Nurse Call Maintenance Checklist Form
Document and track all required tasks for nurse call system maintenance using this checklist form.
Date of Maintenance
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Facility or Unit
*
Equipment or System Identifier
*
Technician Name
*
Inspection Area or Panel Location
*
Core System Checks
*
Rows
Completed
Power supply functional
1
All call points operational
2
Indicator lights working
3
Audio communication clear
4
Panel alarms tested
5
Issue or Defect Description
Corrective Action Taken
Follow-up Needed
*
Yes
No
Overall Status
*
Passed
Requires Follow-up
Failed
Submit
Should be Empty: