CONTROL NO : 20240517-1
CUSTOMER Adventist Hospital DATE 5/17/2024
ADDRESS Santiago, 3311 Isabela NEXT DUE DATE 5/17/2025
EQUIPMENT TYPE INFANT VENTILATOR
ADULT VENTILATOR
BRAND DRAGER HOUR READING
MODEL BABYLOG 8000 PLUS CONTROL NO 17
SERIAL NUMBER ARYD-0001 DEPARTMENT PULMONARY
CHECKLIST INSPECTION AND PREVENTIVE MAINTENANCE
ACCESORIES PHYSICAL TEST RESULT
PROCEDURES
SUPPORT ARM INSPECTION PASS FAIL N/A
HUMIDIFIER ü HOUSING CHASSIS Examine the exterior for cleanliness and physical condition. ü
OXYGEN HOSE ü MOUNTING TROLLEY Examine Trolley, Wall mount , Cart, Shelves ü
OXYGEN FITTINGS ü CASTER WHEEL-BRAKES Casters movement and Locks is appropriate. ü
OXYGEN GAUGE REGULATOR AC PLUG CORD -RESTRAIN Check AC plug, Power Cord, Restrainer for damage ü
AIR HOSE ü PATIENT CABLES Inspect Patient Cables and connectors for damage or leakage ü
AIR FITTINGS ü FUSE Inspect Circuit breaker and Fuses Holders and mounting ü
AIR GAUGE REGULATOR CONTROL PADS - KNOBS Check knobs, touch pad and switches for functionality ü
EXTENSION ü DISPLAY Check all indicator lights, meters ü
AC PLUG ADAPTER ü RELIABILITY Check Display Reliability ü
AC POWER CORD ü INDICATORS/ALARMS Confirm Alarm Sound and Indicator are functioning ü
FAN FILTER ü BATTERY/CHARGERS Run by uplugging AC Source and view Charging Indicators ü
AVR ü FILTERS Check Condition and Clean Air Intake Filters. ü
MONITOR (DISPLAY) PNEUMATICS Check Pneumatic Tubings & Fittings connector for damage. ü
DC ADAPTOR POWER SUPPLY LABELLING ACCESORIES Check that all labels, warnings or instruction are present ü
EXHALATION VALVE ü PERF. EVALUATION Check Operation is within the manufacturer's specification ü
STAND TROLLEY ü REMARKS Patient Ready Condition ü
CALIBRATIONS SERVICE REPORT
The following Results where obtain using The Comparison Method on known Simulated REPORTED PROBLEM
Parameters and Output Readings on Data Analyzers. FOR PREVENTIVE MAINTENANCE
ASSESSMENT AND INITIAL FINDING
OPERATIONAL VERIFICATION NONE
LEAK TEST READING ACTUAL WORK DONE
MODE : CPAP , Pinsp : 80, Insp. Flow : 2, Keep Manual Insp. pressed ü DO PHYSICAL INSPECTION
Pinsp : 80 (80 ±2) cmH2O 80 ü FUNCTIONALITY TEST
AIRWAY PRESSURE TEST READING ACTUAL ü FRONT PANEL BUTTONS TESTING
MODE : CMV/AC, Flow : 10, T in : 0.4, T ex : 0.6 ü PERFORM CALIBRATIONS
Pinsp : 20 (20 ±4) cmH2O 19 ü ACTUAL / SIMULATION
PEEP : 0 (0 ±2) cmH2O 0 ü CHECK ACTUAL MEASURED PARAMETERS USING TOOLS/EQUIPMENTS
PEEP : 10 (10 ±2) cmH2O 10 ü CHECK ACTUAL PARAMETERS/ALARMS/ALARM LIMITS
AIRWAY PRESSURE ALARMS PASS FAIL ü CHECK INPUT AND OUTPUT VOLTAGES - AVR/POWER SUPPLY
High - Kink hose ü ü BURN TESTING
Low - Disconnect tubings ü ü CHECK HUMIDIFIER
ü SECURING PNEUMATICS LIKE O2 HOSE, AIR HOSE, ETC.
POWER FAILURE ALARM PASS FAIL ü BURN TESTING
When AC suddenly disconnect ü ü CHECK FILTERS
ü GENERAL CLEANING
CALIBRATION DATA READING ACTUAL
@21% : 9.2 - 26 15.5 MAINTENANCE EQUIPMENTS USED
O2 SENSOR VOLTAGE (mV)
@100% : 43.6 - 123.6 46.7 CHECK UP/REPAIR WRIGHTS RESPIROMETER
21% +/- 4% 21.42 ü FOR PMS ü VT PLUS ANALYZER- COMEN
30% +/- 4% 29.23 FOR EVALUATION MINIOX ANALYZER
O2 SENSOR PERCENTAGE 60% +/- 4% 61.24 INSTALLATION BIOTEK ECG SIMULATOR
90% +/- 4% 89.67 RECALL - UPGRADE SIMCUBE
100% +/- 4% 99.74 OXSIM SPO2 SIMULATOR
NICD BATTERY VOLTAGE 6.7 - 10.6 V 9.2 WARRANTY IMPULSE 4000
TEMPERATURE MONITORING –20 °C to 75 °C 11 YES RT-200 CALIB. ANALYZER
NO ADULT TEST LUNG
BEHAVIOR PASS FAIL ü CONTRACT ü NEONATE TEST LUNG
Cold - Start Behavior ü ü DIGITAL TESTER
Warm - Start Behavior ü FOR BILLING CONVERTER CHARGER
YES IV BOTTLE, IV LINE
ELECTRICAL CONDITIONS READING PASS FAIL ü NO 10 - 50CC SYRINGE
ELECTRICAL POWER 100/110/127 Volts ± 10 % ü
FUSE AMPERAGE 3.15 AMPERE ü REMARKS
DC BATTERY 9 VOLTS ü
ü UNIT IS READY FOR PATIENT USE
CALIBRATION TOOLS SERIAL NUMBER MANUFACTURER FOR OBSERVATION/BURN TESTING
VT PLUS ANALYZER 136 4288 4628 COMEN FOR REPAIR
MINIOX OXYGEN ANALYZER Z967103 MSA PITTSBURGH ACCESORIES FOR REPLACEMENT
DIGITAL TESTER(M118A) - ANENG FOR PULLOUT
BIOMEDICAL ENGINEER HOSPITAL REPRESENTATIVE - CUSTOMER
ENGR. JAVIE ANDREI S. CLAVERIA ENGR, JAYSON C. ANTONIO
SIGNATURE OVER PRINTED NAME / DATE SIGNATURE OVER PRINTED NAME / DATE
