Periodontal Equipment Maintenance and Inspection Log

Comprehensive Documentation Template for Periodontal Practice Equipment

Periodontics

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Last updated: Mar 24, 2025

Equipment Information

  • Equipment Name: _______________
  • Model Number: ________________
  • Serial Number: ________________
  • Location: ____________________

Daily Maintenance Checklist

Start of Day

  • Visual inspection completed
  • Equipment properly calibrated
  • Safety features tested
  • Water lines flushed
  • Sterilization status verified

End of Day

  • Equipment cleaned and disinfected
  • Instruments properly sterilized
  • Water lines emptied
  • Equipment powered down correctly

Weekly Maintenance

  • Deep cleaning performed
  • Lubrication check/service
  • Water quality tested
  • Calibration verification

Monthly Inspection

Date: //___

System Components

  • Ultrasonic scaler functionality
  • Handpiece performance
  • Suction system efficiency
  • Air/water systems
  • Control panel operation

Safety Checks

  • Emergency stop function
  • Electrical connections
  • Pressure gauges
  • Warning indicators

Quarterly Service Record

Date Service Performed Technician Next Service Due

Issues/Repairs Log

Date Issue Description Action Taken Resolved By

Annual Certification

Last Certification Date: //___ Next Certification Due: //___

Inspected By: _________________ Signature: ____________________

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