What follows is a copy of fields taken from Medical Equipment Export’s technician’s checklist for used equipment.
P.M. CHECKLIST FOR ECG
CUSTOMER:_________________________________
MANUFACTURER:____________________________
MODEL:_____________________________________
SERIAL NUMBER:_____________________________
Printhead pressure: Pass __ Fail __ Adjusted __
Printhead skew: Pass __ Fail __ Adjusted __
Inspect passive backing: Pass __ Fail __
Check type of backing: Kapton __ Synthetic Rubber __
Segment activation: Pass __ Fail __ Adjusted __
Drive supply voltage: Pass __ Fail __ Adjusted __
If unit is interpretive complete this section
Program used: Bonner __ Mortara (MAC) __ New Mortara __ Tokyo Univ. __ Other __
Storage battery: Pass __ Fail __ Replaced __
Memory digitalization filtering: Pass __ Fail __
Complete and attach arrhythmia detection accuracy record: Yes __ No __
Comments and corrective action: _____________________________________________
Date tested: ___________________
Tested by: ____________________