Ultrasound Equipment Evaluation Form
Evaluate ultrasound equipment by recording the model, context of use, performance ratings, feature adequacy, issues, and final recommendation. No patient or sensitive information should be entered.
Equipment Details
Equipment/Model Name
*
Asset/Serial Identifier
Evaluation Context
Department/Location Where Used
Please Select
Radiology
Emergency Department
ICU
Maternity
Outpatient Clinic
Operating Room
Other
Evaluation Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Performance Assessment
Image Quality Rating
*
Poor
1
2
3
4
5
6
7
8
9
Excellent
10
1 is Poor, 10 is Excellent
Ease of Use Rating
*
Difficult
1
2
3
4
5
6
7
8
9
Very Easy
10
1 is Difficult, 10 is Very Easy
Reliability/Consistency Rating
*
Unreliable
1
2
3
4
5
6
7
8
9
Highly Consistent
10
1 is Unreliable, 10 is Highly Consistent
Feature and Workflow Review
Key Feature Adequacy Checklist
*
Portability
Probe handling
Display clarity
Presets
Reporting workflow
Other
Workflow/Usability Notes
Submit
Should be Empty: