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Defib

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Defib

Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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E-mail: service@amssolutionsinc.

com

PREVENTIVE MAINTENANCE REPORT


Customer Details: Date: Visit No: Report No:
Equipment Make & Model:

Defibrillator
Serial Number Department

Mail ID: Contract period Equipment Condition


Mobile No: [ ] Working [ ] Not Working

Equipment Status
Working on AC Voltage [ ] Yes [ ] No Equipment Input Voltage [ ] 220V [ ]110V

Working on Battery [ ] Yes [ ] No Main Supply Voltage L-N: N-E: L-E:

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

External damage [ ]Yes [ ] No ECG:


Printer: Spo2:
Test Energy: Output:

Pacer: Int. Paddles:


AED: Ext. Paddles:
Other Testing:

Engineers Comments

Overall Working Condition


[ ]Excellent [ ]Good [ ]Normal [ ]Bad [ ]Don't Use

Customer Signature with seal


Customer Name: Engineer's Signature

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