Dental Equipment Maintenance and Service Log

Equipment Information

• Equipment Name: ________________
• Model Number: _________________
• Serial Number: _________________
• Location: _____________________
• Purchase Date: ________________
• Warranty Expiration: ___________

Maintenance Schedule

Service Record

Date: //___

• Service Type: □ Routine □ Repair □ Calibration □ Other
• Technician: ________________
• Company: _________________
• Work Performed: ___________________________________________
• Parts Replaced: ___________________________________________
• Cost: $_________________
• Next Service Due: //___

Performance Monitoring

• Operating Parameters Checked: □ Yes □ No
• Safety Features Tested: □ Yes □ No
• Calibration Status: □ Pass □ Fail
• Notes: _________________________________________________

Compliance Verification

• Meets Current Standards: □ Yes □ No
• Documentation Complete: □ Yes □ No
• Staff Training Updated: □ Yes □ No

Additional Notes

Authorization

Verified By: ________________ Date: //___ Signature: _________________