Bolder Surgical
en - CoolSeal™ Generator
Page | 36
Periodic Functional Test Summary Form
Periodic Functional Test Summary Form Page 1/2
Generator SN: ________________
Step
TEST
REQUIREMENT
Record
Values
Circle Pass/
Fail
Inspection
1
Unit Exterior Inspection
No Damage
P / F
2
Power Cord
No Damage
P / F
Indicator Lights and Audio Indicators
1
Normal Power-up
GREEN Power Button and 3-Tones
P / F
2
Normal Instrument Insertion
White Receptacle Display
P / F
3
Stuck Button During Power On
1) GREEN Power Button and 3-Tones
2) 1-Tone then flashing AMBER
Receptacle
P / F
4
Stuck Button After Power On
1-Tone then flashing AMBER Receptacle
P / F
5
Open Circuit Test
1) Short FUCHSIA Display w/Tone
2) AMBER Display w/ 3-Tone Alert
P / F
6
Short Circuit Test
1) 4 second FUCHSIA Display w/Tone
2) AMBER Display w/3-Tone Alert
P / F
7
Seal Timing
Approx. 4 seconds of varying FUCHSIA
Display
______
sec
P / F
8
Volume Test
Volume changes between Min. and Max.
Levels
P / F
Tester
Name
Signature Date
