Sleep Apnea Device Maintenance Checklist Form
Complete this checklist to record routine maintenance for your sleep apnea device.
Maintenance Date
*
-
Month
-
Day
Year
Date
Device Name or Model
*
Device Serial Number (if available)
Was the device exterior cleaned?
*
Yes
No
Not Applicable
Mask/Cushion Inspection
*
No visible damage or wear
Minor wear, still usable
Needs replacement
Hose/Tubing Condition
*
Good (no cracks or leaks)
Minor wear, still functional
Replace soon
Filter Status
*
Clean/Recently replaced
Needs cleaning
Needs replacement
Humidifier Chamber Status
Clean and filled
Needs cleaning
Not used
Power Supply/Battery Check
Working properly
Needs charging/replacement
Not applicable
Overall Device Condition
*
1
2
3
4
5
Additional Notes or Observations
Submit Maintenance Record
Should be Empty: