Defib
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Defibrillator
Serial Number Department
Equipment Status
Working on AC Voltage [ ] Yes [ ] No Equipment Input Voltage [ ] 220V [ ]110V
Display Condition [ ] Good [ ] Bad If S/D transformer present, Voltage L-N: N-E: L-E:
If touch display, Working Condition [ ] Good [ ] Bad Keypad [ ] Working [ ] Not [ ] Partially
Engineers Comments