Index g
(Master – to be added to the documentation)
M688 70 01 05 F04 / 3891 7319 (GB) Sheet 3 of 3
1-Technical Safety Check (TSC)
Perfusor® Space, 3.0 5- 3EN
Mechanical Aids and Measuring
Equipment Used
Accessories Used
❒ Syringe gauge, serial No.__________
Calibrated until_________________
❒ Service connector SP
❒ __________________________
❒ __________________________
❒ Power Supply SP
❒ Battery module
❒ Staff call lead
❒ Space PCA Kit (PCA button)
❒ Syringe Anti Removal Cap PSP
❒ ___________________________
Test result:
Defects found which could endanger patients, users or
third parties: Yes No
Inspection performed by:
Measures to be taken: Repair
Replacement of battery recommended
_________________________
Unit handed over on:
Special features / documentation:
To:
Date / Signature:
Next deadline for TSC:
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