Plasma Donation Equipment Indicator Status Log Form
Log the status of plasma donation equipment indicators accurately. Please complete all fields for each equipment check.
Equipment ID or Serial Number
*
Equipment Type
*
Please Select
Centrifuge
Plasma Separator
Freezer
Refrigerator
Blood Bag Sealer
Other
Equipment Location
*
Name of Person Logging Status
*
First Name
Last Name
Date and Time of Check
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Indicator Type
*
Please Select
Temperature
Pressure
Power
Alarm
Operational Status
Other
Current Indicator Status
*
Normal
Warning
Alarm
Not Operational
Details or Notes on Indicator Status
Is Follow-Up Action Needed?
*
No Action Needed
Monitor
Immediate Maintenance
Schedule Repair
Other
Describe Follow-Up Action (if applicable)
Submit Log
Should be Empty: