Esco FV-001 - Log Record

LOG RECORD
Equipment
:
_______________________________________________________________
Serial Number
:
_______________________________________________________________
Person in Charge
:
_______________________________________________________________
1. This log record should be used by the operator to record any new agent that has been introduced to
the equipment during its operation, problems encountered, etc.
2. Any decontamination procedure performed by either the user or the technician should be recorded
down as well.
3. Please also record any major maintenance procedure performed by the service technician, for
example: parts replacement, recertification, etc.
Date
Event
User Signature
Supervisor Signature
In case of emergencies, please call:
Name
:
_______________________________________________________________
Cell Phone Number
:
_______________________________________________________________
E-mail
:
_______________________________________________________________