Attachment I COA (W) RAP Med Equip Inventory~3.pdf

STAT Bio-Medical certifies that the equipment included in the Bi - Annual Electrical Safety Inspection has been tested and/or calibrated using software and instrumentation producing traceable results as outlined by the National Institute Of Standards and Technology (NIST). Evidence of Traceability is on file at our corporate service center.

Acct: 20490 60 Hodges Ave

Taunton MA 02780

Bi - Annual Electrical Safety Inspection Record: 10329

Completion Date: 12/12/2023 Due Date: 6/12/2024

CERTIFICATE OF INSPECTION

STAT Bio-Medical

RECOVERY FOR ADDICTIONS PROGRAM - W-RAP

If you have questions in regards to our testing or need service for your medical equipment, please contact us at (508) 923-8701 bill@statbiomedical.net

Continued on Next Page

If Blank - Electrical Safety Test Not Performed

Electrical Safety Test Results

Inspections Performed Visual

AED

Tag Number: 0753514 Manufacturer: Zoll Model: AEDPlus Serial: 010084794600224421X21H395454 Medical Risk Factor: 1

Entry Type Inspd/Tstd

Notes Pad Date:

2026-10-03

Location 3rd Floor Laundry Room

Result Pass

CERTIFICATE OF INSPECTION

Inspections Performed

EST: NA

NIBP: NA

Sp02: NA EKG Wave: NA Calibration: NA Performance: NA Visual: Pad Date Expires - ##/##/##

Inspection Notes

AED Tag Number: 0753514

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Calibratio n

Performance Visua l

Result: Pass

Electrical Safety Test Results

Inspections Performed Visual

AED

Tag Number: 0753852 Manufacturer: Zoll Model: AEDPlus Serial: 010084794600224421X21H395314 Medical Risk Factor: 1

Entry Type Inspd/Tstd

Notes Pad Date:

2026-10-03

Location Code Cart

Result

NIBP: NA

Sp02: NA EKG Wave: NA Calibration: NA Performance: NA Visual: Pad Date Expires - ##/##/##

Inspection Notes

AED Tag Number: 0753852

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Calibratio n

Performance Visua

Electrical Safety Test Results

Inspections Performed Visual

AED

Tag Number: 0753856 Manufacturer: Zoll Model: AEDPlus Serial: 010084794600224421X21H395269 Medical Risk Factor: 1

Entry Type Inspd/Tstd

Notes Pad Date:

2026-10-17

Location Code Cart 02

Result

NIBP: NA

Sp02: NA EKG Wave: NA Calibration: NA Performance: NA Visual: Pad Date Expires - ##/##/##

Inspection Notes

AED Tag Number: 0753856

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Asset Test Image

Electrica l

Calibratio n

Performance Visua

STAT Bio-Medical Mobilize App Report Facility: Recovery for Addictions Program - W-RAP Technician: Sydney Asset ID: 0752525 Test Eqpt Model: Safe-T ST-1 S/N 3756 Last Cal: 06/02/23 Electrical Safety Test Profile: EST NO SW Date/Time: 2023/12/12 09:55 AC Voltage: 125 V Peak Load Current: 0.1 A Gnd Resist:

PASS Test Gnd = 3 mOhm (<500 mOhm) Norm Pol Earth Leak:

PASS Norm Cond = 3 uA (< 500 uA) Norm Pol Chassis Leak:

PASS Norm Cond = 0 uA (< 100 uA) PASS Open Gnd = 3 uA (< 500 uA) < Electrical Safety Overall Result: PASS >

Electrical Safety Test Results

Inspections Performed Performance Electrical

Bike Tag Number: 0752525 Manufacturer: BH Model: LK Series Serial: X150636 Medical Risk Factor: 2

Entry Type Inspd/Tstd

Location Exercise Room

Result

EST: Electrical Safety Test utilizing Certified Testing Devices. See results enclosed.

NIBP: NA

Sp02: NA EKG Wave: NA Calibration: NA Performance: NA Visual: NA

Inspection Notes

Bike Tag Number: 0752525

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Asset Test Image

Electrica l

Calibratio n

Performance Visua

Facility: Recovery for Addictions Program - W-RAP Technician: Sydney Asset ID: 0752942 Test Eqpt Model: Safe-T ST-1 S/N 3756 Last Cal: 06/02/23 Electrical Safety Test Profile: EST NO SW Date/Time: 2023/12/12 09:15 AC Voltage: 125 V Peak Load Current: 0.1 A Gnd Resist:

PASS Test Gnd = 0 mOhm (<500 mOhm) Norm Pol Earth Leak:

PASS Norm Cond = 3 uA (< 500 uA) Norm Pol Chassis Leak:

PASS Norm Cond = 0 uA (< 100 uA) PASS Open Gnd = 3 uA (< 500 uA) < Electrical Safety Overall Result: PASS >

Electrical Safety Test Results

Inspections Performed Performance Electrical

Bike Tag Number: 0752942 Manufacturer: BH Model: LK Series Serial: N/A Medical Risk Factor: 2

Entry Type Inspd/Tstd

Location Exercise Room 02

Result

NIBP: NA

Sp02: NA EKG Wave: NA Calibration: NA Performance: NA Visual: NA

Inspection Notes

Bike Tag Number: 0752942

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Asset Test Image

Electrica l

Calibratio n

Performance Visua

Electrical Safety Test Results

Inspections Performed Performance Visual

Blood Pressure - Gauge - Handheld Tag Number: 0752522 Manufacturer: ADC Model: certified Serial: 16797625 Medical Risk Factor: 3

Entry Type Inspd/Tstd

Location Exam Room

Result Pass

BP Gauge Calibration

0 mm

ActualExpct'd Tolerance

+/- 3 mm

50 mm +/- 3 mm

100 mm +/- 3 mm

200 mm +/- 3 mm

300 mm +/- 3 mm

NIBP: Blood Pressure Simulation was performed. See Test Results.

Sp02: NA EKG Wave: NA Calibration: Adjusted to manufacturer Specifications.

Performance: Blood Pressure Performance Testing.

Visual: Inspected case, gauge, tubing, and cuff.

Inspection Notes

Blood Pressure - Gauge - Handheld Tag Number: 0752522

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Asset Test Image

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Calibratio n

Performance Visua

Electrical Safety Test Results

Inspections Performed Performance Visual

Blood Pressure - Gauge - Handheld Tag Number: 0752543 Manufacturer: ADC Model: certified Serial: 17819026 Medical Risk Factor: 3

Entry Type Inspd/Tstd

Location Laundry Room 02

Result Pass

BP Gauge Calibration

0 mm

ActualExpct'd Tolerance

+/- 3 mm

50 mm +/- 3 mm

100 mm +/- 3 mm

200 mm +/- 3 mm

NIBP: Blood Pressure Simulation was performed. See Test Results.

Sp02: NA EKG Wave: NA Calibration: Adjusted to manufacturer Specifications.

Performance: Blood Pressure Performance Testing.

Visual: Inspected case, gauge, tubing, and cuff.

Inspection Notes

Blood Pressure - Gauge - Handheld Tag Number: 0752543

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Asset Test Image

Electrica l

Calibratio n

Performance Visua

Electrical Safety Test Results

Inspections Performed Performance Visual

Blood Pressure - Gauge - Handheld Tag Number: 0752946 Manufacturer: ADC Model: BP Serial: 3684 Medical Risk Factor: 3

Entry Type Inspd/Tstd

Location Exam Room

Result Pass

BP Gauge Calibration

0 mm

ActualExpct'd Tolerance

+/- 3 mm

50 mm +/- 3 mm

100 mm +/- 3 mm

200 mm +/- 3 mm

NIBP: Blood Pressure Simulation was performed. See Test Results.

Sp02: NA EKG Wave: NA Calibration: Adjusted to manufacturer Specifications.

Performance: Blood Pressure Performance Testing.

Visual: Inspected case, gauge, tubing, and cuff.

Inspection Notes

Blood Pressure - Gauge - Handheld Tag Number: 0752946

If Blank - No Asset Image Acguired

Asset Test Image

Electrica l

Calibratio n

Performance Visua

Electrical Safety Test Results

Inspections Performed Performance Visual

Blood Pressure - Gauge - Handheld Tag Number: 0752943 Manufacturer: ADC Model: BP Serial: 150113499 Medical Risk Factor: 3

Entry Type Inspd/Tstd

Location Code Cart

Result Pass

BP Gauge Calibration

0 mm

ActualExpct'd Tolerance

+/- 3 mm

50 mm +/- 3 mm

100 mm +/- 3 mm

200 mm +/- 3 mm

NIBP: Blood Pressure Simulation was performed. See Test Results.

Sp02: NA EKG Wave: NA Calibration: Adjusted to manufacturer Specifications.

Performance: Blood Pressure Performance Testing.

Visual: Inspected case, gauge, tubing, and cuff.

Inspection Notes

Blood Pressure - Gauge - Handheld Tag Number: 0752943

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Asset Test Image

Electrica l

Calibratio n

Performance Visua

Electrical Safety Test Results

Inspections Performed Performance Visual

Blood Pressure - Gauge - Handheld Tag Number: 0753855 Manufacturer: ADC Model: BP Serial: N/A Medical Risk Factor: 3

Entry Type Inspd/Tstd

Location Exam Room 02

Result Pass

BP Gauge Calibration

0 mm

ActualExpct'd Tolerance

+/- 3 mm

50 mm +/- 3 mm

100 mm +/- 3 mm

200 mm +/- 3 mm

NIBP: Blood Pressure Simulation was performed. See Test Results.

Sp02: NA EKG Wave: NA Calibration: Adjusted to manufacturer Specifications.

Performance: Blood Pressure Performance Testing.

Visual: Inspected case, gauge, tubing, and cuff.

Inspection Notes

Blood Pressure - Gauge - Handheld Tag Number: 0753855

If Blank - No Asset Image Acguired

Asset Test Image

Electrica l

Calibratio n

Performance Visua

Electrical Safety Test Results

Inspections Performed Performance Visual

Blood Pressure - Gauge - Handheld Tag Number: 0757247 Manufacturer: ADC Model: sphygmomanometer Serial: 21336993 Medical Risk Factor: 3

Entry Type Inspd/Tstd

Location Exam Room

Result Pass

BP Gauge Calibration

0 mm

ActualExpct'd Tolerance

+/- 3 mm

50 mm +/- 3 mm

100 mm +/- 3 mm

200 mm +/- 3 mm

NIBP: Blood Pressure Simulation was performed. See Test Results.

Sp02: NA EKG Wave: NA Calibration: Adjusted to manufacturer Specifications.

Performance: Blood Pressure Performance Testing.

Visual: Inspected case, gauge, tubing, and cuff.

Inspection Notes

Blood Pressure - Gauge - Handheld Tag Number: 0757247

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Asset Test Image

Electrica l

Calibratio n

Performance Visua

Electrical Safety Test Results

Inspections Performed Performance Visual

Blood Pressure - Gauge - Handheld Tag Number: 0757344 Manufacturer: ADC Model: Cerified Serial: N/A Medical Risk Factor: 3

Entry Type Inspd/Tstd

Location 3rd Floor Med Room

Result Pass

BP Gauge Calibration

0 mm

ActualExpct'd Tolerance

+/- 3 mm

50 mm +/- 3 mm

100 mm +/- 3 mm

200 mm +/- 3 mm

NIBP: Blood Pressure Simulation was performed. See Test Results.

Sp02: NA EKG Wave: NA Calibration: Adjusted to manufacturer Specifications.

Performance: Blood Pressure Performance Testing.

Visual: Inspected case, gauge, tubing, and cuff.

Inspection Notes

Blood Pressure - Gauge - Handheld Tag Number: 0757344

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Asset Test Image

Electrica l

Calibratio n

Performance Visua

Electrical Safety Test Results

Inspections Performed Performance Visual

Blood Pressure - Gauge - Handheld Tag Number: 0757345 Manufacturer: ADC Model: Cerified Serial: N/A Medical Risk Factor: 3

Entry Type Inspd/Tstd

Location 3rd Floor Med Room

Result Pass

BP Gauge Calibration

0 mm

ActualExpct'd Tolerance

+/- 3 mm

50 mm +/- 3 mm

100 mm +/- 3 mm

200 mm +/- 3 mm

NIBP: Blood Pressure Simulation was performed. See Test Results.

Sp02: NA EKG Wave: NA Calibration: Adjusted to manufacturer Specifications.

Performance: Blood Pressure Performance Testing.

Visual: Inspected case, gauge, tubing, and cuff.

Inspection Notes

Blood Pressure - Gauge - Handheld Tag Number: 0757345

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Asset Test Image

Electrica l

Calibratio n

Performance Visua

Electrical Safety Test Results

Inspections Performed Performance Visual

Blood Pressure - Gauge - Handheld Tag Number: 0757346 Manufacturer: ADC Model: Certified Serial: N/A Medical Risk Factor: 3

Entry Type Inspd/Tstd

Location 3rd Floor Med Room

Result Pass

BP Gauge Calibration

0 mm

ActualExpct'd Tolerance

+/- 3 mm

50 mm +/- 3 mm

100 mm +/- 3 mm

200 mm +/- 3 mm

NIBP: Blood Pressure Simulation was performed. See Test Results.

Sp02: NA EKG Wave: NA Calibration: Adjusted to manufacturer Specifications.

Performance: Blood Pressure Performance Testing.

Visual: Inspected case, gauge, tubing, and cuff.

Inspection Notes

Blood Pressure - Gauge - Handheld Tag Number: 0757346

If Blank - No Asset Image Acguired

Asset Test Image

Electrica l

Calibratio n

Performance Visua

Electrical Safety Test Results

Inspections Performed Performance Visual

Blood Pressure - Gauge - Handheld Tag Number: 0757349 Manufacturer: ADC Model: Certified Serial: N/A Medical Risk Factor: 3

Entry Type Inspd/Tstd

Location 3rd Floor Med Room

Result Pass

BP Gauge Calibration

0 mm

ActualExpct'd Tolerance

+/- 3 mm

50 mm +/- 3 mm

100 mm +/- 3 mm

200 mm +/- 3 mm

NIBP: Blood Pressure Simulation was performed. See Test Results.

Sp02: NA EKG Wave: NA Calibration: Adjusted to manufacturer Specifications.

Performance: Blood Pressure Performance Testing.

Visual: Inspected case, gauge, tubing, and cuff.

Inspection Notes

Blood Pressure - Gauge - Handheld Tag Number: 0757349

If Blank - No Asset Image Acguired

Asset Test Image

Electrica l

Calibratio n

Performance Visua

Electrical Safety Test Results

Inspections Performed Performance Visual

Blood Pressure - Gauge - Handheld Tag Number: 0758859 Manufacturer: ADC Model: Sphygmomanometer Serial: 21320919 Medical Risk Factor: 3

Entry Type Inspd/Tstd

Location Exam Room

Result Pass

BP Gauge Calibration

0 mm

ActualExpct'd Tolerance

+/- 3 mm

50 mm +/- 3 mm

100 mm +/- 3 mm

200 mm +/- 3 mm

NIBP: Blood Pressure Simulation was performed. See Test Results.

Sp02: NA EKG Wave: NA Calibration: Adjusted to manufacturer Specifications.

Performance: Blood Pressure Performance Testing.

Visual: Inspected case, gauge, tubing, and cuff.

Inspection Notes

Blood Pressure - Gauge - Handheld Tag Number: 0758859

If Blank - No Asset Image Acguired

Asset Test Image

Electrica l

Calibratio n

Performance Visua

Electrical Safety Test Results

Inspections Performed Performance Visual

Blood Pressure - Gauge - Handheld Tag Number: 0758858 Manufacturer: ADC Model: sphygmomanometer Serial: 21335695 Medical Risk Factor: 3

Entry Type Inspd/Tstd

Location Exam Room

Result Pass

BP Gauge Calibration

0 mm

ActualExpct'd Tolerance

+/- 3 mm

50 mm +/- 3 mm

100 mm +/- 3 mm

200 mm +/- 3 mm

NIBP: Blood Pressure Simulation was performed. See Test Results.

Sp02: NA EKG Wave: NA Calibration: Adjusted to manufacturer Specifications.

Performance: Blood Pressure Performance Testing.

Visual: Inspected case, gauge, tubing, and cuff.

Inspection Notes

Blood Pressure - Gauge - Handheld Tag Number: 0758858

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Asset Test Image

Electrica l

Calibratio n

Performance Visua

Electrical Safety Test Results

Inspections Performed Performance Visual

Blood Pressure - Gauge - Wall Mounted Tag Number: 0753530 Manufacturer: Hillrom Model: Wall Mount Serial: 211228142700 Medical Risk Factor: 3

Entry Type Inspd/Tstd

Location 3rd Floor Exam Room

Result Pass

BP Gauge Calibration

0 mm

ActualExpct'd Tolerance

+/- 3 mm

50 mm +/- 3 mm

100 mm +/- 3 mm

200 mm +/- 3 mm

NIBP: Blood Pressure Simulation was performed. See Test Results.

Sp02: NA EKG Wave: NA Calibration: NA Performance: Blood Pressure Performance Testing Visual: NA

Inspection Notes

Blood Pressure - Gauge - Wall Mounted Tag Number: 0753530

If Blank - No Asset Image Acguired

Asset Test Image

Electrica l

Calibratio n

Performance Visua

Facility: Recovery for Addictions Program - W-RAP Technician: Sydney Asset ID: 0752517 Test Eqpt Model: Safe-T ST-1 S/N 3756 Last Cal: 06/02/23 Electrical Safety Test Profile: EST NO GD NO SW Date/Time: 2023/12/12 10:10 AC Voltage: 125 V Peak Load Current: 0.1 A Norm Pol Earth Leak:

PASS Norm Cond = 9 uA (< 500 uA) Norm Pol Chassis Leak:

PASS Norm Cond = 0 uA (< 100 uA) PASS Open Gnd = 9 uA (< 500 uA) < Electrical Safety Overall Result: PASS >

Electrical Safety Test Results

Inspections Performed Electrical

Exam Light Tag Number: 0752517 Manufacturer: Welch Allyn Model: GS300 Serial: N/A Medical Risk Factor: 3

Entry Type Inspd/Tstd

Location Exam Room

Result

NIBP: NA

Sp02: NA EKG Wave: NA Calibration: NA Performance: NA Visual: NA

Inspection Notes

Exam Light Tag Number: 0752517

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Asset Test Image

Electrica l

Calibratio n

Performance Visua

Facility: Recovery for Addictions Program - W-RAP Technician: Sydney Asset ID: 0752533 Test Eqpt Model: Safe-T ST-1 S/N 3756 Last Cal: 06/02/23 Electrical Safety Test Profile: EST NO GD NO SW Date/Time: 2023/12/12 09:29 AC Voltage: 125 V Peak Load Current: 0.1 A Norm Pol Earth Leak:

PASS Norm Cond = 88 uA (< 500 uA) Norm Pol Chassis Leak:

PASS Norm Cond = 0 uA (< 100 uA) PASS Open Gnd = 88 uA (< 500 uA) < Electrical Safety Overall Result: PASS >

Electrical Safety Test Results

Inspections Performed Electrical

Exam Light Tag Number: 0752533 Manufacturer: Welch Allyn Model: GS300 Serial: N/A Medical Risk Factor: 3

Entry Type Inspd/Tstd

Location Exam Room 02

Result

NIBP: NA

Sp02: NA EKG Wave: NA Calibration: NA Performance: NA Visual: NA

Inspection Notes

Exam Light Tag Number: 0752533

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Asset Test Image

Electrica l

Calibratio n

Performance Visua

Facility: Recovery for Addictions Program - W-RAP Technician: Sydney Asset ID: 0752548 Test Eqpt Model: Safe-T ST-1 S/N 3756 Last Cal: 06/02/23 Electrical Safety Test Profile: EST NO GD NO SW Date/Time: 2023/12/12 10:58 AC Voltage: 123 V Peak Load Current: 0.1 A Norm Pol Earth Leak:

PASS Norm Cond = 86 uA (< 500 uA) Norm Pol Chassis Leak:

PASS Norm Cond = 2 uA (< 100 uA) PASS Open Gnd = 3 uA (< 500 uA) < Electrical Safety Overall Result: PASS >

Electrical Safety Test Results

Inspections Performed Electrical

Exam Light Tag Number: 0752548 Manufacturer: Welch Allyn Model: GS300 Serial: N/A Medical Risk Factor: 3

Entry Type Inspd/Tstd

Location 3rd Floor Exam Room

Result

NIBP: NA

Sp02: NA EKG Wave: NA Calibration: NA Performance: NA Visual: NA

Inspection Notes

Exam Light Tag Number: 0752548

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Asset Test Image

Electrica l

Calibratio n

Performance Visua

Facility: Recovery for Addictions Program - W-RAP Technician: Sydney Asset ID: 0752518 Test Eqpt Model: Safe-T ST-1 S/N 3756 Last Cal: 06/02/23 Electrical Safety Test Profile: EST NO SW Date/Time: 2023/12/12 10:09 AC Voltage: 125 V Peak Load Current: 0.1 A Gnd Resist:

PASS Test Gnd = 0 mOhm (<500 mOhm) Norm Pol Earth Leak:

PASS Norm Cond = 235 uA (< 500 uA) Norm Pol Chassis Leak:

PASS Norm Cond = 0 uA (< 100 uA) PASS Open Gnd = 235 uA (< 500 uA) < Electrical Safety Overall Result: PASS >

Electrical Safety Test Results

Inspections Performed Electrical

Exam Table Tag Number: 0752518 Manufacturer: Ritter Model: 223 Serial: V1747720 Medical Risk Factor: 3

Entry Type Inspd/Tstd

Location Exam Room

Result

NIBP: NA

Sp02: NA EKG Wave: NA Calibration: NA Performance: NA Visual: NA

Inspection Notes

Exam Table Tag Number: 0752518

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Asset Test Image

Electrica l

Calibratio n

Performance Visua

Facility: Recovery for Addictions Program - W-RAP Technician: Sydney Asset ID: 0752534 Test Eqpt Model: Safe-T ST-1 S/N 3756 Last Cal: 06/02/23 Electrical Safety Test Profile: EST NO SW Date/Time: 2023/12/12 09:26 AC Voltage: 125 V Peak Load Current: 0.4 A Gnd Resist:

PASS Test Gnd = 0 mOhm (<500 mOhm) Norm Pol Earth Leak:

PASS Norm Cond = 229 uA (< 500 uA) Norm Pol Chassis Leak:

PASS Norm Cond = 0 uA (< 100 uA) PASS Open Gnd = 229 uA (< 500 uA) < Electrical Safety Overall Result: PASS >

Electrical Safety Test Results

Inspections Performed Electrical

Exam Table Tag Number: 0752534 Manufacturer: Ritter Model: 223 Serial: V1747717 Medical Risk Factor: 3

Entry Type Inspd/Tstd

Location Exam Room 02

Result

NIBP: NA

Sp02: NA EKG Wave: NA Calibration: NA Performance: NA Visual: NA

Inspection Notes

Exam Table Tag Number: 0752534

If Blank - No Asset Image Acguired

Asset Test Image

Electrica l

Calibratio n

Performance Visua

Facility: Recovery for Addictions Program - W-RAP Technician: Sydney Asset ID: 0752545 Test Eqpt Model: Safe-T ST-1 S/N 3756 Last Cal: 06/02/23 Electrical Safety Test Profile: EST NO SW Date/Time: 2023/12/12 10:55 AC Voltage: 123 V Peak Load Current: 0.7 A Gnd Resist:

PASS Test Gnd = 0 mOhm (<500 mOhm) Norm Pol Earth Leak:

PASS Norm Cond = 208 uA (< 500 uA) Norm Pol Chassis Leak:

PASS Norm Cond = 0 uA (< 100 uA) PASS Open Gnd = 208 uA (< 500 uA) < Electrical Safety Overall Result: PASS >

Electrical Safety Test Results

Inspections Performed Electrical

Exam Table Tag Number: 0752545 Manufacturer: Ritter Model: 222 Serial: N/A Medical Risk Factor: 3

Entry Type Inspd/Tstd

Location 3rd Floor Exam Room

Result

NIBP: NA

Sp02: NA EKG Wave: NA Calibration: NA Performance: NA Visual: NA

Inspection Notes

Exam Table Tag Number: 0752545

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Asset Test Image

Electrica l

Calibratio n

Performance Visua

Facility: Recovery for Addictions Program - W-RAP Technician: Sydney Asset ID: 0752537 Test Eqpt Model: Safe-T ST-1 S/N 3756 Last Cal: 06/02/23 Electrical Safety Test Profile: EST NO SW Date/Time: 2023/12/12 09:50 AC Voltage: 126 V Peak Load Current: 0.1 A Gnd Resist:

PASS Test Gnd = 0 mOhm (<500 mOhm) Norm Pol Earth Leak:

PASS Norm Cond = 3 uA (< 500 uA) Norm Pol Chassis Leak:

PASS Norm Cond = 0 uA (< 100 uA) PASS Open Gnd = 3 uA (< 500 uA) < Electrical Safety Overall Result: PASS >

Electrical Safety Test Results

Inspections Performed Electrical

Hospital Bed Tag Number: 0752537 Manufacturer: Stryker Model: CHG Serial: N/A Medical Risk Factor: 3

Entry Type Inspd/Tstd

Location Room S1117

Result

NIBP: NA

Sp02: NA EKG Wave: NA Calibration: NA Performance: NA Visual: NA

Inspection Notes

Hospital Bed Tag Number: 0752537

If Blank - No Asset Image Acguired

Asset Test Image

Electrica l

Calibratio n

Performance Visua

Facility: Recovery for Addictions Program - W-RAP Technician: Sydney Asset ID: 0752538 Test Eqpt Model: Safe-T ST-1 S/N 3756 Last Cal: 06/02/23 Electrical Safety Test Profile: EST NO SW Date/Time: 2023/12/12 09:52 AC Voltage: 125 V Peak Load Current: 0.2 A Gnd Resist:

PASS Test Gnd = 0 mOhm (<500 mOhm) Norm Pol Earth Leak:

PASS Norm Cond = 43 uA (< 500 uA) Norm Pol Chassis Leak:

PASS Norm Cond = 0 uA (< 100 uA) PASS Open Gnd = 43 uA (< 500 uA) < Electrical Safety Overall Result: PASS >

Electrical Safety Test Results

Inspections Performed Electrical

Hospital Bed Tag Number: 0752538 Manufacturer: Stryker Model: CHG Serial: N/A Medical Risk Factor: 3

Entry Type Inspd/Tstd

Location Room S1116

Result

NIBP: NA

Sp02: NA EKG Wave: NA Calibration: NA Performance: NA Visual: NA

Inspection Notes

Hospital Bed Tag Number: 0752538

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Asset Test Image

Electrica l

Calibratio n

Performance Visua

Facility: Recovery for Addictions Program - W-RAP Technician: Sydney Asset ID: 0753519 Test Eqpt Model: Safe-T ST-1 S/N 3756 Last Cal: 06/02/23 Electrical Safety Test Profile: EST NO SW Date/Time: 2023/12/12 11:33 AC Voltage: 124 V Peak Load Current: 0.1 A Gnd Resist:

PASS Test Gnd = 0 mOhm (<500 mOhm) Norm Pol Earth Leak:

PASS Norm Cond = 3 uA (< 500 uA) Norm Pol Chassis Leak:

PASS Norm Cond = 0 uA (< 100 uA) PASS Open Gnd = 3 uA (< 500 uA) < Electrical Safety Overall Result: PASS >

Electrical Safety Test Results

Inspections Performed Electrical

Hospital Bed Tag Number: 0753519 Manufacturer: CHG Model: Hospital Bed Serial: N/A Medical Risk Factor: 3

Entry Type Inspd/Tstd

Location 3rd Floor Room 328

Result

NIBP: NA

Sp02: NA EKG Wave: NA Calibration: NA Performance: NA Visual: NA

Inspection Notes

Hospital Bed Tag Number: 0753519

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Asset Test Image

Electrica l

Calibratio n

Performance Visua

Facility: Recovery for Addictions Program - W-RAP Technician: Sydney Asset ID: 0753520 Test Eqpt Model: Safe-T ST-1 S/N 3756 Last Cal: 06/02/23 Electrical Safety Test Profile: EST NO SW Date/Time: 2023/12/12 11:48 AC Voltage: 123 V Peak Load Current: 0.2 A Gnd Resist:

PASS Test Gnd = 0 mOhm (<500 mOhm) Norm Pol Earth Leak:

PASS Norm Cond = 41 uA (< 500 uA) Norm Pol Chassis Leak:

PASS Norm Cond = 0 uA (< 100 uA) PASS Open Gnd = 40 uA (< 500 uA) < Electrical Safety Overall Result: PASS >

Electrical Safety Test Results

Inspections Performed Electrical

Hospital Bed Tag Number: 0753520 Manufacturer: CHG Model: Hospital Bed Serial: N/A Medical Risk Factor: 3

Entry Type Inspd/Tstd

Location 3rd Floor Room 327B1

Result

NIBP: NA

Sp02: NA EKG Wave: NA Calibration: NA Performance: NA Visual: NA

Inspection Notes

Hospital Bed Tag Number: 0753520

If Blank - No Asset Image Acguired

Asset Test Image

Electrica l

Calibratio n

Performance Visua

Facility: Recovery for Addictions Program - W-RAP Technician: Sydney Asset ID: 0757252 Test Eqpt Model: Safe-T ST-1 S/N 3756 Last Cal: 06/02/23 Electrical Safety Test Profile: EST NO SW Date/Time: 2023/12/12 10:36 AC Voltage: 125 V Peak Load Current: 0.7 A Gnd Resist:

PASS Test Gnd = 0 mOhm (<500 mOhm) Norm Pol Earth Leak:

PASS Norm Cond = 40 uA (< 500 uA) Norm Pol Chassis Leak:

PASS Norm Cond = 0 uA (< 100 uA) PASS Open Gnd = 40 uA (< 500 uA) < Electrical Safety Overall Result: PASS >

Electrical Safety Test Results

Inspections Performed Electrical

Hospital Bed Tag Number: 0757252 Manufacturer: CHC Model: Hospital Bed Serial: N/A Medical Risk Factor: 3

Entry Type Inspd/Tstd

Location Room 117B

Result

NIBP: NA

Sp02: NA EKG Wave: NA Calibration: NA Performance: NA Visual: NA

Inspection Notes

Hospital Bed Tag Number: 0757252

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Asset Test Image

Electrica l

Calibratio n

Performance Visua

Facility: Recovery for Addictions Program - W-RAP Technician: Sydney Asset ID: 0752526 Test Eqpt Model: Safe-T ST-1 S/N 3756 Last Cal: 06/02/23 Electrical Safety Test Profile: EST NO SW Date/Time: 2023/12/12 10:39 AC Voltage: 125 V Peak Load Current: 0.1 A Gnd Resist:

PASS Test Gnd = 0 mOhm (<500 mOhm) Norm Pol Earth Leak:

PASS Norm Cond = 3 uA (< 500 uA) Norm Pol Chassis Leak:

PASS Norm Cond = 0 uA (< 100 uA) PASS Open Gnd = 3 uA (< 500 uA) < Electrical Safety Overall Result: PASS >

Electrical Safety Test Results

Inspections Performed Electrical

Hospital Bed Tag Number: 0752526 Manufacturer: Stryker Model: CHG Serial: N/A Medical Risk Factor: 3

Entry Type Inspd/Tstd

Location Room N110

Result

NIBP: NA

Sp02: NA EKG Wave: NA Calibration: NA Performance: NA Visual: NA

Inspection Notes

Hospital Bed Tag Number: 0752526

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Facility: Recovery for Addictions Program - W-RAP Technician: Sydney Asset ID: 0752513 Test Eqpt Model: Safe-T ST-1 S/N 3756 Last Cal: 06/02/23 Electrical Safety Test Profile: EST NO SW Date/Time: 2023/12/12 10:01 AC Voltage: 125 V Peak Load Current: 0.1 A Gnd Resist:

PASS Test Gnd = 0 mOhm (<500 mOhm) Norm Pol Earth Leak:

PASS Norm Cond = 3 uA (< 500 uA) Norm Pol Chassis Leak:

PASS Norm Cond = 0 uA (< 100 uA) PASS Open Gnd = 3 uA (< 500 uA) < Electrical Safety Overall Result: PASS >

Electrical Safety Test Results

Inspections Performed Electrical

Medicine Sorting System Tag Number: 0752513 Manufacturer: Omnicell Model: Full size Serial: 132105 Medical Risk Factor: 4

Entry Type Inspd/Tstd

Location Medicine Room

Result

NIBP: NA

Sp02: NA EKG Wave: NA Calibration: NA Performance: NA Visual: NA

Inspection Notes

Medicine Sorting System Tag Number: 0752513

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Facility: Recovery for Addictions Program - W-RAP Technician: Sydney Asset ID: 0752941 Test Eqpt Model: Safe-T ST-1 S/N 3756 Last Cal: 06/02/23 Electrical Safety Test Profile: EST NO SW Date/Time: 2023/12/12 09:19 AC Voltage: 125 V Peak Load Current: 0.1 A Gnd Resist:

PASS Test Gnd =364 mOhm (<500 mOhm) Norm Pol Earth Leak:

PASS Norm Cond = 3 uA (< 500 uA) Norm Pol Chassis Leak:

PASS Norm Cond = 2 uA (< 100 uA) PASS Open Gnd = 3 uA (< 500 uA) < Electrical Safety Overall Result: PASS >

Electrical Safety Test Results

Inspections Performed Electrical

Medicine Sorting System Tag Number: 0752941 Manufacturer: Omnicell Model: Full Size Serial: /A Medical Risk Factor: 4

Entry Type Inspd/Tstd

Location Medicine Room 02

Result

NIBP: NA

Sp02: NA EKG Wave: NA Calibration: NA Performance: NA Visual: NA

Inspection Notes

Medicine Sorting System Tag Number: 0752941

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Facility: Recovery for Addictions Program - W-RAP Technician: Sydney Asset ID: 0757352 Test Eqpt Model: Safe-T ST-1 S/N 3756 Last Cal: 06/02/23 Electrical Safety Test Profile: EST NO SW Date/Time: 2023/12/12 11:26 AC Voltage: 124 V Peak Load Current: 0.1 A Gnd Resist:

PASS Test Gnd = 0 mOhm (<500 mOhm) Norm Pol Earth Leak:

PASS Norm Cond = 3 uA (< 500 uA) Norm Pol Chassis Leak:

PASS Norm Cond = 0 uA (< 100 uA) PASS Open Gnd = 3 uA (< 500 uA) < Electrical Safety Overall Result: PASS >

Electrical Safety Test Results

Inspections Performed Electrical

Medicine Sorting System Tag Number: 0757352 Manufacturer: Omnicell Model: Full size Serial: N/A Medical Risk Factor: 4

Entry Type Inspd/Tstd

Location 3rd Floor Med Room

Result

NIBP: NA

Sp02: NA EKG Wave: NA Calibration: NA Performance: NA Visual: NA

Inspection Notes

Medicine Sorting System Tag Number: 0757352

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Facility: Recovery for Addictions Program - W-RAP Technician: Sydney Asset ID: 0752520 Test Eqpt Model: Safe-T ST-1 S/N 3756 Last Cal: 06/02/23 Electrical Safety Test Profile: EST NO GD Date/Time: 2023/12/12 10:14 AC Voltage: 125 V Peak Load Current: 0.1 A Norm Pol Earth Leak:

PASS Norm Cond = 3 uA (< 500 uA) Norm Pol Chassis Leak:

PASS Norm Cond = 0 uA (< 100 uA) PASS Open Gnd = 3 uA (< 500 uA) < Electrical Safety Overall Result: PASS >

Electrical Safety Test Results

Inspections Performed Electrical

Nebulizer Tag Number: 0752520 Manufacturer: Devilbiss Model: 3655D Serial: D2811849 Medical Risk Factor: 3

Entry Type Inspd/Tstd

Location Exam Room

Result

NIBP: NA

Sp02: NA EKG Wave: NA Calibration:

Performance: NA Visual: NA

Inspection Notes

Nebulizer Tag Number: 0752520

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Facility: Recovery for Addictions Program - W-RAP Technician: Sydney Asset ID: 0752523 Test Eqpt Model: Safe-T ST-1 S/N 3756 Last Cal: 06/02/23 Electrical Safety Test Profile: EST NO GD Date/Time: 2023/12/12 10:14 AC Voltage: 125 V Peak Load Current: 0.1 A Norm Pol Earth Leak:

PASS Norm Cond = 3 uA (< 500 uA) Norm Pol Chassis Leak:

PASS Norm Cond = 0 uA (< 100 uA) PASS Open Gnd = 3 uA (< 500 uA) < Electrical Safety Overall Result: PASS >

Electrical Safety Test Results

Inspections Performed Electrical

Nebulizer Tag Number: 0752523 Manufacturer: DeVilbiss Model: 3655D Serial: D2811846 Medical Risk Factor: 3

Entry Type Inspd/Tstd

Location Exam Room

Result

NIBP: NA

Sp02: NA EKG Wave: NA Calibration:

Performance: NA Visual: NA

Inspection Notes

Nebulizer Tag Number: 0752523

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Facility: Recovery for Addictions Program - W-RAP Technician: Sydney Asset ID: 0752535 Test Eqpt Model: Safe-T ST-1 S/N 3756 Last Cal: 06/02/23 Electrical Safety Test Profile: EST NO GD Date/Time: 2023/12/12 09:38 AC Voltage: 126 V Peak Load Current: 0.2 A Norm Pol Earth Leak:

PASS Norm Cond = 3 uA (< 500 uA) Norm Pol Chassis Leak:

PASS Norm Cond = 0 uA (< 100 uA) PASS Open Gnd = 3 uA (< 500 uA) < Electrical Safety Overall Result: PASS >

Electrical Safety Test Results

Inspections Performed Electrical

Nebulizer Tag Number: 0752535 Manufacturer: Devilbiss Model: 3655D Serial: D2811848 Medical Risk Factor: 3

Entry Type Inspd/Tstd

Location Exam Room 02

Result

NIBP: NA

Sp02: NA EKG Wave: NA Calibration:

Performance: NA Visual: NA

Inspection Notes

Nebulizer Tag Number: 0752535

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Facility: Recovery for Addictions Program - W-RAP Technician: Sydney Asset ID: 0753531 Test Eqpt Model: Safe-T ST-1 S/N 3756 Last Cal: 06/02/23 Electrical Safety Test Profile: EST NO GD Date/Time: 2023/12/12 11:00 AC Voltage: 123 V Peak Load Current: 0.1 A Norm Pol Earth Leak:

PASS Norm Cond = 3 uA (< 500 uA) Norm Pol Chassis Leak:

PASS Norm Cond = 2 uA (< 100 uA) PASS Open Gnd = 3 uA (< 500 uA) < Electrical Safety Overall Result: PASS >

Electrical Safety Test Results

Inspections Performed Electrical

Nebulizer Tag Number: 0753531 Manufacturer: Devillbiss Model: 3655D Serial: D2765879 Medical Risk Factor: 3

Entry Type Inspd/Tstd

Location 3rd Floor Exam Room

Result

NIBP: NA

Sp02: NA EKG Wave: NA Calibration:

Performance: NA Visual: NA

Inspection Notes

Nebulizer Tag Number: 0753531

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Vital Signs Testing Profile: URL Preset: Vitals Simulation Date/Time: 2023/12/12 10:26 Sim Time: 0:21 Param Sim Result HR 95 95 Pass SpO2 95 95 Pass ( SpO2 Perfusion:95% )

< PASS >

Info-ST=S/N 3756 Last Cal:06/02/23 Info-SC=S/N 11091 Last Cal:01/11/23 Info-OX=S/N 02282 Last Cal:01/11/23

Electrical Safety Test Results

Inspections Performed Visual Performance Electrical

Pulse Oximeter - Handheld Tag Number: 0752532 Manufacturer: Covidien Model: PM10N Serial: MBP1623510 Medical Risk Factor: 3

Entry Type Inspd/Tstd

Location Exam Room 02

Result

NIBP: NA

Sp02: Simulation was performed. See Test Results.

EKG Wave: NA Calibration: NA Pulse Oximeter Performance Testing Visual: NA

Inspection Notes

Pulse Oximeter - Handheld Tag Number: 0752532

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Profile: URL Preset: Vitals Simulation Date/Time: 2023/12/12 09:34 Sim Time: 0:40 Param Sim Result HR 95 95 Pass SpO2 95 95 Pass ( SpO2 Perfusion:95% )

< PASS >

Info-ST=S/N 3756 Last Cal:06/02/23 Info-SC=S/N 11091 Last Cal:01/11/23 Info-OX=S/N 02282 Last Cal:01/11/23

Electrical Safety Test Results

Inspections Performed Visual Performance Electrical

Pulse Oximeter - Handheld Tag Number: 0752971 Manufacturer: Nelcore Model: Coviden Serial: N/A Medical Risk Factor: 3

Entry Type Inspd/Tstd

Location Exam Room

Result

NIBP: NA

Sp02: Simulation was performed. See Test Results.

EKG Wave: NA Calibration: NA Pulse Oximeter Performance Testing Visual: NA

Inspection Notes

Pulse Oximeter - Handheld Tag Number: 0752971

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Profile: URL Preset: Vitals Simulation Date/Time: 2023/12/12 10:16 Sim Time: 0:06 Param Sim Result HR 95 95 Pass SpO2 95 95 Pass ( SpO2 Perfusion:95% )

< PASS >

Info-ST=S/N 3756 Last Cal:06/02/23 Info-SC=S/N 11091 Last Cal:01/11/23 Info-OX=S/N 02282 Last Cal:01/11/23

Electrical Safety Test Results

Inspections Performed Visual Performance Electrical

Pulse Oximeter - Handheld Tag Number: 0757248 Manufacturer: Nellcorr Model: PM10N Serial: MBP2046901 Medical Risk Factor: 3

Entry Type Inspd/Tstd

Location Exam Room

Result

NIBP: NA

Sp02: Simulation was performed. See Test Results.

EKG Wave: NA Calibration: NA Pulse Oximeter Performance Testing Visual: NA

Inspection Notes

Pulse Oximeter - Handheld Tag Number: 0757248

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Profile: URL Preset: Vitals Simulation Date/Time: 2023/12/12 11:10 Sim Time: 0:06 Param Sim Result HR 95 95 Pass SpO2 95 95 Pass ( SpO2 Perfusion:95% )

< PASS >

Info-OX=S/N 02282 Last Cal:01/11/23

Electrical Safety Test Results

Inspections Performed Visual Performance Electrical

Pulse Oximeter - Handheld Tag Number: 0758856 Manufacturer: ADC Model: 2200 Serial: 184306601883 Medical Risk Factor: 3

Entry Type Inspd/Tstd

Location 3rd Floor Housekeeping

Result

NIBP: NA

Sp02: Simulation was performed. See Test Results.

EKG Wave: NA Calibration: NA Pulse Oximeter Performance Testing Visual: NA

Inspection Notes

Pulse Oximeter - Handheld Tag Number: 0758856

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Facility: Recovery for Addictions Program - W-RAP Technician: Sydney Asset ID: 0752536 Test Eqpt Model: Safe-T ST-1 S/N 3756 Last Cal: 06/02/23 Electrical Safety Test Profile: EST NO SW Date/Time: 2023/12/12 09:40 AC Voltage: 126 V Peak Load Current: 0.1 A Gnd Resist:

PASS Test Gnd =194 mOhm (<500 mOhm) Norm Pol Earth Leak:

PASS Norm Cond = 3 uA (< 500 uA) Norm Pol Chassis Leak:

PASS Norm Cond = 2 uA (< 100 uA) PASS Open Gnd = 3 uA (< 500 uA) < Electrical Safety Overall Result: PASS >

Electrical Safety Test Results

Inspections Performed Electrical

Refrigerator Tag Number: 0752536 Manufacturer: Magic Chef Model: Half size under counter Serial: N/A Medical Risk Factor: 4

Entry Type Inspd/Tstd

Location Exam Room 02

Result

NIBP: NA

Sp02: NA EKG Wave: NA Calibration: NA Performance: NA Visual: NA

Inspection Notes

Refrigerator Tag Number: 0752536

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Facility: Recovery for Addictions Program - W-RAP Technician: Sydney Asset ID: 0752950 Test Eqpt Model: Safe-T ST-1 S/N 3756 Last Cal: 06/02/23 Electrical Safety Test Profile: EST NO SW Date/Time: 2023/12/12 10:00 AC Voltage: 125 V Peak Load Current: 0.1 A Gnd Resist:

PASS Test Gnd =387 mOhm (<500 mOhm) Norm Pol Earth Leak:

PASS Norm Cond = 3 uA (< 500 uA) Norm Pol Chassis Leak:

PASS Norm Cond = 0 uA (< 100 uA) PASS Open Gnd = 0 uA (< 500 uA) < Electrical Safety Overall Result: PASS >

Electrical Safety Test Results

Inspections Performed Electrical

Refrigerator Tag Number: 0752950 Manufacturer: Accucold Model: 1/2 Size Serial: N/A Medical Risk Factor: 4

Entry Type Inspd/Tstd

Location Medicine Room

Result

NIBP: NA

Sp02: NA EKG Wave: NA Calibration: NA Performance: NA Visual: NA

Inspection Notes

Refrigerator Tag Number: 0752950

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Facility: Recovery for Addictions Program - W-RAP Technician: Sydney Asset ID: 0752949 Test Eqpt Model: Safe-T ST-1 S/N 3756 Last Cal: 06/02/23 Electrical Safety Test Profile: EST NO SW Date/Time: 2023/12/12 10:05 AC Voltage: 124 V Peak Load Current: 0.1 A Gnd Resist:

PASS Test Gnd = 0 mOhm (<500 mOhm) Norm Pol Earth Leak:

PASS Norm Cond = 3 uA (< 500 uA) Norm Pol Chassis Leak:

PASS Norm Cond = 0 uA (< 100 uA) PASS Open Gnd = 3 uA (< 500 uA) < Electrical Safety Overall Result: PASS >

Electrical Safety Test Results

Inspections Performed Electrical

Refrigerator Tag Number: 0752949 Manufacturer: Avanti Model: 1/2 Size Serial: N/A Medical Risk Factor: 4

Entry Type Inspd/Tstd

Location Exam Room

Result

NIBP: NA

Sp02: NA EKG Wave: NA Calibration: NA Performance: NA Visual: NA

Inspection Notes

Refrigerator Tag Number: 0752949

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Facility: Recovery for Addictions Program - W-RAP Technician: Sydney Asset ID: 0752940 Test Eqpt Model: Safe-T ST-1 S/N 3756 Last Cal: 06/02/23 Electrical Safety Test Profile: EST NO SW Date/Time: 2023/12/12 09:18 AC Voltage: 124 V Peak Load Current: 0.1 A Gnd Resist:

PASS Test Gnd =489 mOhm (<500 mOhm) Norm Pol Earth Leak:

PASS Norm Cond = 3 uA (< 500 uA) Norm Pol Chassis Leak:

PASS Norm Cond = 0 uA (< 100 uA) PASS Open Gnd = 0 uA (< 500 uA) < Electrical Safety Overall Result: PASS >

Electrical Safety Test Results

Inspections Performed Electrical

Refrigerator Tag Number: 0752940 Manufacturer: Accucold Model: 1/2 Size Serial: N/A Medical Risk Factor: 4

Entry Type Inspd/Tstd

Location Medicine Room 02

Result

NIBP: NA

Sp02: NA EKG Wave: NA Calibration: NA Performance: NA Visual: NA

Inspection Notes

Refrigerator Tag Number: 0752940

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Facility: Recovery for Addictions Program - W-RAP Technician: Sydney Asset ID: 0753513 Test Eqpt Model: Safe-T ST-1 S/N 3756 Last Cal: 06/02/23 Electrical Safety Test Profile: EST NO SW Date/Time: 2023/12/12 11:08 AC Voltage: 123 V Peak Load Current: 0.1 A Gnd Resist:

PASS Test Gnd = 0 mOhm (<500 mOhm) Norm Pol Earth Leak:

PASS Norm Cond = 3 uA (< 500 uA) Norm Pol Chassis Leak:

PASS Norm Cond = 0 uA (< 100 uA) PASS Open Gnd = 3 uA (< 500 uA) < Electrical Safety Overall Result: PASS >

Electrical Safety Test Results

Inspections Performed Electrical

Refrigerator Tag Number: 0753513 Manufacturer: ABS Model: Med Fridge Serial: N/A Medical Risk Factor: 4

Entry Type Inspd/Tstd

Location 3rd Floor Laundry Room

Result

NIBP: NA

Sp02: NA EKG Wave: NA Calibration: NA Performance: NA Visual: NA

Inspection Notes

Refrigerator Tag Number: 0753513

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Facility: Recovery for Addictions Program - W-RAP Technician: Sydney Asset ID: 0757351 Test Eqpt Model: Safe-T ST-1 S/N 3756 Last Cal: 06/02/23 Electrical Safety Test Profile: EST NO SW Date/Time: 2023/12/12 11:25 AC Voltage: 124 V Peak Load Current: 0.1 A Gnd Resist:

PASS Test Gnd = 0 mOhm (<500 mOhm) Norm Pol Earth Leak:

PASS Norm Cond = 3 uA (< 500 uA) Norm Pol Chassis Leak:

PASS Norm Cond = 0 uA (< 100 uA) PASS Open Gnd = 3 uA (< 500 uA) < Electrical Safety Overall Result: PASS >

Electrical Safety Test Results

Inspections Performed Electrical

Refrigerator Tag Number: 0757351 Manufacturer: Accucold Model: Half size under counter Serial: N/A Medical Risk Factor: 4

Entry Type Inspd/Tstd

Location 3rd Floor Med Room

Result

NIBP: NA

Sp02: NA EKG Wave: NA Calibration: NA Performance: NA Visual: NA

Inspection Notes

Refrigerator Tag Number: 0757351

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Electrical Safety Test Results

Inspections Performed Calibration Performance

Scale - Beam Tag Number: 0752549 Manufacturer: Seca Model: 700 Serial: 100000061906 Medical Risk Factor: 4

Scale Calibration

ActualExpct'd Tolerance

Adult Beam

25 lbs

50 lbs

75 lbs

+/- 4 oz

+/- 4 oz

+/- 4 oz

Entry Type Inspd/Tstd

Location 3rd Floor Exam Room

Result

NIBP: NA

Sp02: NA EKG Wave: NA Calibration: Scale Calibration Testing Performance: Tested with known weights. Results enclosed.

Visual: NA

Inspection Notes

Scale - Beam Tag Number: 0752549

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Electrical Safety Test Results

Inspections Performed Calibration Performance Electrical

Scale - Digital Tag Number: 0752948 Manufacturer: Rice Lake Model: H150-10-6 Serial: 111715C134370 Medical Risk Factor: 4

Scale Calibration

ActualExpct'd Tolerance

Adult Digital

25 lbs

50 lbs

75 lbs

+/- 4 oz

+/- 4 oz

+/- 4 oz

Entry Type Inspd/Tstd

Location Exam Room

Result

NIBP: NA

Sp02: NA EKG Wave: NA Calibration: Scale Calibration Testing Performance: NA Visual: NA

Inspection Notes

Scale - Digital Tag Number: 0752948

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Electrical Safety Test Results

Inspections Performed Calibration Performance Electrical

Scale - Digital Tag Number: 0752939 Manufacturer: Rice Lake Model: H150-10-6 Serial: 111715C134369 Medical Risk Factor: 4

Scale Calibration

ActualExpct'd Tolerance

24.8

49.8

74.8

Adult Digital

25 lbs

50 lbs

75 lbs

+/- 4 oz

+/- 4 oz

+/- 4 oz

Entry Type Inspd/Tstd

Location Exam Room 02

Result

NIBP: NA

Sp02: NA EKG Wave: NA Calibration: Scale Calibration Testing Performance: NA Visual: NA

Inspection Notes

Scale - Digital Tag Number: 0752939

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Electrical Safety Test Results

Inspections Performed Calibration Performance Electrical

Scale - Digital Tag Number: 0758857 Manufacturer: Health-O-Meter Model: 895KLT Serial: 8950109739 Medical Risk Factor: 4

Scale Calibration

ActualExpct'd Tolerance

74.8

Adult Digital

25 lbs

50 lbs

75 lbs

+/- 4 oz

+/- 4 oz

+/- 4 oz

Entry Type Inspd/Tstd

Location 3rd Floor Exam Room

Result

NIBP: NA

Sp02: NA EKG Wave: NA Calibration: Scale Calibration Testing Performance: NA Visual: NA

Inspection Notes

Scale - Digital Tag Number: 0758857

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Facility: Recovery for Addictions Program - W-RAP Technician: Sydney Asset ID: 0752524 Test Eqpt Model: Safe-T ST-1 S/N 3756 Last Cal: 06/02/23 Electrical Safety Test Profile: EST NO GD NO SW Date/Time: 2023/12/12 09:56 AC Voltage: 125 V Peak Load Current: 0.3 A Norm Pol Earth Leak:

PASS Norm Cond = 114 uA (< 500 uA) Norm Pol Chassis Leak:

PASS Norm Cond = 0 uA (< 100 uA) PASS Open Gnd = 113 uA (< 500 uA) < Electrical Safety Overall Result: PASS >

Electrical Safety Test Results

Inspections Performed Electrical

Stress System - Treadmill Tag Number: 0752524 Manufacturer: BH Model: LK Series Serial: X150634 Medical Risk Factor: 2

Entry Type Inspd/Tstd

Location Exercise Room

Result

NIBP: NA

Sp02: NA EKG Wave: NA Calibration: NA Performance: NA Visual: NA

Inspection Notes

Stress System - Treadmill Tag Number: 0752524

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Facility: Recovery for Addictions Program - W-RAP Technician: Sydney Asset ID: 0752528 Test Eqpt Model: Safe-T ST-1 S/N 3756 Last Cal: 06/02/23 Electrical Safety Test Profile: EST NO GD NO SW Date/Time: 2023/12/12 09:14 AC Voltage: 125 V Peak Load Current: 0.1 A Norm Pol Earth Leak:

PASS Norm Cond = 139 uA (< 500 uA) Norm Pol Chassis Leak:

PASS Norm Cond = 0 uA (< 100 uA) PASS Open Gnd = 139 uA (< 500 uA) < Electrical Safety Overall Result: PASS >

Electrical Safety Test Results

Inspections Performed Electrical

Stress System - Treadmill Tag Number: 0752528 Manufacturer: BH Model: LK Series Serial: X151077 Medical Risk Factor: 2

Entry Type Inspd/Tstd

Location Exercise Room 02

Result

NIBP: NA

Sp02: NA EKG Wave: NA Calibration: NA Performance: NA Visual: NA

Inspection Notes

Stress System - Treadmill Tag Number: 0752528

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Facility: Recovery for Addictions Program - W-RAP Technician: Sydney Asset ID: 0752945 Test Eqpt Model: Safe-T ST-1 S/N 3756 Last Cal: 06/02/23 Electrical Safety Test Profile: EST NO SW Date/Time: 2023/12/12 10:31 AC Voltage: 125 V Peak Load Current: 0.1 A Gnd Resist:

PASS Test Gnd = 13 mOhm (<500 mOhm) Norm Pol Earth Leak:

PASS Norm Cond = 3 uA (< 500 uA) Norm Pol Chassis Leak:

PASS Norm Cond = 0 uA (< 100 uA) PASS Open Gnd = 3 uA (< 500 uA) < Electrical Safety Overall Result: PASS >

Electrical Safety Test Results

Inspections Performed Electrical

Suction Pump Tag Number: 0752945 Manufacturer: Devillbiss Model: 7314P-D Serial: 4PD050022 Medical Risk Factor: 2

Entry Type Inspd/Tstd

Location Code Cart

Result

NIBP: NA

Sp02: NA EKG Wave: NA Calibration: NA Performance: NA Visual: NA

Inspection Notes

Suction Pump Tag Number: 0752945

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Facility: Recovery for Addictions Program - W-RAP Technician: Sydney Asset ID: 0752959 Test Eqpt Model: Safe-T ST-1 S/N 3756 Last Cal: 06/02/23 Electrical Safety Test Profile: EST NO SW Date/Time: 2023/12/12 09:44 AC Voltage: 126 V Peak Load Current: 0.2 A Gnd Resist:

PASS Test Gnd = 37 mOhm (<500 mOhm) Norm Pol Earth Leak:

PASS Norm Cond = 3 uA (< 500 uA) Norm Pol Chassis Leak:

PASS Norm Cond = 0 uA (< 100 uA) PASS Open Gnd = 3 uA (< 500 uA) < Electrical Safety Overall Result: PASS >

Electrical Safety Test Results

Inspections Performed Electrical

Suction Pump Tag Number: 0752959 Manufacturer: DeVillbiss Model: 7314P-D Serial: 4PD053416 Medical Risk Factor: 2

Entry Type Inspd/Tstd

Location Code Cart 02

Result

NIBP: NA

Sp02: NA EKG Wave: NA Calibration: NA Performance: NA Visual: NA

Inspection Notes

Suction Pump Tag Number: 0752959

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Electrical Safety Test Results

Inspections Performed Performance

Thermometer Tag Number: 0752515 Manufacturer: Welch Allyn Model: 690 Serial: 20141489 Medical Risk Factor: 3

Thermometer Calibration

97.3 +/- 0.2º

+/- 0.2º98.6º

97.3º

ActualExpct'd Tolerance

Calibration Key

Entry Type Inspd/Tstd

Location Exam Room

Result

NIBP: NA

Sp02: NA EKG Wave: NA Calibration: NA Thermometer Testing Visual: NA

Inspection Notes

Thermometer Tag Number: 0752515

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Electrical Safety Test Results

Inspections Performed Performance

Thermometer Tag Number: 0752521 Manufacturer: Welch Allyn Model: 690 Serial: 21100261 Medical Risk Factor: 3

Thermometer Calibration

97.3 +/- 0.2º

+/- 0.2º98.6º

97.3º

ActualExpct'd Tolerance

Calibration Key

Entry Type Inspd/Tstd

Location Exam Room

Result

NIBP: NA

Sp02: NA EKG Wave: NA Calibration: NA Thermometer Testing Visual: NA

Inspection Notes

Thermometer Tag Number: 0752521

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Electrical Safety Test Results

Inspections Performed Performance

Thermometer Tag Number: 0752530 Manufacturer: Welch Allyn Model: 690 Serial: 16291669 Medical Risk Factor: 3

Thermometer Calibration

97.3 +/- 0.2º

+/- 0.2º98.6º

97.3º

ActualExpct'd Tolerance

Calibration Key

Entry Type Inspd/Tstd

Location Exam Room 02

Result

NIBP: NA

Sp02: NA EKG Wave: NA Calibration: NA Thermometer Testing Visual: NA

Inspection Notes

Thermometer Tag Number: 0752530

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Electrical Safety Test Results

Inspections Performed Performance

Thermometer Tag Number: 0752541 Manufacturer: Welch Allyn Model: 690 Serial: 15292020 Medical Risk Factor: 3

Thermometer Calibration

97.3 +/- 0.2º

+/- 0.2º98.6º

97.3º

ActualExpct'd Tolerance

Calibration Key

Entry Type Inspd/Tstd

Location Laundry Room 02

Result

NIBP: NA

Sp02: NA EKG Wave: NA Calibration: NA Thermometer Testing Visual: NA

Inspection Notes

Thermometer Tag Number: 0752541

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Electrical Safety Test Results

Inspections Performed Performance

Thermometer Tag Number: 0753528 Manufacturer: Welch Allyn Model: 690 Serial: 94711 Medical Risk Factor: 3

Thermometer Calibration

97.3 +/- 0.2º

+/- 0.2º98.6º

97.3º

ActualExpct'd Tolerance

Calibration Key

Entry Type Inspd/Tstd

Location 3rd Floor Exam Room

Result

NIBP: NA

Sp02: NA EKG Wave: NA Calibration: NA Thermometer Testing Visual: NA

Inspection Notes

Thermometer Tag Number: 0753528

If Blank - No Asset Image Acguired

Asset Test Image

Electrica l

Calibratio n

Performance Visua

Electrical Safety Test Results

Inspections Performed Performance

Thermometer Tag Number: 0753534 Manufacturer: Welch Allyn Model: 690 Serial: N/A Medical Risk Factor: 3

Thermometer Calibration

97.3 +/- 0.2º

+/- 0.2º98.6º

97.3º

ActualExpct'd Tolerance

Calibration Key

Entry Type Inspd/Tstd

Location 3rd Floor Med Room

Result

NIBP: NA

Sp02: NA EKG Wave: NA Calibration: NA Thermometer Testing Visual: NA

Inspection Notes

Thermometer Tag Number: 0753534

If Blank - No Asset Image Acguired

Asset Test Image

Electrica l

Calibratio n

Performance Visua

Electrical Safety Test Results

Inspections Performed Performance

Thermometer Tag Number: 0753535 Manufacturer: Welch Allyn Model: 690 Serial: N/A Medical Risk Factor: 3

Thermometer Calibration

97.3 +/- 0.2º

+/- 0.2º98.6º

97.3º

ActualExpct'd Tolerance

Calibration Key

Entry Type Inspd/Tstd

Location 3rd Floor Exam Room

Result

NIBP: NA

Sp02: NA EKG Wave: NA Calibration: NA Thermometer Testing Visual: NA

Inspection Notes

Thermometer Tag Number: 0753535

If Blank - No Asset Image Acguired

Asset Test Image

Electrica l

Calibratio n

Performance Visua

Facility: Recovery for Addictions Program - W-RAP Technician: Sydney Asset ID: 0753529 Test Eqpt Model: Safe-T ST-1 S/N 3756 Last Cal: 06/02/23 Electrical Safety Test Profile: EST NO GD NO SW Date/Time: 2023/12/12 10:57 AC Voltage: 123 V Peak Load Current: 0.1 A Norm Pol Earth Leak:

PASS Norm Cond = 3 uA (< 500 uA) Norm Pol Chassis Leak:

PASS Norm Cond = 2 uA (< 100 uA) PASS Open Gnd = 3 uA (< 500 uA) < Electrical Safety Overall Result: PASS >

Electrical Safety Test Results

Inspections Performed Electrical

Transformer - Wall Mounted Tag Number: 0753529 Manufacturer: Hillrom Model: Wall Mount Serial: N/A Medical Risk Factor: 3

Entry Type Inspd/Tstd

Location 3rd Floor Exam Room

Result

NIBP: NA

Sp02: NA EKG Wave: NA Calibration: NA Performance: NA Visual: NA

Inspection Notes

Transformer -…