(Master – to be added to the documentation)
Sheet 3 of 3
6 Technical Safety Check (TSC)
Infusomat® compact
plus
P 1.0 6 - 3
EN
For internal use, only
Mech. Aids and Measuring Equip. Used Accessories used
❒ Disposables
Type: ________________________
Part No.: _____________________
❒ Manometer
Ident. No.: ____________________
Calibrated until: _______________
❒ Scales
Ident. No.: ____________________
Calibrated until: _______________
❒ Safety tester
Ident. No.: _____________________
Calibrated until: ________________
❒ Measuring Adapter Accessory
Connector CP
❒ Graduated cylinder
❒ Stop watch
❒ ___________________________
❒ ___________________________
❒ Mains power supply cable
❒ Staff call cable compact
plus
❒ Connection lead 12V
❒ Infusion line
❒ __________________________
❒ __________________________
Test result: Defects found that could endanger patients, users, or
third parties: Yes No
Inspection performed by:
Measures to be taken: None
Unit handed over on:
Repair
________________________________
To:
Special features / documentation:
___________________________________________________________
Date / Signature:
___________________________________________________________ Next deadline:
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