CHECKLIST NO:

KEMENTERIAN KESIHATAN MALAYSIA 16861-123

BEMS Planned Preventive Maintenance Checklist
BER
SEKUTU

BER TAM
BAH
MUTU
Baths, Water, Laboratory PPM YTD : ( 1 / 1 )
TYPE CODE : 16-861

PART 1 ASSET DETAILS

WORK ORDER NO ASSET NO

MANUFACTURER Grant Instruments Ltd MODEL Gran t W14-ZA

FREQUENCY 3 MONTHLY ( ) 6 MONTHLY ( ) 12 MONTHLY ( ) PPM HOURS 0.75

PART 2 SPECIAL PRECAUTION

If there is evidence of body fluid contamination, submit the device for cleaning and decontamination before inspecting it.
Wear appropriate Personnel Protection Equipment (PPE) during work.
Wear grounded electrostatic wristband when handling PCB or electronic components.
Refer to the safety procedure for additional precautions and guidance as per manufacturer guidelines.
Make sure the test equipment used are duly calibrated.

PART 3 TEST APPARATUS

Tick ( ) where appropriate

DESCRIPTION ASSET NO / SERIAL NO CALIBRATION DUE ON

ELECTRICAL SAFETY ANALYZER

DIGITAL THERMOMETER
______________________________

______________________________

______________________________

PART 4 QUALITATIVE TASKS

Tick ( ) where appropriate

PASS FAIL NA PASS FAIL NA
1. Chassis - verify physical integrity, 9. Heater assembly - verify operation and
( ) ( ) ( ) ( ) ( ) ( )
cleanliness and condition condition

2. Mount/ Fasteners - verify physical

( ) ( ) ( )
integrity and proper mounting

3. Power Cord - verify proper insulation

( ) ( ) ( )
and integrity

4. Strain Relief - verify physical integrity at

( ) ( ) ( )
both ends of line cord

5. Circuit Breaker/ Fuse - verify integrity of

( ) ( ) ( )
external circuit breaker and/or rating of
external fuse

6. Fittings/ Connectors - check all ( ) ( ) ( )

fittings/connectors

7. Controls/Switches/Keypad - verify
( ) ( ) ( )
proper operation of controls

8. Indicators/ Displays - verify proper

( ) ( ) ( )
illumination and operation

PART 5 PREVENTIVE MAINTENANCE TASKS

Tick ( ) where appropriate

DONE NOT DONE ** NA
1. Cleanliness - Clean Interior and Exterior
( ) ( ) ( )
of the Equipment

Notes:
*For all parts, NA defined as NOT APPLICABLE

**If you have ticked 'NOT DONE', then input relevant remarks in Part 8

***Choose whichever applicable. Please indicate in Part 8 for any part replaced

KKM/BEMS/0634 Version 1.00, 01-Jun-16

 CHECKLIST NO:
KEMENTERIAN KESIHATAN MALAYSIA 16861-123
BER
SEKUTU

BER TAM
BEMS Planned Preventive Maintenance Checklist
BAH
MUTU

Baths, Water, Laboratory PPM YTD : ( 1 / 1 )

TYPE CODE : 16-861

WORK ORDER NO

PART 6 QUANTITATIVE TASKS

Tick ( ) where appropriate

Set Measured
Description UOM Limit/Tolerance PASS FAIL NA
Values Values

1 Temperature accuracy c 37 5% ( ) ( ) ( )

KKM/BEMS/0634 Version 1.00, 01-Jun-16

 CHECKLIST NO:
KEMENTERIAN KESIHATAN MALAYSIA 16861-123
BER
SEKUTU

BER TAM
BEMS Planned Preventive Maintenance Checklist
BAH
MUTU

Baths, Water, Laboratory PPM YTD : ( 1 / 1 )

TYPE CODE : 16-861

WORK ORDER NO

PART 7 ELECTRICAL SAFETY TEST

ELECTRICAL SAFETY TEST, (attach report)

(accordance to MS IEC 60601 / 61010 / 62353 )

PASS FAIL NA

PART 8 NOTES

CORRECTIVE MAINTENANCE REQUIRED FUNCTIONING NOT FUNCTIONING

WORK ORDER NO ____________________________________________ NEXT PPM DATE _________________

PPM has been performed in accordance to the checklist and the equipment is functioning to the intended purpose.
COMPLETED BY :

DATE :

KKM/BEMS/0634 Version 1.00, 01-Jun-16