Note: In the event a device fails any test, has sustained obvious damage, has a missing or illegible specification
badge, or has any indication it may not be fit for intended use, return unit to Smith & Nephew global repair center.
UNIT SERIAL #
Steps
Device cleaning and single-use component removal (performed after each patient use)
1
Device cleaning record is present and/or cleaned
according to this procedure.
2
Inlet port and air exhaust port are free from obstructions,
dust or foreign materials.
3
Existing O-ring and odor filters are removed.
4
Inlet port and air exhaust port cleaned.
5
All external surfaces of the device, power cord
and power supply are cleaned with recommended
antimicrobial disposable wipes.
Single-use component replacement (performed after each patient use)
6
New O-ring correctly fitted on inlet port.
7
Two (2) odor filters placed within odor filter door.
Device physical appearance check (performed after each patient use)
8
Device is unplugged and placed on flat surface.
9
Device is free of damage, cracks or missing pieces .
10
Buttons and indicator lights below display screen
and display itself are undamaged.
11
Inlet port is undamaged.
12
AC mains power inlet is undamaged.
13
Carry strap pins are present and secure.
14
Power cord is not fraying, missing insulation, and has
no bent, loose or missing plug blades or earth/ground.
15
Power supply cord is not fraying, missing insulation,
and DC plug is not bent, loose or missing.
16
Device is free from rattles indicating loose components.
17
The device specification badge is present and REF
and SN numbers are clearly visible.
18
The power supply labels are present and clearly visible.
Functionality check - Operations check (performed after each patient use)
19
All indicator lights and status/alarm indicator flash
briefly as AC mains power is connected.
20
When AC mains power is connected the battery
indicator light flashes green or illuminates solid
green if battery is fully charged.
21
Screen display shows "Welcome, Starting", current
software version, and changes to "Standby" and
therapy set-point after powering on.
Record the software version under comments.
Service and maintenance sample checklist
Yes No
Comments
Date (mm/dd/yyyy):
Date (mm/dd/yyyy):
REF:
REF:
Version:
15
SN:
SN: