VG70 Ventilator Acceptance Test Log Ver 1.0 May 2020

VG70 Acceptance Test Log Customer/ Organisation Date

Ticket Number

Manufacturer/ Supplier Serial number

Asset number

Software, firmware and configuration

Software version main Paperwork 1. Packaging undamaged 2. Delivery note checks with order

3. Goods check with delivery note 4. User manual supplied 5. Warranty document included 6. Final test certificate provided Visual & Physical Inspection Check 1. Main unit 2. Base / Trolley 3. Accessories Functional Checks 1. Pre-use self-test as per user manual 2. Technical test 3. 4. 5. 6. 7. 8. 9. 10. 11.

Pass

Fail

N/A

Remarks

Pass

Fail

N/A

Remarks

Pass

Fail

N/A

Remarks

Electrical class Pass

Fail

Electrical type N/A

Test Results

Yes

No

N/A

Remarks

A

B

C

AC/Battery test Gas supply test Oxygen sensor test Leak test Flow sensor test Pressure sensor test Safety valve test Patient circuit test CO2 sensor test

Electrical safety

1. Electrical safety test Admin 1. Time / date set 2. Hours run O2 Sensor Connection Type (Please refer to images on the back) Please tick which connection type matches your device

Authorised person

Date

Remarks

Signature

To register the product and its warranty, please complete this form and return to [email protected] within 30 days.

Version 1.0 Issued 13/05/2020

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