Installation check form
A - 1 (4)
2062973-002
APPENDIX A: Installation check form
CARESCAPE Monitor B650
Prior to testing verify all equipment is calibrated via “Cal” labeling and record Cal Due Dates
PASS = Test passed
N.A. = Test not applicable
FAIL = Test failed
Customer
Monitor type B650-
S/N
Service record #
Software version
Service engineer
Measuring equipment / test gases used:
Equipment / tool / gas:
Manufacturer:
Model/Type/Part No:
Serial Number/ID:
Cal Due Date:
Observed result
PASS
FAIL
The monitor and the connected peripheral devices are undamaged.
The monitor and the connected peripheral devices are properly
mounted with specified mounting solutions.
The cables between the patient monitor and the connected devices
are intact, properly connected and secured to the right connectors.
The modules are properly connected and locked.
The pivoting module frame and battery door are properly locked.
Manufacturing week and year of the device:
Is there less than 12 months since the device was manufactured?
Yes:
Yes: you do not have to perform the electrical safety tests. To continue the
installation check, mark the electrical safety test completion N.A. and proceed
to
. If available, attach the original electrical safety test
results to this check form.
No:
No: continue to perform the electrical safety tests.
Power outlet is correctly wired.
Power cord and plug are undamaged and all conductors are properly connected.
Observed result
Acceptance
criteria
PASS
N.A.
FAIL
a.) Ground continuity test
without power cord
≤
0.1 ohms
with power cord
≤
0.2 ohms
Summary of Contents for CARESCAPE Monitor B650
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