Final Product Inspection of Breathing

Circuit
Form No.: WI-73-01 Issue No.: 01

Test Date: …………………………… Production order #: ………………….

Product Name: ……………………………… Lot #: …………….
Lot Size: …………………. C= No. of conforming units & NC = No. of non-conforming units
Apparatus used (Name & Code) ……………………………………………… Sample Size:………………
Applicable Standards: ISO 5367 For Test Method and acceptance criteria: refer to WI-73

Tube Dimensions Security of Attachment Leakage test Tested Units

SN Visual Inspection
Length Diameter Pass Fail Pass Fail C NC
1. 
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11.

Conclusion: Test Pass Test Fail

Tested by Checked by Checked & Approved by

Title: QC Specialist/ Technician QC Supervisor QC Manager
Date:
Sig./Initial:

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