AUTOCLAVE HISTORY RECORD SHEET (TYPE N)
[Example: consult Manufacturer’s Instructions for specific safety checks and tests relating to your machine and adapt if required]Sheet Number_____ Month Commencing______________ Sheet End Date______________Sterilizer Test Record (VACUUM / TYPE B)Sterilizer serial number____________________Location__________________Daily tests – week commencing __________ DayChecksPass/FailCycle numberAutomatic Control Test (ACT)Steam Penetration Test Pass/FailSignatureReservoir drained**Values during hold periodCycle timemin:secPass/FailM = manual test*Temp. Deg CPressure BarHold time min:secMonTueWedThuFriSatDaily tests – week commencing __________ DayChecksPass/FailCycle numberAutomatic Control Test (ACT)Steam Penetration Test Pass/FailSignatureReservoir drained**Values during hold periodCycle timemin:secPass/FailM = manual test*Temp. Deg CPressure BarHold time min:secMonTueWedThuFriSatDaily tests – week commencing __________ DayChecksPass/FailCycle numberAutomatic Control Test (ACT)Steam Penetration Test Pass/FailSignatureReservoir drained**Values during hold periodCycle timemin:secPass/FailM = manual test*Temp. Deg CPressure BarHold time min:secMonTueWedThuFriSat*Note – it is recommended that at least once a week the ACT is done manually by directly observing the sterilization temperature and pressure and measuring the hold time with a stopwatch. Note this on the test sheet by placing (M) after Pass/Fail on the day it is conducted.** The reservoir is drained at the end of each day and left to dry overnight. Sterilizer Test Record (VACUUM / TYPE B)Sterilizer serial number____________________ Location__________________Daily tests – week commencing __________ DayChecksPass/FailCycle numberAutomatic Control Test (ACT)Steam Penetration Test Pass/FailSignatureReservoir drained**Values during hold periodCycle timemin:secPass/FailM = manual test*Temp. Deg CPressure BarHold time min:secMonTueWedThuFriSatDaily tests – week commencing __________ DayChecksPass/FailCycle numberAutomatic Control Test (ACT)Steam Penetration Test Pass/FailSignatureReservoir drained**Values during hold periodCycle timemin:secPass/FailM = manual test*Temp. Deg CPressure BarHold time min:secMonTueWedThuFriSat*Note – it is recommended that at least once a week the ACT is done manually by directly observing the sterilization temperature and pressure and measuring the hold time with a stopwatch. Note this on the test sheet by placing (M) after Pass/Fail on the day it is conducted.** The reservoir is drained at the end of each day and left to dry overnight. Weekly safety checks & weekly tests §Dateweek commen-ncingCycle numberSafety Checks Pass/FailTests Pass/FailSignatureOverall Pass/FailDoor sealDoor pressure interlockDoor closed interlock[Other specify]Automatic ControlAutomatic Air LeakageAutomatic Air Detect’n System Function§ Consult Manufacturer’s Instructions for specific safety checks and tests relating to this machine.Next maintenance by Test Person (Sterilizers) due___________________Yearly maintenance and Revalidation by Test Person (Sterilizers) due___________________Pressure Vessel Inspection due___________________ ................
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