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Ventilator Operational Checklist
Ventilator Operational Checklist
Ventilator Operational Checklist
Ventilator Operational Checklist
Owned by:
Serial #
Hour Meter Reading:
Date:
User:
Serviced by:
Address:
Address:
City:
City:
State:
State, Zip
Zip
Service Representative:
User Phone:
Test
Operation
Test Results
Pass
Fail
Visual
Inspect
As specified
❒
❒
Control Settings
Procedure
Not applicable
Connections
Procedure
Not applicable
Patient Circuit Leak Test
Perform Test
As specified
❒
❒
Power
Perform Tests
As specified
❒
❒
Assist/Control Mode
Perform Tests
As specified
❒
❒
SIMV
Perform Tests
As specified
❒
❒
Pressure Cycle Mode
Perform Tests
As specified
❒
❒
Pressure Limit (LP10, LP20)
Perform Tests
As specified
❒
❒
Comments
:
Signature:
Date: