BIOMEDICAL ENGINEERING DEPARTMENT

PLANNED PREVENTIVE MAINTENANCE (PPM)

DEFIBRILLATOR INSPECTION FORM

WO #: . Estimated time: 30 minutes

Equipment information
EQUIPMENT NAME:________________ASSET/INVENTORY#: _________________ Manufacturer: __________________
Model: ___________ Serial number: __________________ Location:____________
Test information
ENGINEER/Technician: ____________________Date Started: __________________
Test type: PPM Post repair
Test equipment needed: ESA615 Electrical Safety Analyzer (or equivalent)
Impulse 7000 Defibrillator Analyzer (or equivalent)
Ohmmeter (can be a multi-meter, such as the Fluke 73 series digital multi-meter)
Cables and connectors to connect defibrillator to analyzer

Test Result
QUANTITATIVE TASK
Pass Fail N/A
Physical condition

Device is clean and decontaminated

No physical damage to case, display, mounts, cart, or components

Switches and controls operable and correctly aligned

Display intensity adequate for daytime use

Control numbers, labeling, and warnings present and legible

Inlets and hoses

Power cord, accessory cables, charger

Filters and vents clean

Electrical safety Criteria IEC
62353/60601
Ground wire resistance/protective earth 0.3 W

< 100 µA NC
Chassis leakage < 500 A SPC
< 100 µA B and BF
Patient leakage current < 10 µA CF
Patient lead leakage current – isolation test (mains on patient < 100 µA BF
applied part) < 10 µA CF
Insulation test (optional) 500 V <2Ω

PREVENTIVE QUANTITATIVE TASK

MAINTENANCE
Replace battery every 24 months

Verify electrodes, gel and paddles are stored with the defibrillator and are within expiration
dates
Verify proper time and date, correct if necessary
 BIOMEDICAL ENGINEERING DEPARTMENT
PLANNED PREVENTIVE MAINTENANCE (PPM)
DEFIBRILLATOR INSPECTION FORM

Complete model-specific preventive maintenance

Test Result
Performance testing
Pass Fail N/A

QUANTITATIVE TASK
Verify unit operates on battery

Paddle continuity ≤ 0.15 Ω

Heart rate accuracy ±5%
Recorder speed ±4%
Verify operation of alarms

Output accuracy ± 15 %
Output accuracy, multiple loads ± 15 % (each delivery)
Output energy at maximum setting for 10 charge cycles (battery
± 15 %
power)
Charge time after 10 discharge cycles (battery power) ≤ 15 sec
Energy after 60 sec of full charge (battery power) ≥ 85 %
Internal discharge function

Synchronizer operation ≤ 60 msec

Shock advisory/AED functionality

Pacer output accuracy ± 10 %

Pacer rate accuracy ±5%
Demand-mode sensitivity

Complete model-specific performance testing

TIME STARTED: TIME COMPLETED: NEXT PPM DUE: (MM/DD/YYYY)

END USER ON DUTY:

NAME : .

POSITION/DESIGNATION : .

SIGNATURE : .