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: ____________________