5 - Technical Safety Check (TSC)
Infusomat® Space 6.0 5 - 3EN
M686 70 01 05 F04 / 38918838 Sheet 3 of 3
Index h
(Master – to be added to the documentation)
Air inline sensor
❒ Water value (> 600 mV) ____ mV
❒ Difference of temperature
sensors (< 3 °C) ____ °C
❒ Air alarm
❒ Air value (< 100 mV) ____ mV
Note: If the water or air value is not
reached immediately, these values must be
read again after 120 seconds.
Switch on unit without power supply
❒ Self-test
❒ Magnetic function of the battery com-
partment cover
Remove battery module
❒ Alarm for min. 3 minutes
Mech. Aids and Measuring Equip. Used Accessories Used
❒ Disposables
Type: _______________________
Part No.: __________________
❒ Manometer
Ident. No.: ____________________
Calibrated until ________________
❒ Scales
Ident. No.: ____________________
Calibrated until ________________
❒ Graduated cylinder
❒ Stop watch
❒ Service connector SP
❒ __________________________
❒ __________________________
❒ Staff call line
❒ Power Supply SP
❒ Battery module
❒ Space PCA Kit (PCA button)
❒ Infusomat® Space Line, standard type
❒ Drop sensor
❒ __________________________
❒ __________________________
Test result: Defects found which could endanger patients, users or
third parties: Yes No
Inspection performed by:
Measures to be taken: None Repair
Unit handed over on:
Replacement of battery recommended
__________________________________________
To:
Special features / documentation:
___________________________________________________________________________
Date / Signature:
___________________________________________________________________________ Next deadline:
Visual Inspection Electrical Safety
According to IEC 60601-1 or IEC 62353
Functional Inspection
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