Rumah Sakit Siloam Gleneagles
Preventive Maintenance Checklist
Equipment: Electrocardiograph
Date
: __________________
Merk
:
Period : __________________
Serial No.: _________________________Room
: __________________
Visual Inspection :Disconnect the cardiograph form AC power and
inspect for the
Following :
LLoss or missing hardware
____________________________
Frayed or damage wiring
____________________________
Mechanical damage
____________________________
Evidence of liquid spill
____________________________
Printer drive gear wear
____________________________
Printer roller wear
____________________________
Wear or damage to power cord and
Associated strain relief
____________________________
Corroded or damage electrodes
____________________________
Damage lead wires or patient module
cable____________________________
Dirt on thermal printer head
____________________________
Connect the cardiograph to AC power and turn on the AC
switch.
Verify the following :
The AC indicator is lit
____________________________
One or more green battery indicator are lit when On-Standby is
pressed
Turn on the cardiograph
____________________________
Extended Self-test : Run Extended self-test, select ALL menu
choice and verify that
each test passes with no errors.
Patient module and cable
____________________________
CPU assembly
____________________________
Printer
____________________________
Preview display
____________________________
Keyboard display
________________________
Electrocardiograph Simulation : Record an ECG wave using an ECG
simulator.
Verify the following :
Trace activity for all 12 leads
No gross distortion of complexes or calibration pulses
Calibration pulses are of proper duration (200 ms) and amplitude
(1 mV)
The trace will vary depending on simulation setting used and
simulation type.
calibration pulse measurements will vary depending on the
cardiograph gain
and speed setting.
Comments :
_______________________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
Pulse Recorder :
Test Equipment Used
: ECG Stimulator BIOTEK, Fluke multi meterRemarks
: ________________________________________________________
Performed by : _____________________
Verified by : _______________________
BM.0308.46/1
