKS IN COFLEX

4 CHECK FOR LEAKS IN SINK
MIXERS AND SINKS

5 VERIFY THAT THE CESPOL DOES

NOT PRESENT LEAKS AND IS
CORRECT
DOWNLOAD
6 CHECK THAT THERE ARE NO
LEAKS IN THE HANDLES
(WATERING CAN)

7 CHECK FOR CORRECT DOWNLOAD

IN THE BOAT BASKET

8 CHECKING AND CLEANING THE

WATERING CAN
9 GENERAL PIPE REVIEW

AREA
1 REVIEW OF LEAKS IN TOILET
HARDWARE

2 REVIEW OF CORRECT TOILET

FLUSH

3 CHECK FOR LEAKS IN COFLEX

4 CHECK FOR LEAKS IN SINK
MIXERS AND SINKS

5 VERIFY THAT THE CESPOL DOES

NOT PRESENT LEAKS AND IS
CORRECT
DOWNLOAD
6 CHECK THAT THERE ARE NO
LEAKS IN THE HANDLES
(WATERING CAN)
7 REVIEW OF CORRECT DOWNLOAD
IN THE CESPOL OF
BOAT

8 CHECKING AND CLEANING THE

WATERING CAN
9 GENERAL PIPE REVIEW
UNIT:
DEPARTMENT: PLACE:

CITY : Start of Service End of

service
service

MAINTENANCE PROGRAM FOR EMERGENCY PLANT sheet 1 of 2

MAINTENANCE PROGRAM FOR EMERGENCY PLANT sheet 2 of 2
MONTH YEAR MONTHLY OPERATION AND CONSERVATION ACTIVITIES
MONTH YEAR MONTHLY OPERATION AND CONSERVATION ACTIVITIES
ACTIVITY
ACTIVITY
1 REVIEW AND NOTE NUMBER OF HOURS OF OPERATION
10 CLEAN THE AIR PURIFIER
2 CHECK AND CORRECT ENGINE OIL LEVEL
11 WASH THE RADIATOR CAP WITH PRESSURE WATER
3 CHECK AND/OR CORRECT OIL LEAKS
12 CHECK THAT THE RADIATOR HAS NO LEAKS
4 CHECK AND/OR CORRECT WATER LEAKS
13 CHECK,ADJUST,ALIGN AND TENSION FAN BANDS
5 CHECK AND/OR CORRECT FUEL LEAKS
14 ADD DISTILLED WATER TO THE ACCUMULATOR UP TO ITS LEVEL (5 mm ABOVE THE
6 PLATES) CORRECT LEVEL IN THE FUEL TANK
715 CHECK AND
CHECK ANDCORRECT OIL LEVEL
PURGE SEDIMENT IN THE
FROM INJECTION
THE PUMP
FUEL TANK
816 CORRECT LEVEL IN THE COOLING SYSTEM
9 CLEAN THE FUEL TANK BY OPENING
CORRECT THE
AIR PURGE VALVE,
PURIFICATION OILUNTIL
LEVELIMPURITIES LEAVE

MADE SUPERVISE
MADE D SUPERVISED