Oxygen Equipment Maintenance Checklist
Complete this form to document the inspection and maintenance of oxygen equipment. All fields are required for accurate maintenance tracking.
Equipment Identification Number
*
Inspection Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Location of Equipment
*
Equipment Type
*
Please Select
Portable Oxygen Concentrator
Stationary Oxygen Concentrator
Oxygen Cylinder
Oxygen Regulator
Oxygen Mask/Nasal Cannula
Other
Current Condition/Status
*
Please Select
Operational
Needs Maintenance
Out of Service
Other
Inspection Checklist Items
*
Check for leaks
Inspect tubing and connections
Test flow rate
Clean exterior surfaces
Check alarms and indicators
Other
Maintenance Actions Performed
*
Cleaned components
Adjusted settings
Replaced worn parts
Lubricated moving parts
Tested operation
Other
Parts Replaced (if any)
Technician Notes
Next Inspection Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit Maintenance Checklist
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