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Performance Verification Procedure
Model / Serial Number:
Hospital Name / Reference:
Inspection
Physical inspection and clean
CH2
Operation
Power-up Check
Pump Removal/Loading Checks
Battery Test
CH2
Setup
Set the correct Date and Time .
Class I (no applied parts)
Test in accordance with the standard
EN 60601-1 and test equipment
Electrical
operation manual .
CH2
Safety Tests
Verification
Performed
By
___________________________
Sign
chX indicates the chapter number in the Technical Service Manual (TSM) - 1000SM00015 .
CH2
E .G .
= Refer to TSM Chapter 3 .
• Ensure that the speaker and Keypad LEDs are functioning correctly .
• Check Beacon operation (if fitted) .
1000SM00015 Issue 8
Service Order / Inventory Number:
Software Version:
Test results are stored:
¨
• Electronically
¨
• Print-out
¨
• Other
____________________
__________________________
Print
15/72
Alaris® Gateway Workstation
Routine Maintenance
PASS / FAIL
__________________
Date
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