Location OR Room…….

Daily Check list of medical equipment

Equipment name: suction machine Equipment status:

Model: Functional Non Functional

z Check Well cleaned

Note…………………………………………
Ensure appropriate power supply ………………………………………………
Check motor pump start and suction ………………………………..
pressure User comment
Check vacuum control and leakage ………………………....................................
........................................................................
Equipment status: ....................................

Functional Non Functional

Note…………………………………………
………………………………………………
……………………… Equipment name: OR Light /Operation light

User comment……………………………… Model:

……………………………………………… Well cleaned
………………………………………
Check appropriate power sources with
grounding system
Equipment name: OR Table / operation table Check light control unit
Model: Check battery status and bulb
Well cleaned Equipment status:
Check power supply and grounding system Functional Non Functional
Dose all parts move easily in all direction Note
Check control unit ………………………………………………
………………………………………………
……………………

User comment
………………………………………………
………………………………………………
Equipment name: Electro surgical unit Equipment name: Anesthesia machine
(cautery machine)
Model:
Model:
Well cleaned
Well cleaned
Check proper power sources and
Ensure appropriate power supply with grounding system
grounding system
Check pneumatic system
Check smoothly operates foot switch and
electrodes Check flow control and pressure gauges

Check return plate and cable dis connection Check soda lime and scavenging system
alarm Test any movable parts move freely
Check proper operation of all controls, Check any leak and alarm status
indicator and display unit
Check proper operation of vaporizer
Equipment status:
Equipment status:
Functional Non Functional
Functional Non Functional
Note
……………………………………………… Note
……………………………………………… ………………………………………………
……………….. ………………………………………………
…………………..
User comment
……………………………………………… User comment
……………………………………………… ………………………………………………
…………….. ………………………………………………
…………….

User name ……………..sign……..date……

Approved engineer: ……………………

Date…………….sign ………
Equipment name: patient monitor Check proper operation of electro surgery
units
Model:
Check laser light source status
Well cleaned
Check the two image monitor display and
Check appropriate power supply with save data
grounding cable
Ensure proper operation of camera
Check each vital sign parameter
electrodes Check any control unit operation

Check alarm and setting mode Test any movable parts move freely in all
direction
Check proper operation of parameter control
and display unit

Equipment status: Equipment status:

Functional Non Functional Functional Non Functional

Note
………………………………………………
Note
………………………………………………
………………………………………………
……………….
………………………………………………
User comment ……………
………………………………………………
User comment
………………………………………………
………………………………………………
…………………..
………………………………………………
User name ……………sign ……date…… ………………

Equipment name: laparoscopy User name ………….sign……. date…….....

Model:

Well cleaned

Check CO2 cylinder full or empty and leak

Check appropriated power supply with

good grounding system

Check status of battery back up

Check connection of cables

Daily Check list of medical equipment
Location ICU Room…….

Equipment name: Defibrillator machine Equipment name: patient monitor

Model: Model:

Check well cleaned Well cleaned

Check proper power supply with ground Check appropriate power supply with
cable grounding cable

Ensure proper connection of cable to the Check each vital sign parameter
two large metal paddles electrodes

Check battery backup system Check alarm and setting mode

Check any control unit Check proper operation of parameter

control and display unit
Equipment status:
Equipment status:
Functional Non Functional
Functional Non Functional

Note…………………………………………
……………………………………………… Note…………………………………………
…………………….. ………………………………………………
…………………….
User comment
……………………………………………… User comment
……………………………………………… ………………………………………………
…………………… ………………………………………………
…………………..

Equipment name: ECG

Model:
Equipment status:
Check Cleaning
Functional Non Functional
Ensure proper operation of power source

Check electrodes cable connection

Note…………………………………………
Test ECG paper loaded ………………………………………………
…………………….
Check setting mode and effect of any
artifacts User comment
………………………………………………
………………………………………………
Equipment status: …………………..
Equipment name: Oxygen concentrator
Functional Non Functional
Model:

Check well cleaned

Note…………………………………………
……………………………………………… Test appropriate power source
……………………..
Check compressor and alarm
User comment
……………………………………………… Check regulator and oxygen flow
………………………………………………
…………………… Check out put O2 concentration level

Equipment name: Mechanical ventilator Check leakage

Model: Equipment status:

Check well cleaned
Functional Non Functional
Approve Self-test check

Test appropriate power source with

grounding Note…………………………………………
Check gas supply ………………………………………………
…………………….
Check setting and mode of operation
User comment ……………………………...
Check any movable parts move freely
in all direction

Equipment name: CPAP

Model: User comment
………………………………………………
Cleanliness ………………………………………………
…………………..
Check all parts

Leak test
Equipment name: suction machine
Check power source
Model:
Check regulator and controller
z Check well cleaned
Equipment status:
Ensure appropriate power supply
Functional Non Functional
Check motor pump start and suction
pressure

Note………………………………………… Check vacuum control and leakage

………………………………………………
Equipment status:
…………………….
Functional Non Functional
User comment
……………………………………………… Note…………………………………………
………………………………………………
………………………………………………
…………………..
………………………

Equipment name: Pulse Ox meter User comment………………………………

………………………………………………
Model: ………………………………………
Cleanliness

Check DC battery User name ……………..sign……..date……

Test probe sensors Approved engineer: ……………………
Test output result and alarm Date…………….sign ………
Equipment status:

Functional Non Functional

Note………………………………………… Daily Check list of medical equipment

………………………………………………
……………………. Location NICU Room…….
Equipment name: ECG Functional Non Functional

Model:

Check Cleaning Note…………………………………………

………………………………………………
Ensure proper operation of power source …………………….
Check electrodes cable connection User comment
………………………………………………
Test ECG paper loaded
………………………………………………
Check setting mode and effect of any ……………………
artifacts

Equipment status:
Equipment name: suction machine
Functional Non Functional
Model:

z Check well cleaned

Note…………………………………………
……………………………………………… Ensure appropriate power supply
……………………..
Check motor pump start and suction
User comment pressure
………………………………………………
……………………………………………… Check vacuum control and leakage
……………………
Equipment status:
Equipment name: CPAP
Functional Non Functional
Model:
Note…………………………………………
Cleanliness ………………………………………………
………………………
Check all parts
User comment………………………………
Leak test ………………………………………………
Check power source ………………………………………

Check regulator and control Equipment name: Oxygen concentrator

Model:

Equipment status: Check well cleaned

 Test appropriate power source Note…………………………………………
………………………………………………
Check compressor and alarm ………………………
Check regulator and oxygen flow User comment………………………………
………………………………………………
Check out put O2 concentration level
………………………………………
Check leakage
Equipment name: Infant incubator
Equipment status: Model:
Functional Non Functional
 Check cleanliness

Check proper operation of power

supply
Note…………………………………………
……………………………………………… Check setting operation modes
…………………….
Check connection of temperature
User comment sensors
………………………………………………
……………………………………………… Check parts movable in all directions
…………………… Check proper operation of regulators
Equipment name: Infant radiant warmer
Equipment status:
Model: Functional Non Functional
 Check cleanliness Note…………………………………………
Check proper power supply ………………………………………………
………………………
Test heater output and check
connection of temperature sensor User comment………………………………
………………………………………………
Check proper operation of regulator ………………………………………
or control unit

Freely movable in all directions

Check setting operation

Equipment status:
Functional Non Functional Equipment name: photo therapy

Model:


 Check cleanliness Cleanliness

Check proper power supply Check DC battery

Test light output Test probe sensors

Check proper operation of regulator or Test output result and alarm
control unit
Equipment status:
Freely movable in all directions
Functional Non Functional
Check setting operation
Note
………………………………………………
Equipment status:
………………………………………………
Functional Non Functional
…………………..
Note…………………………………………
User comment
………………………………………………
………………………………………………
………………………
………………………………………………
User comment……………………………… …………….
………………………………………………
User name ……………..sign……..date……
………………………………………
Approved engineer: ……………………

Date…………….sign ………

Equipment name: Pulse Ox meter

Model: