Biomedical Equipment Maintenance Program Checklist
Use this form to document biomedical equipment maintenance tasks, inspection results, issues, and follow-up service dates.
Equipment Identification
Equipment Name or Model
*
Equipment ID or Asset Tag
*
Location or Department
*
Maintenance Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Next Service Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Maintenance Checklist and Status
Maintenance Tasks Completed
*
Visual inspection
Power and cable inspection
Functionality test
Cleaning/sanitization check
Alarm/safety check
Calibration verification
Battery backup check
Documentation review
Inspection Status
*
Pass
Needs attention
Out of service
Issues Found
Corrective Action Needed
Technician Sign-off
Technician Name
*
First Name
Last Name
Notes / Comments
Submit Checklist
Should be Empty: