DateName of Technician Performing MaintenanceFacilityDevice Manufacturer / Model NumberDevice Serial NumberEquipment cleaned following the manufacturer's instructions for use?Was the heater-cooler tubing changed during this cleaning?When was the tubing last changed?If using a LivaNova 3T, was the Aerosol Collection Set changed during this cleaning?H2O2 level measured semi-quantitatively by visual comparison of the reaction zone of a hydrogen peroxide test strip.When was the Aerosol Collection Set last changed?Was a water sample obtained and sent for analysis?Date Water Sample ShippedEdit EntryDelete EntryDownload PDF
DateName of Technician Performing MaintenanceFacilityDevice Manufacturer / Model NumberDevice Serial NumberEquipment cleaned following the manufacturer's instructions for use?Was the heater-cooler tubing changed during this cleaning?When was the tubing last changed?If using a LivaNova 3T, was the Aerosol Collection Set changed during this cleaning?H2O2 level measured semi-quantitatively by visual comparison of the reaction zone of a hydrogen peroxide test strip.When was the Aerosol Collection Set last changed?Was a water sample obtained and sent for analysis?Date Water Sample ShippedEdit EntryDelete EntryDownload PDF
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