Installation check form
A- 1 (4)
2106778-001
APPENDIX A: Installation check form
CARESCAPE Monitor B850
Prior to testing verify all equipment is calibrated via “Cal” labeling and record Cal Due Dates
PASS = Test passed N.A. = Test not applicable FAIL = Test failed
Customer Monitor type S/N
Service record # Software version
Service engineer
Other devices connected to the monitor system
Device Serial number Device Serial number
Measuring equipment / test gases used:
Equipment / tool / gas: Manufacturer: Model/Type/Part No: Serial Number/ID: Cal Due Date:
Visual inspection
Observed result PASS FAIL
The monitor and the connected peripheral devices are undamaged.
The monitor and the connected peripheral devices are properly mounted
with specified mounting solutions.
The cables between the patient monitor and the connected devices are
intact, properly connected and secured to the right connectors.
The power cord and USB cables are properly secured with the supplied
retaining clips.
All the network cables, both MC and IX Network, are intact and properly
connected to the right connectors.
The modules are properly connected and locked.
Electrical safety tests
Date of manufacture of the device:
Is there less than 12 months since the device was manufactured?
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