Kingdom of Saudi Arabia ‫المملكة العربية السعودية‬

Ministry of health
‫وزارة الصحة‬
General directorate for
infection prevention and ‫اإلدارة العامة لمكافحة عدوى‬
control ‫المنشئات الصحية‬

Hospital : ------------------------------------------------- Directorate :---------------------------------------------Date :--------------------------

Monitoring LOG FORM

Sterilization Monitoring Schedule

Month:
Day DATE Warm up Bowie- dick test Leak test Biological Test

Daily Daily Weekly Weekly

DONE

Failed

NOT DONE

SIGNATURE
DONE

Passed

Failed

NOT DONE

SIGNATURE

DONE

Passed

Failed

NOT DONE

SIGNATURE

DONE

NEGATIVE

POSIYIVE

NOT DONE

SIGNATURE
Saturday
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday

REMARKS:
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CHIEF OF CSSD NAME: SIGNATURE:

ST-15, 9.5 Monitoring Test Schedule (5)