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| Patient Care Equipment (STEP) | | |
| Last Inspection Date (DATE) | | |
| Bed Height (inches) (NUMBER) | | |
| Mattress Pressure Relief Settings (1-10) (NUMBER) | | |
| Condition of Side Rails (SELECTION options: Excellent, Good, Fair, Poor) | | |
| Malfunctions Observed (SELECTION options: Noisy Operation, Difficulty Adjusting Height, Worn Upholstery, Locking Mechanism Issues, None) | | |
| Notes/Additional Comments (TEXT) | | |
| Technician Signature (SIGNATURE) | | |
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| Diagnostic Imaging Equipment (STEP) | | |
| X-Ray Tube Current (mA) (NUMBER) | | |
| X-Ray Tube Voltage (kV) (NUMBER) | | |
| Last Calibration Date - X-Ray (DATE) | | |
| MRI Magnet Quench Events (Since Last Service) (NUMBER) | | |
| MRI Gradient Coil Status (SELECTION options: Normal, Minor Noise, Significant Noise, Repair Needed) | | |
| Last Filter Change Time - CT (DATE) | | |
| Notes/Observations - Ultrasound (TEXT) | | |
| Upload Image - Calibration Result (UPLOAD) | | |
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| Respiratory Therapy Equipment (STEP) | | |
| Last Calibration Date (DATE) | | |
| Pressure Readings (psi) (NUMBER) | | |
| Flow Rate (LPM) (NUMBER) | | |
| Humidification System Status (SELECTION options: Functional, Needs Repair, Out of Service) | | |
| Any unusual noises or observations? (TEXT) | | |
| Filters Checked? (SELECTION options: Inlet Filter, Outlet Filter, Humidifier Filter) | | |
| Calibration Time (DATE) | | |
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| Sterilization Equipment (STEP) | | |
| Last Cycle Validation Date (DATE) | | |
| Cycle Time (Minutes) (NUMBER) | | |
| Temperature (°C) (NUMBER) | | |
| Pressure (PSI) (NUMBER) | | |
| Cycle Type (SELECTION options: Gravity, Steam Flush, Air Displacement) | | |
| Cycle Notes/Observations (TEXT) | | |
| Cycle Validation Report (UPLOAD) | | |
| Water Quality Check (SELECTION options: Pass, Fail, Requires Further Testing) | | |
| Cycle Start Time (DATE) | | |
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| Emergency Power Systems (STEP) | | |
| Last Generator Test Date (DATE) | | |
| Generator Runtime (Hours) (NUMBER) | | |
| Fuel Level (Gallons/Liters) (NUMBER) | | |
| Fuel Type (SELECTION options: Diesel, Gasoline, Propane, Natural Gas) | | |
| Time of Last Test (DATE) | | |
| Observations/Notes from Last Test (TEXT) | | |
| Upload Test Report (Optional) (UPLOAD) | | |
| UPS Status (SELECTION options: Operating Normally, Warning, Error, Offline) | | |
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| Life Support Systems (STEP) | | |
| Ventilator Pressure (cmH2O) (NUMBER) | | |
| Oxygen Flow Rate (LPM) (NUMBER) | | |
| Last Filter Replacement Date (DATE) | | |
| Alarm Test Time (DATE) | | |
| Any Abnormal Noises Observed? (TEXT) | | |
| Ventilator Mode (SELECTION options: Volume Control, Pressure Control, Assist Control) | | |
| Functional Checks Completed (SELECTION options: Power On/Off, Volume Delivery, Alarm Response, Back-up Battery Status) | | |
| Technician Signature (SIGNATURE) | | |
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| Monitoring Devices (STEP) | | |
| Heart Rate (BPM) (NUMBER) | | |
| Blood Pressure (Systolic) (NUMBER) | | |
| Blood Pressure (Diastolic) (NUMBER) | | |
| Oxygen Saturation (%) (NUMBER) | | |
| Respiratory Rate (breaths/min) (NUMBER) | | |
| Last Calibration Date (DATE) | | |
| Time of Reading (DATE) | | |
| Notes/Observations (TEXT) | | |
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| Mobility & Transfer Equipment (STEP) | | |
| Last Inspection Date (DATE) | | |
| Wheelchair Tire Pressure (PSI) (NUMBER) | | |
| Hospital Bed Rail Functionality (SELECTION options: Fully Functional, Minor Issue, Requires Repair, Non-Functional) | | |
| Lift Inspection - Check all that apply (SELECTION options: Battery Condition, Cable Integrity, Motor Operation, Emergency Stop Function, Load Capacity Verified) | | |
| Notes/Observations regarding chair movement or function (TEXT) | | |
| Technician Signature (SIGNATURE) | | |
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| Laboratory Equipment (STEP) | | |
| Spectrophotometer Lamp Hours (NUMBER) | | |
| Last Calibration Date (Centrifuge) (DATE) | | |
| Last PM Time (PCR Machine) (DATE) | | |
| pH Meter Calibration Factor (NUMBER) | | |
| Any unusual observations? (TEXT) | | |
| Reagent Storage Conditions (SELECTION options: Appropriate Temperature, Unstable, Expired) | | |
| Attach calibration certificates (UPLOAD) | | |
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| HVAC & Environmental Controls (STEP) | | |
| Last Filter Replacement Date (DATE) | | |
| Supply Air Temperature (F) (NUMBER) | | |
| Return Air Temperature (F) (NUMBER) | | |
| Fan RPM (NUMBER) | | |
| Refrigerant Level (SELECTION options: Optimal, Low, High, Not Checked) | | |
| Notes on System Performance (TEXT) | | |
| Next Scheduled Maintenance Date (DATE) | | |
| Attach Maintenance Report/Images (UPLOAD) | | |
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