Periodic Functional Test Summary Form Page 2/2
Generator SN: ________________
Step
TEST
8
Ground Continuity Value
7
Normal/Closed with Cable
8
Normal/Open with Cable
9
Reverse/Open with Cable
10
Reverse/Closed with Cable
12
Normal/Closed no Cable
13
Normal/Open no Cable
14
Reverse/Open no Cable
15
Reverse/Closed no Cable
10
Impedance 25 Ω/Power 25 W
12
Impedance 25 Ω/Power 35 W
14
Impedance 25 Ω/Power 50 W
19
Impedance 50 Ω/Power 25W
21
Impedance 50 Ω/Power 35W
23
Impedance 50 Ω/Power 50W
28
Impedance 225 Ω/Power 25W
30
Impedance 225 Ω/Power 35W
32
Impedance 225 Ω/Power 50W
Tester Name
Bolder Surgical
REQUIREMENT
Ground Continuity Testing
< .200 ohms
Earth Leakage Testing
< .500 µA
Impedance
21.8 W – 28.2W
30.4W – 39.6W
45.2W – 54.8W
21.8 W – 28.2W
30.4W – 39.6W
45.2W – 54.8W
21.8 W – 28.2W
30.4W – 39.6W
45.2W – 54.8W
Signature
Page | 37
Record
Circle Pass/
Values
Fail
____
P / F
ohms
_____ µA
P / F
_____ µA
P / F
_____ µA
P / F
_____ µA
P / F
_____ µA
P / F
_____ µA
P / F
_____ µA
P / F
_____ µA
P / F
______ W
P / F
______ W
P / F
______ W
P / F
______ W
P / F
______ W
P / F
______ W
P / F
______ W
P / F
______ W
P / F
______ W
P / F
Date
en - CoolSeal™ Generator