X-ray Equipment Evaluation Checklist
Use this checklist to evaluate the condition, safety, and performance of X-ray equipment.
Equipment Identification
Equipment Name / Asset Label
*
Equipment Type / Model
*
Serial Number / Internal Asset ID
Facility / Department / Location
*
Please Select
Radiology
Emergency Department
Surgery
Outpatient Clinic
Imaging Center
Other
Evaluator Name and Role
*
Evaluation Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Operational and Safety Evaluation
Power-up Status
*
Pass
Needs Attention
Fail
Control Panel Function
*
Pass
Needs Attention
Fail
Detector / Console Responsiveness
*
Pass
Needs Attention
Fail
Image Acquisition Readiness
*
Pass
Needs Attention
Fail
Warning Indicators / Alarms
*
Normal
Needs Attention
Active Alarm
Radiation Shielding / Interlock Status
*
Pass
Needs Attention
Fail
Cable / Connector Condition
*
Pass
Needs Attention
Fail
Cleanliness Condition
Clean
Needs Attention
Dirty
Immediate Safety Concern Present?
*
No
Yes
Image Quality and Performance Checklist
Image quality criteria
*
Rows
Excellent
Good
Fair
Poor
Image clarity
1
2
3
4
Exposure consistency
5
6
7
8
Positioning accuracy
9
10
11
12
Calibration status
13
14
15
16
Alignment
17
18
19
20
Are repeat images needed?
*
No
Yes
If repeat images are needed, explain why
Overall image performance rating
*
Poor
1
2
3
4
5
6
7
8
9
Excellent
10
1 is Poor, 10 is Excellent
Performance issues observed
Blurred images
Exposure variation
Positioning errors
Calibration drift
Misalignment
Repeat images required
Other
Overall assessment
*
Please Select
Pass
Pass with notes
Needs corrective action
Issues, Maintenance, and Final Review
Issues Observed
Maintenance Priority / Required Action
*
None needed
Monitor
Service required
Remove from service
Recommended Follow-up
Final Overall Outcome
*
Please Select
Pass
Pass with notes
Needs follow-up
Fail
Remove from service
Final Remarks / Comments
Submit Checklist
Should be Empty: