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APPENDIX A, Functional check form, AS/3 CM and CS/3 CMC
A - 1(7)
Document No. 896 623
FUNCTIONAL CHECK FORM
Datex-Ohmeda AS/3 Compact Monitor, CS/3 Compact Monitor
Customer
Service
Service engineer
Date
Monitor installation
F-CM
B-
M-
S-
B-
M-
B-
K-
M-
OK = Test OK
N.A. = Test not applicable
Fail = Test Failed
Visual inspection/preparation
Displays
OK
N.A.
Fail
OK
N.A.
Fail
1.
External parts
2.
Module motherboard
position
Notes
Keyboards
OK
N.A.
Fail
OK
N.A.
Fail
3.
Anesthesia Keyboard
4.
Remote Control
Notes
Compact Airway Module
S/N
OK
N.A.
Fail
5.
External parts
Notes