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�J <br />St Joseph's Medical Center Environmental Services Dept <br />Date test, performed <br />y.� I <br />I'ot 0 <br />North Corner Lot Sterilizer - Spordi Test <br />Test performed by <br />tnxplrat:ion date <br />2 – ?ti I "L--. <br />St.1plo SPORIA Test Envelope in space laelow atter completing test: <br />.... 1.. ®/..`««.J .. e+. <br />AL—A A-6 .. d..:...« .: 11 ....t fall out) <br />® • SUPERVISOR<- _ _ _ _ , <br />(Supervisor) <br />)artment___ .__._ . _..--------- <br />:errime strips were cultured.__._.____ <br />nperature at which strips were incubated: <br />30"C to 35°C ❑ 55"C to 60-C <br />sults of culture tests (check one) <br />th strips NEGATIVE ❑ POSITIVE ❑ <br />e sVip NEGATIVE the other POSITIVE <br />ntrdl strip results: NEGATIVE ❑ POSITIVEX <br />commended Actions: <br />3 azure aTe <br />STERILIZATION TEST DATA <br />Institution c.. <br />°-7 <br />Date of test 7 -- e <br />Sterilant _ Steam <br />EO ❑ <br />Dry Heat ❑ <br />Location of sterilizer4?._/ <br />Type of Load a "! <br />Sterilizing conditions: <br />Time of Strip Retrieval ________._ <br />Test conducted by ---..-.--- <br />`1 Vi <br />Dopartment <br />44 r Al a i1/ 0 !E L40 <br />Directions for Laboratory Specknen Processing Dept- <br />Do <br />order test in RUBICON SPORDI Envelope <br />attached directly to thO Microbiologyp <br />Set top Date:_ t-� .. Time:.�G � �,� � By:—Al — <br />2 � --3 <br />Day I <br />Positive Control— <br />Test strip 1 --- <br />Test strip 2 <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 />Dept. _.. /,-H- y,,�ess� ° <br />J�` C Environmental Services Dept. <br />,ttentiom Gloria Shepherd <br />a <br />at X 6472 immediately if there is a test failure. <br />