07-19-B1-729 FLO-GARD 6301 DUAL CHANNEL VOLUMETRIC INFUSION PUMP SERVICE MANUAL A-5
Operational Checkout Data Sheet
Pump Serial Number: _____________________________
Printed Name Signature Date
Tester: _____________________________ _____________________________ ____________
Reviewer (optional): _____________________________ _____________________________ ____________
Scale Calibration Due Date/ID: ____________________________________________
Graduated Cylinder Calibration Due Date/ID: _________________________________
Accuracy Tests
Note: Perform either Volume Measurement with VTBI or Measurement by Volume per Time.
Measurement by Volume per Time
N/A ______
PRI Rate 200mL/VTBI 20mL 18.6mL-21.4mL mL
Volume Measurement with VTBI
N/A ______
PRI Rate 200mL/ VTBI 35mL 32.5mL-37.5mL mL
1 Hour Accuracy Test
Note: Perform only if pump failed Volume Measurement w/VTBI or Measurement by Volume per Time
N/A ______
PRI Rate 125mL/ VTBI 1000mL 116.25mL-133.75mL mL
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