Performance Test of Bed Side Monitor

Merk Mindray No. Inventaris RSR/ADM/01/12/PM/02/2010

Type MEC 1000 Ruang IGD

S/N AQ-76101283

I.Alat Ukur dan Bahan Yg Digunakan

No. Nama Alat/Bahan Merk Type S/N

1 AVOmeter
2 ECG Simulator
3 Blood Pressure Simulator

II. Keselamatan Listrik

No. Parameter Terukur Toleransi

III. Kinerja Alat

A. Saturasi O2 ( SpO2 )

Ukur Hasil Ukur Hasil

Setting SpO2 Setting SpO2
I II Pass Fail I II Pass Fail

80 95

B. Pulse Rate

Setting Pulse Ukur Hasil Setting Pulse Ukur Hasil

Rate I II Pass Fail Rate I II Pass Fail

C. Heart Rate ( bpm ) D. Tekanan Darah/NIBP (mmHg)

Hasil Ukur Hasil Setting Ukur Hasil

Setting BPM
I II Pass Fail (mmHg) I II Pass Fail
Sys
60 bpm
60 MAP
Dyas
90 bpm
Sys
120 MAP
120 bpm
Dyas
Sys
E. Alarms 200 MAP
Dyas
Set Alarms Pass Fail
40 bpm
120 bpm

Customer Checked by,

PT.GMM - T/R Div

Date,
Start Time
End Time ( ) ( )

PT.GMM - T/R Div

 Check List Bed Side Monitor 2
Merk Mindray No. Inventaris RSR/ADM/01/12/PM/02/2010

Type MEC 1000 Ruang IGD

S/N AQ-76101283

A. Main Unit

No Descriptions Results

1. Chasis/Housing Pass Fail NA

2. Mount/Fasteners Pass Fail NA

3. Circuit Breakers/Fuse Pass Fail NA

4. Fittings/Connectors Pass Fail NA

5. Controls/Switches Pass Fail NA

6. Recorders Pass Fail NA

7. Indicators/Displays Pass Fail NA

8 Alarms Pass Fail NA

9 Charging Systems Pass Fail NA

10 Back Up Battery Powered Pass Fail NA

B. Accessories

No Descriptions Results Quantity

1. Power Cable Pass Fail NA pc

2. ECG Cable Pass Fail NA pc

3. ECG Addhisive Conductive Leads Pass Fail NA pc

4. Finger Probe + Extention Cable Pass Fail NA pc

5. Temperature Probe Pass Fail NA pc

6. Cuff of Adult Neonate Pass Fail NA pc

7. ECG Paper Pass Fail NA pc

9. S O P /Manual Book Pass Fail NA pc

10. Battery/Charger Pass Fail NA pc

Date Customer Checked By,

Start Time
End Time

( ) ( )

PT.GMM - T/R Div

 Check List/Test Reports

A. Customer

Customer Name
Address
Telp/Fax
Contact Person

B. Equipment Data

Equipment Name Bed Side Monitor

Merk Mindray
Type MEC 1000
S/N AQ-76101283

C. On Duty

Date
Place/Room
Technician

Notes

Customers Technician

( ) ( )