Philips Respironics V60 - 8.9 Performance Verification Data Form

Chapter 8
Performance Verification
1049766 Rev A V60 Ventilator Service Manual 8-45
8.9 Performance
Verification Data
Form
Complete this form at every performance verification. Make copies of this form
for data collection.
Date: Notification number(s):
Customer Information
Name:
Address:
City/State:
Account no.:
Preliminary ventilator cleaning and inspection Circle one
Was the ventilator damaged? YES NO
If yes, provide a brief description of damage and repair:
Cleaned ventilator exterior? YES NO
Inspected cooling fan filter? YES NO
Inspected inlet filter? YES NO
Serial number: Software version:
Installed options
(circle all that apply):
PAV>>>>>>AVAPS>>>>>>C-Flex>>>>>>Ramp
Other: _______________________________________________
Total power-on hours: Hours since last PM:
Battery lot number: Battery manufacture
date:
Environmental
readings:
Barometric pressure:
mmHg
Relative humidity:
%
Temperature:
o
C
Test 1: Electrical Safety Circle one
Pass value Fail value
Value after
repair
Proper cooling fan operation? YES NO
Proximal pressure port GND resistance (<0.2 ohm) ohm ohm ohm
Gas outlet port GND resistance (<0.2 ohm) ohm ohm ohm
Oxygen fitting GND resistance (<0.2 ohm) ohm ohm ohm
Forward leakage current
100-120 VAC: <300 uA, 220-240 VAC: <500 uA
uA uA uA
Reverse leakage current
100-120 VAC: <300 uA, 220-240 VAC: <500 uA
uA uA