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Medical Equipment Maintenance Log Template

Comprehensive Documentation System for Family Medicine Practices

Family Medicine

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Template Content

Last updated: Mar 24, 2025

Equipment Information

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

Maintenance Schedule

Date Type Next Due
□ Daily Checks
□ Weekly Checks
□ Monthly Checks
□ Quarterly Service
□ Annual Certification

Service Record

Date: ________________

  • Service Type: □ Routine Maintenance □ Repair □ Calibration □ Safety Check □ Other: ________________

  • Work Performed: ________________

  • Parts Replaced: ________________

  • Technician Name: ________________

  • Company: ________________

  • Cost: ________________

Safety Checks

  • Electrical Safety Test Date: ________________
  • Calibration Date: ________________
  • Infection Control Check: ________________

Issues/Observations

Date Issue Description Action Taken Resolved By

Equipment Disposal/Replacement

  • Disposal Date: ________________
  • Reason: ________________
  • Disposal Method: ________________
  • Replacement Equipment: ________________

Verification

  • Log Reviewed By: ________________
  • Review Date: ________________
  • Next Review Due: ________________

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