VINCENT MEDICAL INSPIRED O2 FLO - OPERATIONAL VERIFICATION PROCEDURE

Equipment Type Customer Test Date

Manufacturer Group Certificate No

Model Location Job Card No

Type Serial No SAFE FOR PATIENT USE Y N

VINCENT MEDICAL INSPIRED O2 FLO - OPERATIONAL VERIFICATION PROCEDURE

VISUAL INSPECTION

Test Description Pass / Yes Fail / No N/A Value Actual Value Notes

General Device Condition -

Housing and Outer Bezel -

LCD Screen / Display / Back light -

QA and Next Service Decal Attached -

Date and Time Set -

Filter Cover -

Oxygen Inlet Port -

Chamber Lock -

Heater Plate -

Heater and Temperature Socket -

START UP / SELF-TEST

Test Description Pass / Yes Fail / No N/A Value Actual Value Notes

Software Ver

Self Test -

Status LED -

Control Knob -

Power / Standby Button -

Start / Pause Button -

LCD Display function -

FUNCTIONAL TEST - PATIENT, OUTLET, AMBIENT TEMPERATURE TEST

Test Description Pass / Yes Fail / No N/A Value Actual Value Notes

Patient Temp, Outlet Temp and Ambient Temp 00.0 C No Probes connected

Temperature correction plug - 2.2K +/- 1% 25.5 C +/- 1 C Patient Temp

Temperature correction plug - 2.2K +/- 1% 25.5 C +/- 1 C Outlet Temp

Temperature correction plug - 2.2K +/- 1% 25.5 C +/- 1 C Ambient Temp

Temperature correction plug - 1K +/- 1% 44.5 C +/- 1 C Patient Temp

Temperature correction plug - 1K +/- 1% 44.5 C +/- 1 C Outlet Temp

Temperature correction plug - 1K +/- 1% 44.5 C +/- 1 C Ambient Temp

Temperature Probe Accuracy Test 40 C +/- 1 C Patient Temp

Temperature Probe Accuracy Test 40 C +/- 1 C Outlet Temp

Temperature Probe Accuracy Test 40 C +/- 1 C Ambient Temp

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 VINCENT MEDICAL INSPIRED O2 FLO - OPERATIONAL VERIFICATION PROCEDURE

FUNCTIONAL TEST - FLOW AND OXYGEN CONCENTRATION

Test Description Pass / Yes Fail / No N/A Value Actual Value Notes

Flow Set - 10L 8-10LPM

Flow Set - 30L 26-34LPM

Flow Set - 60L 54-66LPM

Flow Set - 10L Oxygen set - 30% 25-35%

Flow Set - 30L Oxygen set - 60% 55-65%

Flow Set - 60L Oxygen set - 90% 85%-95%

FUNCTIONAL TEST - ALARMS

Test Description Pass / Yes Fail / No N/A Value Actual Value Notes

Check Chamber -

Lack of water -

Temp. probe uninstalled/failure -

Check heater wire -

Circuit failure/data cable uninstalled -

Tube not match -

Check for blockages -

Oxygen too high -

Oxygen too low -

Flow over range -

Temperature over range - 2 C Higher or lower - Target

Temp. Probe out -

SD Card uninstalled -

No alarm sound -

FUNCTIONAL TEST

Test Description Pass / Yes Fail / No N/A Value Actual Value Notes

Adult Mode, 37 C Temperature setting 37 C +/- 2 C

Adult Mode, 60L/min flow 60LPM ± 6LPM

Pediatric Mode, 34 C Temperature setting 34 C +/- 2 C

Pediatric Mode, 25L/min flow 25LPM ± 4LPM

Functional Test Runtime

INSULATION RESISTANCE TEST

Test Description Pass / Yes Fail / No N/A Value Actual Value Notes

Insulation Resistance Test - 500v >10 MOhm

VALVE SEAL TEST

Test Description Pass / Yes Fail / No N/A Value Actual Value Notes

Set Flow Rate - 60LPM

BLOWER TEST

Test Description Pass / Yes Fail / No N/A Value Actual Value Notes

Set Flow Rate - 60 LPM - Displayed Flow Rate <1 LPM

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 VINCENT MEDICAL INSPIRED O2 FLO - OPERATIONAL VERIFICATION PROCEDURE

Analyser PM Description

Model PM Interval

Serial No
Notes
Next CAL due date

Signature : Signature :

Client : Engineer :

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