GE Datex-Ohmeda S/5 Series - Page 119

Appendix A Planned maintenance check form, S/5 Compact Monitors
A1(4)
Document no. M1144953-001
APPENDIX A: Planned maintenance check form,
S/5 Compact Monitors
OK = Test OK N.A. = Test not applicable Fail = Test failed
Customer
Service
Service engineer Date
Monitor Installation
Frame: F-CM________ System options: E/M-
Software: N- E/M-
K- N- E/M-
K- N- E/M-
Measuring equipment / test gases used:
Equipment / tool / gas: Manufacturer: Model/Type/Part
Number:
Serial Number /
ID:
Calibration
Date:
Visual Inspection OK N.A. Fail
2.1.1. General
2.1.2. Compact Airway Module, E-CXX/ M-CXX S/N
2.1.3. Single-width Airway Module, E-miniC/ M-miniC S/N
2.1.4. Tonometry Module, E-TONO/ M-TONO S/N
2.1.5. Recorder Unit S/N
2.1.6. Modules with NIBP measurement S/N
S/N