Newport e360 - Safety Check Record

OPR360U A0509
5-1
5
OPR360U A0509
5-1
5
OPR360U A0509
5-1
5
OPR360U A0509
5-1
5
OPR360US H0711
3-13
Unpacking, Assembly, and Safety Check
3
NOTE: Make copies of this form to record the results of safety checks .
Newport e360 Ventilator
Safety Check Record
Newport Medical recommends that you perform a complete Safety
CheckpriortoA)Theinitialuseoftheventilator;and,B)Atleastat
every Preventative Maintenance interval.
UnitSerialNumber:
Item Pass Fail
Setup and Inspection
EmergencyIntakeValve
Circuit Check
GasSupplyAlarms
ACPowerLoss/BatteryBackupAlarm
PressureAlarms/CircuitDisconnect
Alarm/AlarmSilence
MinuteVolume/BackupVentilation/
ApneaAlarms
Trigger/PressureSupport
Volume/Flow/RateAccuracyTest
ShutDownAlarm
Comments:
Performed by: Date: Unit Hours: