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HTMC PM Procedure No. IN.IN–01 rev 2 .……........…………….INFANT INCUBATOR

(This document was last revised on 7-15-18)
If any part(s) required reconditioning or replacement, or any adjustments or minor repairs were required to bring the device into conformance with its performance and safety specifications, check the box on the left of the relevant statement number, and record what was done, or what was found in the Note box at the foot of the page. ________________________________________________________________________________________________________

[ ] R1. Verify that the device is functional. If it is not, check the box at the left and open a repair work order.__

Visual Inspection (VI) tasks) – predictive maintenance to detect any indications that components are beginning to fail.

[ ] VI1. With power off inspect the entire system for signs of damage, especially any moving parts, including any user-accessible areas that are under covers. Clean as needed. Adjust or replace any loose or damaged parts. Lubricate (if applicable) as required. Rate your finding for this task using the PHYSICAL CONDITION Finding scale described below and note your rating for this task (1, 5 or 9), here: __

[ ] VI2. Confirm that all markings and labeling are legible. Clean or replace, as required. __

[ ] VI3. Check that the physical condition of the power cord and cap, including the strain relief, is OK. Check the auxiliary receptacles (if applicable). Check the circuit breaker/ fuse. __

[ ] VI4. Inspect all cables, electrodes and transducers to confirm integrity and proper function. __ (Serious failure may cause patient injury)

[ ] VI5. Inspect the fan, motor/ pump and the air filter(s) to ensure they are free from any debris that might be reducing proper air flow. __ (Serious failure may cause patient injury)

[ ] VI6. Inspect the heater for discoloration or foreign deposits. __

[ ] VI7. Review the on-board error log/ event history for any unusual indications. __

Device Restoration (DR) tasks – reconditioning or replacement of the device’s non-durable parts. (For specific "how to" instructions, refer to the manufacturer's PM procedure)

[ ] DR1. Check the battery, or replace it if so scheduled. Enter your rating for this task here: __ (If battery replaced per schedule, enter 1; if not scheduled and battery found to be OK enter 5; if not OK enter 9)

  • If battery replacement was not scheduled and it was no longer holding a charge [task rating = 9] this could have resulted in a high severity, life-threatening outcome
Safety Verification (SV) tasks) – to detect and correct any hidden performance/ safety degradations. (For specific "how to" instructions, refer to the manufacturer's PM procedure)

[ ] SV1. If there is exposed metal that could conceivably become energized, check the continuity to ground. (< 0.5 ohm). __ (Serious failure is potentially Life-Threatening)

[ ] SV2. Verify that the battery charging system is operating within specifications. __

[ ] SV3. Verify that the time/ date indication (if applicable) is correct. __

[ ] SV4. Verify the functional performance of all controls, switches, latches, clamps, soft touch keys, etc. __ (Serious failure is potentially Life-Threatening)

[ ] SV5. Verify proper performance of all indicators and displays, in all modes. __ (Serious failure is potentially Life-Threatening)

[ ] SV6. Verify that the temperature control tracks within the specified limits. __ (Serious failure is potentially Life-Threatening)

[ ] SV7. Verify that all alarms operate correctly, in all modes. __ (Serious failure is potentially Life-Threatening)


PERFORMANCE/ SAFETY = A, B, or F (circle one) / Where A= nominal; B= minor OOS condition(s) was found; F= serious OOS condition(s) was found
Write in Task Number(s) where out-of-spec (OOS) B or F conditions were found and provide details in the Note field below.____________

PHYSICAL CONDITION = 1, 5, 9, or 0 (circle one) / Where 1 = better than expected; 5 = nominal; 9 = serious physical deterioration, and 0 = device has no parts needing physical restoration.
Write in Task Number(s) where out-of-spec (OOS) "9" conditions were found and provide details in the Note field below.____________

Note . __________________________________________________________________________________________________

When done make sure controls are set at normal positions and place a CAUTION tag in a prominent position asking the next user to verify control settings, set up and function before use.

If the device passed (grade A1, A5, B1 or B5), attach a new PM sticker indicating the next PM due date.

This is a PM-critical device and it should be removed from service immediately if any of the critical PVST tasks received a failing grade of F (serious out-of-spec condition).

HTMC PM Procedure No. IN.IN–01 rev 2 ............................................... Date: _________ Initials: ________

Disclaimer: This PM procedure may not reference all of the maintenance tasks specified by the manufacturer's technical or user manual. In many instances the manufacturer suggests a number of user-level tasks, such as cleaning or replacing consumables, which need to be completed. These are considered to be outside the scope of this technician-level procedure.

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