Appendix A: Functional Check Form, Datex-Ohmeda S/5 Am, Ccm - GE Datex-Ohmeda S/5 Technical Reference Manual

APPENDIX A: Functional check form,
Datex-Ohmeda S/5 AM, CCM
Customer
Service
Service engineer
Measuring equipment / test gases used:
Equipment / tool / gas:
Monitor Installation
F-CU5(P)
F-CPU
N-AC
F-CU8
L-
D-
OK = Test OK
Visual Inspection
1. Check all units visually
Functional Inspection
5.3.1. General
5.3.2. Display(s)
5.3.3. Keyboard(s)
Appendix
Manufacturer:
B-
B-
B-
B-
K-
D-
N.A. = Test not applicable
A
Functional check form, Datex-Ohmeda S/5 AM, CCM
Model/Type/Part Serial Number /
Number: ID:
N-
Fail = Test failed
S/N
S/N
Date
Calibration
Date:
OK N.A. Fail
OK N.A. Fail
A1(4)
Document no. M1137263-04