Daily, Weekly, and Monthly Equipment Inspection and Service Record
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Equipment Name: _______________ Model Number: ________________ Serial Number: ________________ Location: _____________________
| Date | Time | Inspector | Visual Check | Functionality Test | Sterilization | Comments | Initials |
|---|---|---|---|---|---|---|---|
| □ | □ | □ |
Technician Notes: _________________
Date Performed: _______________ Service Provider: _______________ Next Service Due: _______________
| Date | Issue Description | Action Taken | Parts Replaced | Cost | Technician | Follow-up Required |
|---|---|---|---|---|---|---|
Last Certification Date: _______________ Certification Agency: _______________ Next Due Date: _______________
Maintain this log for each piece of major orthodontic equipment
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