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CADD-Prizm
®
Pump Cleaning and Functional Testing Checklist
The following checklist is provided as a guide only to assist in establishing documentation of cleaning and
functional testing for the CADD-Prizm
®
pump. If service is provided, fill out this sheet and return it with the
device.
Serial # _________________ Reference Number _________________________ Date _________________________
(Refer to the Technical Manual procedures.)
I. Cleaning Completed Ⅺ Yes Ⅺ No
II. Visual Inspection
Ⅺ LCD Ⅺ Lock Ⅺ Data In/Out Jack
Ⅺ Occlusion Sensor Seals Ⅺ Cassette Sensors (3) Ⅺ Air Detector or Port Cover
Ⅺ Valves and Expulsors Ⅺ Keyboard Ⅺ Pump Housing
Ⅺ Reservoir Hinge Area Ⅺ Indicator Light Ⅺ Battery Door
Ⅺ Latch Ⅺ Power Jack Ⅺ Battery Compartment
III. Mechanical Inspection
Ⅺ Keyboard Ⅺ Cassette Latch
Ⅺ Battery Door Ⅺ Cassette Lock
IV. Functional Inspection
Ⅺ Power-up Ⅺ RES VOL Alarm Ⅺ Dose Given / Attempted
Ⅺ Latch / Lock Ⅺ Stop / Start Ⅺ MG Given
Ⅺ Cassette Sensor Ⅺ Activation Timing Ⅺ Air Detector
Ⅺ LCD Ⅺ Dose Key Ⅺ Printer Tests
Ⅺ Motor / Gear Train Ⅺ Remote Dose Cord
V. Occlusion Tests (Only need to perform 1 or 2; not both)
Downstream Option 1: Activations Before Alarm ___________
Downstream Option 2: High Pressure Alarm At ____________ psi
Upstream Occlusion Sensor Test
Pass ________ Fail ___________
VI. Accuracy Testing (Only need to perform 1 or 2; not both)
Volumetric Accuaracy Test
Intended Actual Inaccuracy Accuracy Accuracy
Delivery Delivery Volume Error Error
Volume Volume Percentage
ml ml ml %
Gravimetric Accuracy Test
Pre-Delivery Post-Delivery Amount Intended Inaccuracy Accuracy Accuracy
Weights Weight Delivered Delivery Volume Error Error
Volume
g g ml ml ml %