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St Joseph's Medical Center Environmental Services Dept <br /> North Corner Lot Sterilizer - Spordi Test <br /> Date test performed 11 Test performed by fi-wAVx% <br /> Lot# C>i Expiration*Pat:-'- <br /> c)AK0 <br /> Staple S ORDI Test Envelope in space below after co e In e t!f <br /> (Make sure that flaps are securely closed so that test strips will not fall out) <br /> = ' • • SUPERVISOR <br /> • • <br /> •• • STERILIZATION TEST DATA <br /> . .. . <br /> It <br /> (Supervisor) Institution y ' — <br /> Department � x Date of test <br /> Date/Time strips were cultured li._ {� Steam' <br /> Sterilant <br /> Temperature at which strips were incubated: EO ❑ <br /> 30°C to 35'C ❑ 55`C to 60°C IC <br /> a� Dry Heat ❑ <br /> Results of culture tests(check one) Location of steriliz r <br /> Both strips NEGATIVE Y POSITIVE ❑ iype of Load <br /> One strip NEGATIVE the other POSITIVE ❑ Sterilizing conditions: <br /> Control strip results:NEGATIVE ❑ POSITIVE <br /> Recommended Actions: <br /> Time of Strip Retrieval <br /> p2 �A Test conducted by <br /> Sgn re Q'r a Department — <br /> (•� Z I If ESP <br /> Directions for Laboratory Specimen Processing Dept: <br /> Do not order test in RUBICON System. Send this form with the SPORDI Envelope <br /> attached directly to the Microbiology Dept at HCCL <br /> Set up Date: Time: IJ By: <br /> Date <br /> Day 1 11 21 31 41 51 6 <br /> r <br /> Positive Control " 41 <br /> Test strip 1 r— — <br /> Test strip 2 --- 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. <br /> Attention: Linda McAlister <br /> Please contact Linda McAlister at X 6472 immediately if there is a test failure. <br />