Equipment Maintenance Cleaning Log
| Date | Name of Technician Performing Maintenance | Facility | Device Manufacturer / Model Number | Device Serial Number | Is the device being stored empty and free of water? | Equipment 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. | If using a LivaNova 3T, when was the Aerosol Collection Set last changed? | Was a Peroxide (H2O2) analysis performed? | Was the Peroxide (H2O2) concentration greater than 100 ppm? | Was a water sample obtained and sent for analysis? | Date Water Sample Shipped | Notes/Certifications | Edit Entry | Delete Entry | Download PDF |
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| Date | Name of Technician Performing Maintenance | Facility | Device Manufacturer / Model Number | Device Serial Number | Is the device being stored empty and free of water? | Equipment 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. | If using a LivaNova 3T, when was the Aerosol Collection Set last changed? | Was a Peroxide (H2O2) analysis performed? | Was the Peroxide (H2O2) concentration greater than 100 ppm? | Was a water sample obtained and sent for analysis? | Date Water Sample Shipped | Notes/Certifications | Edit Entry | Delete Entry | Download PDF |