PROVINSI JAWA

TENGAH

CHECK LIST PREVENTIVE

MAINTENANCE

RSUD Dr. ADHYATMA, MPH

N. Invent

Building

Model /Type

Room

Serial N.

Interval Maint

Equipment

: Sphygmomanometer

Sub-Unit

Brand

Year : 2014

CHECK LIST MAINTENANCE

1
OK

2
Not OK

OK

Not OK

SAFETY CHECK
1

Cek tahanan ground

Cek kebocoran arus ground pada kondisi normal

**)
**)

MAINTENANCE
1

Bersihkan Unit dari kotoran

Bersihkan Koneksi Kelistrikan

3.

Cek kondisi Manset

Cek kondisi Air Raksa

Cek kondisi Selang tensimeter

Cek fungsi Bola Pompa

Cek kondisi Battrey

PERFORM DATE
EXECUTION TIME
(PPM STANDARD TIME

Hrs.)

TECHNICIAN NAME AND SIGNATURE

USER NAME AND SIGNATURE

OBSERVATIONS :
1. ...............................................................................................................................................................
............................................................................................................................................................
2. ...............................................................................................................................................................
.............................................................................................................................................................
3. ...............................................................................................................................................................
.............................................................................................................................................................

ELECTRICAL SAFETY EVALUATION

(For equipment class I)

No

Measure step

Norm

Measure
unity

22010%

Volts

MONITOR
1

Mains Voltage

Power

-----*

VA

Ground Leakage Current

500

3.1

Single fault condition (Open feed line)

1000

Insulated Resistance between line conductors to ground

Ground Resistance

0.2

Changeable Material
Surface cleaner, Lens cleaner
Contact cleaner, Grease
Flannel / tissue, Brush

Minimum Spare parts

Fuse

Tools and Measuring Equipments

Multimeter
Standard Service Tools
Electrical Safety Analyzer/
Portable Vacuum Cleaner

OBSERVATIONS
1.

2.

RECOMMENDATION

The equipment has no problems. Result of safety test showed no deviation from the required
reference values

The equipment has minor problems that do restrict its use. However they should be corrected as the
preventive measure. Result of safety test showed no deviation from the required reference values

The equipment has major problems. For safety reasons, the equipment may not be used until the
problem has been resolved.

In the equipment evaluation it must not exceed a consume power of 3.5KW.