Check List/Test Reports Of Syringe Pump

Merk No.Order

Type Ruang Alat

S/N Tempat PPM

A. Main Unit

No Descriptions Results

1. Chasis/Housing Pass Fail NA

2. Mount/Fasteners Pass Fail NA

3. Circuit Breakers/Fuse Pass Fail NA

4. Fittings/Connectors Pass Fail NA

5. Controls/Switches Pass Fail NA
6. Indicators/Displays Pass Fail NA
7. Audiable Signals Pass Fail NA

8. Alarms Pass Fail NA

9. Charging Systems Pass Fail NA

10. Back Up Battery Powered Pass Fail NA

11. Flow Stop Mechanism Pass Fail NA

12. Occlusion Pass Fail NA

13. Plungger Mechanism/Misloaded Syringe Set Pass Fail NA

14. Labeling Pass Fail NA

B. Accessories

No Descriptions Results Quantity

1. Power Cable Pass Fail NA pc

2. Clamp Hanger Pass Fail NA pc

3. S O P /Manual Book Pass Fail NA pc

4. Pass Fail NA pc

5. Pass Fail NA pc

Date Customer Checked By,

Start Time
End Time

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