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• <br />St ,Joseph's Medical Center Environmental Services Dept <br />North Corner Lot Sterilizer - Spordi Test <br />Date test performed_`7/1_�_" <br />A . <br />LUt # <br />Test performed by <br />Expiration date <br />Z /1 `? <br />Staple SPORDI Test Envelope in space below after completing test: <br />(Make sure that flaps are Securely closed so that test strips will not fall out) <br />To (Supervisor) <br />Depment <br />Dat ime strips were cultured <br />Tem erature at which strips were incubated: <br />' 30'C to 35'C ❑ 55°C to 60°C <br />Results of culture tests (check one) <br />Both strips NEGATIVE ❑ POSITIVE>C <br />One strip NEGATIVE the other POSITIVE ❑ <br />Control strip results: NEGATIV11 POSITIVE ❑ <br />Re --mended Actions:J_�� <br />Signature �� batteo <br />SUPERVISOR I <br />STERILIZATION TEST DATA <br />Institution _ S N -M C <br />Date of test 7 2 - l/ <br />Sterilant Steam 1116�� <br />EO ❑ <br />Dry Heat ❑ <br />Location of sterilizer N' 1 ,� 2 k W_r_ I --e t' <br />Type of Load L o 7 �} �8 /�1 <br />Sterilizing conditions: <br />Time of Strip Retrieval <br />Test conducted by <br />Department . :Fy,S <br />ler ot a-wc <br />Directions for Laboratory Specimen Processing Dept,- <br />Do <br />ept:Do not order test in RUBICON System. Send this form with the SPORDI Envelope <br />attached directly to the Microbiology Dept at HCCL <br />1 1} 1 B F -t <br />Setup Date:_.,_? _ Time:`Y: <br />Date <br />1 ,l <br />7 JC' <br />--- <br />Day <br />1— <br />2 <br />3 <br />4 5 6 <br />7 <br />Positive Control tJ lY -- <br />Test strip 1 UMt <br />Test strip 2 r (n <br />v <br />Tech initials} — <br />Directions for Microbiology CLS: <br />When test is complete, fill out the Sterility Test Report section on the envelope. <br />Remember to sign and date the form, reattach a copy then send original test envelope to: <br />SJMC Environmental Services Dept. u�,�,( �rncti I <br />Attention: Linda McAlister <br />Please contact Linda McAlister at X 6472 immediately if there is a test failure. <br />!`) y �C '2l <br />