RSUD MUNYANG KUTE

IPS-RS CHECK LIST PREVENTIVE REDELONG

RSUD MKR MAINTENANCE KABUPATEN BENER MERIAH

Equipment : Bed Patient N. Invent :

Sub-Unit :
Brand : Building :
Model /Type : Room :
Serial N. : Interval Maint :
Year : 2019
CHECK LIST MAINTENANCE
1 2
OK Not OK OK Not OK

SAFETY CHECK
1 Cek tahanan ground **)  
2 Cekke bocoran arus ground pada kondisi normal **)  
MAINTENANCE
1 Periksa Kebersihan Bed Pasien  
2 Periksa Roda Bed Pasien  
3. Periksa Kekuatan Rangka dan Kaki Bed Pasien  
4 Periksa Fungsi Crank  
5 Periksa Apakah Roda Dalam Keadaan Baik  
6 Periksa Fungsi Trail Bed Pasien  
7 Lakukan Uji Kinerja Alat  
 
 
 
 
 
 
 

PERFORM DATE (Tanggal Melakukan)

EXECUTION TIME (Waktu Eksekusi)
(PPM STANDARD TIME Hrs.)
TECHNICIAN NAME AND SIGNATURE
(Nama dan Tanda Tangan Teknisi)
USER NAME AND SIGNATURE
(Nama Pengguna dan Tanda Tangan)
OBSERVATIONS (Pengamatan):
1. ...............................................................................................................................................................
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2. ...............................................................................................................................................................
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3. ...............................................................................................................................................................
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 ELECTRICAL SAFETY EVALUATION
(For equipment class I)

No Measure
Measure step Norm unity 1 2
MONITOR
1 Mains Voltage 22010% Volts
2 Power -----* VA
3 Ground Leakage Current ≤ 500 µA
3.1 Single fault condition (Open feed line) ≤ 1000 µA
4 Insulated Resistance between line conductors to ground 2 M
5 Ground Resistance ≤ 0.2 

Changeable Material Minimum Spare parts Tools and Measuring Equipments

Surface cleaner, Lens cleaner Fuse Multimeter

Contact cleaner, Grease Standard Service Tools
Flannel / tissue, Brush Electrical Safety Analyzer/
Portable Vacuum Cleaner

OBSERVATIONS

1.

2.

RECOMMENDATION 1 2
The equipment has no problems. Result of safety test showed no deviation from the required
reference values  
The equipment has minor problems that do restrict its use. However they should be corrected as the
preventive measure. Result of safety test showed no deviation from the required reference values  
The equipment has major problems. For safety reasons, the equipment may not be used until the
problem has been resolved.  

* In the equipment evaluation it must not exceed a consume power of 3.5KW.