Dental Equipment Maintenance Checklist
Complete this checklist to document the condition, cleaning, inspection, and servicing of dental equipment.
Equipment Name or ID
*
Equipment Type
*
Please Select
Autoclave
Dental Chair
X-Ray Machine
Handpiece
Ultrasonic Scaler
Curing Light
Compressor
Other
Equipment Location
Date of Maintenance
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Maintainer Full Name
*
First Name
Last Name
Equipment Condition
*
Excellent
Good
Fair
Poor
Cleaning/Disinfection Status
*
Completed - No Issues
Completed - Minor Issues
Not Completed
Inspection Results
*
No visible damage
All functions operational
Wear or deterioration observed
Calibration required
Leaks or unusual noises
Other
Parts Replaced / Issues Found
Actions Taken
*
Next Service Due Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Additional Notes
Maintenance Sign-Off (Signature)
*
Submit Checklist
Submit Checklist
Should be Empty: