Accutron

Nitrous Oxide-Oxygen Sedation Systems

Field Preventative Inspection Testing F1224 Rev 02

Inspection Testing

1 Page

Customer Name: ___________________________________________________________  1733 W Parkside Lane Phoenix, AZ 85027 Ph: 623-780-2020 website: www... cutron-inc... m  Address: __________________________________________________________________  Requirement / Test Actions  Pass (P) Fail (F)  Item / Function  Model#:  SN:  Possible Corrective Actions if Test Fails  1 2 3,4  Leak Check 1 (outspout)  5,6  Leak Check 2 (air override, tubes, joints)  7  Non-rebreathing Replace non-rebreathing (outspout) leaf... o testing valve required... 9  Oxygen Flush  10  Failsafe Test  11  [ ] Order parts (Remove from service until new parts arrive, no need for follow-up) ______________________________________________________________________  O2 Flow Point 1  12  Check for tears, cracks, holes, etc (list parts here)  Tubing and Rubber Goods  O2 Flow Point 2  15,16 13,14  [ ] Non-critical (Cosmetic) damage, use as is [ ] Return to Accutron  N2O Flow Point 1  17  Check for damaged components (list parts here) Physical Check  Percent N2O Control  Ball style (PC,DC,CM only) - O2 at 6 lpm and N2O at 6 lpm... erify Nitrous % knob at 50% per procedure... non-critical if flow tubes pass previous 4 test steps)  [ ] Return to Accutron for repair [ ] Customer chooses to keep unit and rely on flow tubes since %knob is only an aid... ustomer Signature:  18  Step  Meter Desc:  O2 Resuscitator (100 lpm min)  Plug fixture into resuscitator outlet... erify min flow in fixture  [ ] Return to Accutron for repair [ ] Customer chooses to keep unit, believes current flow meets emergency needs... ustomer Signature:  N2O Flow Point 2  Final Status:  With gas supply connected and unit off, soap outspout  [ ] Return to Accutron for repair [ ] Customer keeping unit, is aware it might increase ambient levels of N2O in room and cause some gas loss... ustomer Signature:  With gas supply connected and unit flowing 4 lpm of each gas, soap override in two places per procedure, (PC/DC only) test joints per procedure  [ ] Return to Accutron for repair [ ] Customer keeping unit, is aware it might increase ambient levels of N2O in room and cause some gas loss... ustomer Signature: [ ] Non-rebreathing leaf replaced  Minimum flow of 20 lpm  [ ] Return to Accutron for repair [ ] Customer accepts Flush as is... ustomer Signature:  Both gases to 4 lpm flow... hut oxygen supply at source... erify all flow stops (digital gives Failure Oxygen alarm)  [ ] Stop using and return to Accutron for repair  Ball style meters - O2 3 lpm... erify fixture 3 lpm... igital - Total Flow 3 lpm %N2O at 0... erify fixture 3 lpm... [ ] 1st test failed... as supply was low... fter correcting supply unit passed retest...  ] Proper flow could not be achieved, return to Accutron for repair  Ball style meters - O2 6 lpm... erify fixture 6 lpm... igital - Total Flow 6 lpm %N2O at 0... erify fixture 6 lpm... [ ] 1st test failed... as supply was low... fter correcting supply unit passed retest...  ] Proper flow could not be achieved, return to Accutron for repair  Ball Style - O2 3 lpm, N2O 3 lpm... erify fixture 6 lpm... igital - Total flow 6 lpm, %N2O 50%... erify fixture 6 lpm... all Style - O2 6 lpm, N2O 6 lpm... erify fixture 12 lpm... igital - Total flow 9... lpm, %N2O 70%... erify fixture 9... lpm... [ ] 1st test failed... as supply was low... fter correcting supply unit passed retest...  ] Proper flow could not be achieved, return to Accutron for repair  [ ] Meets minimum requirements  Tested by: __________________________________ Date: _______________  [ ] 1st test failed... as supply was low... fter correcting supply unit passed retest...  ] Proper flow could not be achieved, return to Accutron for repair  [ ] Fails minimum requirements, return to Accutron for repair Test fixture # _________________ Fixture Calibration Due Date: __________________  Comments:  F 1224 rev02  CN#:CN-0646  Field Certification Test Sheet  Accutron, Inc... ASTER
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