Maintenance check form
B - 1 (4)
2106778-001
APPENDIX B: Maintenance 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 B850- S/N
Service record # Software version
Service engineer Module type S/N
Planned maintenance Corrective maintenance
Start date
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 modules are properly connected and locked.
The pivoting module frame and battery door are properly locked.
Electrical safety tests
Power outlet is correctly wired.
Power cord and plug are undamaged and all conductors are properly connected.
Ground integrity check Observed result Acceptance
criteria
PASS N.A. FAIL
a.) Ground continuity test without power cord 0.1 ohms
with power cord 0.2 ohms
b.) Impedance of protective earth
connection
without power cord 0.1 ohms
with power cord 0.2 ohms
Ground leakage current test
Normal Condition (NC) Polarity: Normal
500 µA EN /IEC
300 µA UL
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