Inspection Form for PPM

Validation / Version Date: Authorized Contractor:

Last Date Reviewed:

Unique Reference / Code Number:

Item to be inspected: Ventilator, CPAP/BIPAP-E30

Measuring Measured Auditors

Check List Frequency Remarks PASS FAIL N/A
Levels Value Grading

L H A B C D
Check AC Plug / Receptacles 6 Months
1
2 Check Circuit Breakers / Fuses 6 Months

Check Control panel and Switches 6 Months

3
4 Check AC/DC Power adaptor 6 Months

Check Indicators / LCD Display 6 Months

5
6 Check CPAP Cycle/Trigger 6 Months
Performance
7 Check all the modes 6 Months

8 Verifying the pressure

8.1 CPAP 4 Cm H2O- ( +2.5 Cm H2O) 6 Months
8.1 EPAP 20 Cm H2O- ( +2.5 Cm H2O) 6 Months
8.2 IPAP 30 Cm H2O- ( +2.5 Cm H2O) 6 Months
9 Verifying the alarms
9.1 Patient disconnect alarm test 6 Months
9.2 Apnea alarm test 6 Months
9.3 Low minute ventilation alarm test 6 Months
9.4 Loss of power alarm test 6 Months
10 Air Filter Change 6 Months
11 Humidifier Testing 6 Months
12 Blower Hours 6 Months
13 Perform Electrical Safety Test 12 Months
and Attach the Test Result
14 Clean all the acessories/necessary 6 Months
Parts/Clean the exterior of the unit
and remove all the previous labels,
Update current PPM sticker
15 Mention Spare Parts 6 Months
Replaced If any

SEHA-FMD-BM-001 1 NOV 11
rev 0