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Documentation Sheet

to monitor sterilization processes

Sterilizer No.: _______________ Sterilization Department:

Date: _______________

Sterilization process:  Steam  Ethylene oxide  Formaldehyde  Hydrogen peroxide

Bowie-Dick-Simulation Test (BDS)  not applicable (no BDS-test necessary)

BDS-test indicator strip Release Responsible User


 yes  no

Batch Monitoring*
Stick in gke-documentation labels or complete the form manually
User, sterilizer and
batch number 1 2 3 4
Date of production

Expiry date

Stick in indicator strip

Program
Temperature
°C °C °C °C
Starting Time
Release  yes  no  yes  no  yes  no  yes  no

Signature

User, sterilizer and


batch number 5 6 7 8
Date of production

Expiry date

Stick in indicator strip

Program
Temperature
°C °C °C °C
Starting Time
Release  yes  no  yes  no  yes  no  yes  no

Signature

* Package monitoring indicator will be filed in the patient documentation.

Page 1 of 2
gke GmbH Auf der Lind 10 65529 Waldems/Germany  +49 - 6126 - 9432 - 0  +49 - 6126 - 9432 - 10  www.gke.eu
Documentation Sheet
to monitor sterilization processes

Sterilizer No.: _______________ Sterilization Department:

Date: _______________

User, sterilizer and


batch number 9 10 11 12
Date of production

Expiry date

Stick in indicator strip

Program
Temperature
°C °C °C °C
Starting Time
Release  yes  no  yes  no  yes  no  yes  no

Signature

User, sterilizer and


batch number 13 14 15 16
Date of production

Expiry date

Stick in indicator strip

Program
Temperature
°C °C °C °C
Starting Time
Release  yes  no  yes  no  yes  no  yes  no

Signature

User, sterilizer and


batch number 17 18 19 20
Date of production

Expiry date

Stick in indicator strip

Program
Temperature
°C °C °C °C
Starting Time
Release  yes  no  yes  no  yes  no  yes  no

Signature

760-061 EN V03 03/2014

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gke GmbH Auf der Lind 10 65529 Waldems/Germany  +49 - 6126 - 9432 - 0  +49 - 6126 - 9432 - 10  www.gke.eu