Philips EverFlo Q - Everflo Test Data Sheet

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VERFLO
TM
SERVICE & TECHNICAL INFORMATION 1039055, VER. 06
9.3 EVERFLO TEST DATA SHEET
NOTE
All information on this data sheet should be entered in the correct location after the associated test
was completed. The data sheet must then be signed in ink and dated by the technician performing
tests. Circle “Pass” or “Fail”. Leave all unused boxes blank.
Step 2 Step 3 Step 4
Serial Number: ___________________ VAC: __________ Hz: __________ Hour Meter: ______________
Model Number: ___________________
Step 5
Oxygen Outlet Pressure
5.0 - 7.0 psig Pediatric Flow Meter Yes No
Step 6
No Flow Alarms < 120 sec.
EverFlo T Devices < 160 sec.
Pass Fail
Step 7
Flow Meter Oxygen
Concentration
(Pediatric Flow Settings)
EverFlo Models
90-96% @ 2 LPM
90-96% @ 5 LPM
1020007 and 1020008
87-96% @ 2 LPM
87-96% @ 5 LPM
2 LPM
(0.1LPM)
5 LPM
(1LPM)
2 LPM
(0.1LPM)
5 LPM
(1LPM)
Step 8 Step 13
OPI Verification
Pass Fail O2 Coupler Flow > 10 SLPM Pass Fail
Signature: _____________________ Date: _____________ Notification Number: ______________________
(PRI internal use Only)
Print Name __________________________Asset Numbers____________________/ ____________________
(PRI internal use Only)