baxter Flo-Gard 6301 - Page 241

07-19-B1-729 FLO-GARD 6301 DUAL CHANNEL VOLUMETRIC INFUSION PUMP SERVICE MANUAL A-3
Operational Checkout Data Sheet
Pump Serial Number: _____________________________
Printed Name Signature Date
Tester: _____________________________ _____________________________ ____________
Reviewer (optional): _____________________________ _____________________________ ____________
Stopwatch or Timer Calibration Due Date/ID: _________________________________
FSR Test
Pump 1 LEFT
"CHECK SET LOADING" message displays
Alarm LED flashes
Audible alarm sounds
Fail R Pass R
RIGHT
Pump 2 LEFT
"CHECK SET LOADING" message displays
Alarm LED flashes
Audible alarm sounds
Fail R Pass R
RIGHT
Downstream Occlusion Test
Pump 1 "DOWNSTREAM OCCLUSION" message displays
Alarm LED flashes
Audible alarm sounds
Fail R Pass R
Pump 2 "DOWNSTREAM OCCLUSION" message displays
Alarm LED flashes
Audible alarm sounds
Fail R Pass R
Upstream Occlusion Test
Pump 1 Pump stops
"UPSTREAM OCCLUSION" message displays
Alarm LED flashes
Audible alarm sounds
Time to Alarm
< 3 Minutes
Time to Alarm:
Pump 2 Pump stops
"UPSTREAM OCCLUSION" message displays
Alarm LED flashes
Audible alarm sounds
Time to Alarm
< 3 Minutes
Time to Alarm: