BD BACTEC FX40 - Page 115

5 – Reference
115
Figure 5-21 – Sample Maintenance QC Report
Maintenance QC Report
Kirk Memorial Hospital
1313 Mockingbird Lane
Instrument - 1
Software Version - 0.10Y Date/Time - 03/15/13 04:19 p.m.
FX40 serial number FFPP03 FX40 serial number
Temperature 35.1 (33.5 - 36.5) _____ _____
A Pass Fail
QC Thermometer Reading _________ _____ _____
Internal Green LEDs _____ _____
Internal Red LEDs _____ _____
Unusable/Blocked Stations*
A
*All stations have been verified for proper operation since the last automatic QC report except those listed above, if any.
Pass Fail
External System Yellow Indicator
A _____ _____
External System Red Indicator
A _____ _____
External System Green Indicator
A _____ _____
Audible Al ert
_____ _____
Filters Checked - Yes _____ No _____ Date ____________________
Filters Changed - Yes _____ No _____ Date ____________________
Comments _______________________________________________________________________________________________________________
Technologist ___________________________________ Date _________________________
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