New Technical Bulletins- Correlation of TOSI * Enzymatic Cleaners

ProFormance^TM (TOSI) Test
Product Evaluation Form

Name of Hospital:		Date:
City & State:,		No of Beds:
Washer Make & Mode:
Age of Washer:		Location ( dept):
Approximate number of loads/day:
Any additional washers in this Dept. Yes No		How many?
Any additional washers in hospital: Yes No		How many?
List Other Departments with Washer:

INFORMATION ABOUT THE CLEANING PROCESS BEING USED AT THIS INSTITUTION
Please provide the name of the manufacturer, brand name and any other descriptive information:

Detergent Used		Neutral or alkaline pH:
Enzyme Cleaner Used:		Lubricant Used:
Neutralizer Used:		Does the hospital pre-soak Yes No
If yes, what is used beside water?		Describe pre-soak procedure:

Test Results:

Did the TOSI come clean?Yes No

If no, please descibe appearance (refer to the Wall Chart for reference)

Describe the cycle used:

If the TOSI failed to come clean, what appears to be the cause?

Blocked SprayArms	Lack of Enzyme
Low Temperature	Detergent
other

If other, please describe:

Describe Customer Reaction to Each Subject Below

TOSI product:

Literature:

What additional information, if any is needed:

The Price is?

Additional Feedback on Pricing:

Will the customer purchase TOSI for a daily test of the washer/disinfector
Yes No

If "no" please explain:

Comments:

Please attach a copy of any printout(s).
Name of Evaluator:	Name of Sales Rep:

ProFormanceTM (TOSI) Test Product Evaluation Form

Copyright © 2001 [Healthmark Industries Company, Inc.]. All rights reserved. Revised: February 21, 2007

ProFormance^TM (TOSI) Test
Product Evaluation Form

Copyright © 2001 [Healthmark Industries Company, Inc.]. All rights reserved.
Revised: February 21, 2007