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Endoscopy Equipment Maintenance & Service Log

Comprehensive Documentation Template for GI Equipment Management

Gastroenterology

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Template Content

Last updated: Mar 24, 2025

Equipment Information

  • Device Name/Model: _______________
  • Serial Number: _______________
  • Manufacturer: _______________
  • Purchase Date: _______________
  • Location/Room: _______________

Daily Maintenance Checklist

Pre-procedure Check

  • Visual inspection of scope integrity
  • Air/water channel function test
  • Suction channel patency check
  • Angulation control check
  • Light source intensity verification
  • Video image quality assessment

Post-procedure Documentation

  • Leak testing completed
  • Manual cleaning performed
  • Automated endoscope reprocessor (AER) cycle completed
  • Final rinse and dry
  • Storage cabinet placement

Periodic Maintenance Record

Date Service Type Technician Details Next Due Date

Repair History

Date Issue Description Resolution Cost Service Provider

Quality Control Checks

Monthly Verification

  • Electrical safety testing
  • Biopsy channel measurement
  • Image quality assessment
  • Leak test system inspection

Quarterly Assessment

  • Scope calibration check
  • Light guide inspection
  • Channel cleaning verification
  • Control mechanism evaluation

Notes & Observations

Compliance Verification

Inspected By: _______________ Date: _______________ Signature: _______________

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