Medical Device Safety Test Checklist
Complete this checklist to document the safety inspection of a medical device. Ensure all items are reviewed and findings are recorded accurately.
Device Information
Enter the details of the medical device being inspected.
Device Name
*
Device Model
*
Serial Number
*
Location of Device
*
Date of Inspection
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Inspector Full Name
*
First Name
Last Name
Inspector Email Address
*
example@example.com
Safety Test Items
*
Rows
Compliant
Not Compliant
N/A
Device labeling is clear and legible
1
2
3
Power cord and plug are intact
4
5
6
No visible damage to device housing
7
8
9
All controls and displays function properly
10
11
12
Alarm systems operate as intended
13
14
15
Device passes electrical safety test
16
17
18
Accessories are present and in good condition
19
20
21
Calibration is up to date
22
23
24
Cleaning/disinfection status is verified
25
26
27
Device manuals are available
28
29
30
Comments or Corrective Actions Required (if any)
Inspector Signature
*
Submit Checklist
Submit Checklist
Should be Empty: