3-14 
 
3.2.5 Preventative maintenance test report 
Customer name   
Customer address   
Servicing person   
Servicing company   
Equipment under test 
(EUT) 
 
Model of EUT   
SN of EUT   
Hardware version   
Software version   
Test equipment  Model/No.  Effective date of calibration 
     
     
     
     
     
     
 
Test items  Test records  Test results 
(Pass/Fail) 
Visual inspection 
The case, display screen, buttons, knob, SMR, modules, power 
cord, wall-mount bracket and accessories have no obvious signs 
of damage. 
   
The external connecting cables are not frayed and the connector 
pins are not loose and bent. 
   
The external connectors are not loose or their pins are not bent. 
   
The safety labels and data plate are clearly legible. 
   
NIBP test 
The difference is within ±3 mm when 0, 50 or 200 mmHg is set 
for NIBP accuracy test. 
   
There is no leakage with NIBP, or the manual leakage test result 
does not exceed 6mmHg/min. 
   
Sidestream CO
2
 test