P
AGE
55
1127179,
V
ER
.
02
D
REAM
S
TATION
B
I
PAP
S/T
AND
AVAPS
S
ERVICE
&
T
ECHNICAL
R
EFERENCE
M
ANUAL
System Checkout Data Sheet
Device Information
Notification # (if applicable)
Model #/Serial #
Model name
Device firmware version
Blower hours
Humidifier Verification
Test
Result (circle one)
Humidification test: heater plate operation
Pass/Fail
System and Alarm Verification
Test
Result/Tolerance
Result (circle one)
CPAP @ 4 cmH
2
O
[ ] +/- 1 cmH
2
O
Pass/Fail
CPAP @ 20 cmH
2
O
[ ] +/- 2 cmH
2
O
Pass/Fail
S mode trigger performance
Pass/Fail
S/T mode - machine-delivered breath
Pass/Fail
Apnea
Pass/Fail
Patient Disconnect
Pass/Fail
Low Minute Ventilation
Pass/Fail
Loss of Power
Pass/Fail