OPERATING ROOM COMPLEX EQUIPMENT CHECKLIST

PLEASE CHECK FOR FUNCTIONALITY, CLEANLINESS, AND AVAILABILITY 5 MINUTES PRIOR TO RECEIVING OF ENDORSEMENTS. ANY INCURRED PROBLEMS OF THE ITEMS BELOW ARE SUBJECT FOR NOTIFICATION TO THE OR NURSE SUPERVISOR ASAP! LOOK
OUTS DUE TO NOT CHECKING IS THE ACCOUNTABILITY OF THE INCOMING SHIFT TO REPLACE FOR COMPLETENESS...THANK YOU!
INSTRUCTION: CHECK ( / ) IF COMPLETE ----- WRITE THE QUANTITY OF AVAILABLE EQUIPMENT IF INCOMPLETE
April 2024 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
NAME OF EQUIPMENT QTY. LOC. BRAND / MODEL SERIAL NO. 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P
AUTOCLAVE 1 1 CSSR EZ-40D C1020008
AUTOCLAVE 2 1 CSSR TC-406 103406-08
AUTOCLAVE 3 (BIG) 1 CSSR GLE-582 2436-300179

AUTOCLAVE 4 (NEW)-4/26/23 1 CSSR SDL-D102 SDL-D0402

ANESTHESIA MACHINE w/ vaporizer 1 OR DRAGER ATLAS A300 XCCS-0177
ANESTHESIA MACHINE w/ vaporizer 1 OR DRAGER FABULOUS PLUS XL ASJ-0079
ANESTHESIA MACHINE w/ vaporizer 1 OR MINDRAY WATO-EX-30 DY-12000893
ANESTHESIA MACHINE 1 DR OHMEDA
CAUTERY MACHINE 1 OR BERCHTOLD 1122004-1
CAUTERY MACHINE wt trolley UPS 1 OR ZEUS AO3CNA02243

CAUTERY MACHINE wt trolley UPS 1 OR ZEUS AO3CNA02288

ENDOSCOPE SET 1 OR OLYMPUS 7127411

DEFIBRILATOR W/ MONITOR 1 RR PRICEPS/PHILIPS /EFFICIADFM100 CN32629331

FETAL MONITORING (CTG) 1 DR COMEN C21 K1210716001

INFANT WARMER 1 DR BABY LIFE / BLR 2100 BDT00148

LAPAROSCOPE SET #1 1 OR STORZ/XENON NOVA 175 220667076
LAPAROSCOPE SET #2 1 OR TEKNO/LIGHT XM 300 924839
OR MICROSCOPE 1 OR KARL KAPS
PATIENT MONITOR 1 OR DRAGER VISHNO056
PATIENT MONITOR 1 OR INFINIUM OMN13-0910-50598

PATIENT MONITOR #16 W/ STAND 1 OR DRAGER/VISTA120S SISND0023

PATIENT MONITOR #2 W/ STAND 1 RR DRAGER/VISTA121S S3S3NC0066
PATIENT MONITOR #3 W/ STAND 1 RR DRAGER/VISTA122S S3SNC0104
PATIENT MONITOR 1 (1/19/23) FAZZINI E7210828042

PATIENT MONITOR 2 (1/19/23) 3 RR FAZZINI E7210828059

PATIENT MONITOR 3 (1/19/23) FAZZINI E7210828083

PROCTOSCOPE 1 OR WELCH ALLYN/REFR-73210

SUCTION MACHINE 1 OR GEMMY 888/SU-305-P 15635
SUCTION MACHINE 1 OR CHEIRON / VICTORIA V14900
SUCTION MACHINE 1 OR CHEIRON / VICTORIA V14905
SUCTION MACHINE 1 OR HOSPIVAC / CAMI YBA 03221
SUCTION MACHINE (PORTABLE) 1 DR APEX / VACMAXI
SUCTION MACHINE (PORTABLE) 1 DR INDOPLAS / MS801-1 1683
SUCTION MACHINE (PORTABLE) 1 OR INDOPLAS / MS801-1 1684
SUCTION MACHINE (PORTABLE) 1 OR INDOPLAS / MS801-1 665
CAUTERY MACHINE-BORROWED 1 OR NET / DP 2700 350A201911280101

NAME OF NOD INCHARGE

 OPERATING ROOM COMPLEX EQUIPMENT CHECKLIST

PLEASE CHECK FOR FUNCTIONALITY, CLEANLINESS, AND AVAILABILITY 5 MINUTES PRIOR TO RECEIVING OF ENDORSEMENTS. ANY INCURRED PROBLEMS OF THE ITEMS BELOW ARE SUBJECT FOR NOTIFICATION TO THE OR NURSE SUPERVISOR ASAP! LOOK
OUTS DUE TO NOT CHECKING IS THE ACCOUNTABILITY OF THE INCOMING SHIFT TO REPLACE FOR COMPLETENESS...THANK YOU!
INSTRUCTION: CHECK ( / ) IF COMPLETE ----- WRITE THE QUANTITY OF AVAILABLE EQUIPMENT IF INCOMPLETE
April 2024
17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
NAME OF EQUIPMENT QTY. LOC. BRAND / MODEL SERIAL NO. 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P
AUTOCLAVE 1 1 CSSR EZ-40D C1020008
AUTOCLAVE 2 1 CSSR TC-406 103406-08
AUTOCLAVE 3 (BIG) 1 CSSR GLE-582 2436-300179

AUTOCLAVE 4 (NEW)-4/26/23 1 CSSR SDL-D102 SDL-D0402

ANESTHESIA MACHINE 1 OR DRAGER ATLAS A300 XCCS-0177
ANESTHESIA MACHINE 1 OR DRAGER FABULOUS PLUS XL ASJ-0079
ANESTHESIA MACHINE 1 OR MINDRAY WATO-EX-30 DY-12000893
ANESTHESIA MACHINE 1 DR OHMEDA
CAUTERY MACHINE 1 OR BERCHTOLD 1122004-1
CAUTERY MACHINE wt trolley UPS 1 OR ZEUS AO3CNA02243

CAUTERY MACHINE wt trolley UPS 1 OR ZEUS AO3CNA02288

ENDOSCOPE SET 1 OR OLYMPUS 7127411

DEFIBRILATOR W/ MONITOR 1 RR PRICEPS/PHILIPS /EFFICIADFM100 CN32629331

FETAL MONITORING (CTG) 1 DR COMEN C21 K1210716001

INFANT WARMER 1 DR BABY LIFE / BLR 2100 BDT00148

LAPAROSCOPE SET #1 1 OR STORZ/XENON NOVA 175 220667076
LAPAROSCOPE SET #2 1 OR TEKNO/LIGHT XM 300 924839
OR MICROSCOPE 1 OR KARL KAPS
PATIENT MONITOR 1 OR DRAGER VISHNO056
PATIENT MONITOR 1 OR INFINIUM OMN13-0910-50598

PATIENT MONITOR #16 W/ STAND 1 OR DRAGER/VISTA120S SISND0023

PATIENT MONITOR #2 W/ STAND 1 RR DRAGER/VISTA121S S3S3NC0066
PATIENT MONITOR #3 W/ STAND 1 RR DRAGER/VISTA122S S3SNC0104
PATIENT MONITOR 1 (1/19/23) FAZZINI E7210828042

PATIENT MONITOR 2 (1/19/23) 3 RR FAZZINI E7210828059

PATIENT MONITOR 3 (1/19/23) FAZZINI E7210828083

PROCTOSCOPE 1 OR WELCH ALLYN/REFR-73210

SUCTION MACHINE 1 OR GEMMY 888/SU-305-P 15635
SUCTION MACHINE 1 OR CHEIRON / VICTORIA V14900
SUCTION MACHINE 1 OR CHEIRON / VICTORIA V14905
SUCTION MACHINE 1 OR HOSPIVAC / CAMI YBA 03221
SUCTION MACHINE (PORTABLE) 1 DR APEX / VACMAXI
SUCTION MACHINE (PORTABLE) 1 DR INDOPLAS / MS801-1 1683
SUCTION MACHINE (PORTABLE) 1 OR INDOPLAS / MS801-1 1684
SUCTION MACHINE (PORTABLE) 1 OR INDOPLAS / MS801-1 665
CAUTERY MACHINE-BORROWED 1 OR NET / DP 2700 350A201911280101

NAME OF NOD INCHARGE

 OPERATING ROOM COMPLEX EQUIPMENT CHECKLIST
PLEASE CHECK FOR FUNCTIONALITY, CLEANLINESS, AND AVAILABILITY 5 MINUTES PRIOR TO RECEIVING OF ENDORSEMENTS. ANY INCURRED PROBLEMS OF THE ITEMS BELOW ARE SUBJECT FOR NOTIFICATION TO THE OR NURSE SUPERVISOR ASAP! LOOK OUTS DUE TO NOT CHECKING IS THE
ACCOUNTABILITY OF THE INCOMING SHIFT TO REPLACE FOR COMPLETENESS...THANK YOU!
INSTRUCTION: CHECK ( / ) IF COMPLETE ----- WRITE THE QUANTITY OF AVAILABLE EQUIPMENT IF INCOMPLETE
March 2024 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
NAME OF EQUIPMENT QTY. LOC. BRAND/MODEL SERIAL NUMBER 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P
BAG VALVE MASK-ADULT 1 HD-BLUE
BAG VALVE MASK-PEDIA 1 HD-BLUE
RR
BAG VALVE MASK-ADULT 1 WHITE
BAG VALVE MASK-PEDIA 1 WHITE
BAG VALVE MASK-ADULT 1 SURGITECH
BAG VALVE MASK-NEONATE 1 DR SURGITECH
BAG VALVE MASK-NEONATE 1 OLD
BP APPARATUS-ADULT 1 RR BAXTEL STAND TYPE
BP APPARATUS-ADULT 1 DR TABLE TOP TABLE TOP
BP APPARATUS-ADULT 3 ORC BAXTEL 679365 / 656309 / 686300

BP APPARATUS-PEDIA 1 OR ERKA-STAND
DROPLIGHTS #1 & #2 2
DROPLIGHT W/ BLUE 3
ORC
DROPLIGHT TOP CARE 1 TOP CARE
DROPLIGHT TOP CARE (NEW) 6 TOP CARE
DR DROP LIGHT #1 1 PROVITA
DR
DR DROP LIGHT #2 1 PROVITA
FETAL DOPPLER 1 DR EDAN 560042-M17910370064

LARYNGOSCOPE SET-NEONATE 1 DR OLTEN

LARYNGOSCOPE SET-ADULT 3 OR/RR/DR OLTEN
OXYGEN REGULATOR 6 ORC
OXYGEN REGULATOR (NEW) 6 ORC SHINE
OTHOSCOPE 1 ORC WELCHALLYN
PULSE OXYMETER 2 HAND HELD
ORC
PULSE OXYMETER 1 EDAN
PULSE OXYMETER 4 ORC c/o NA
STETHOSCOPE-ADULT 4 ORC LITTMAN
STETHOSCOPE-PEDIA 1 DR LIT-RED
STETHOSCOPE-NEONATE 1 DR LIT-RED
THERMOMETER 3 ORC OMRON
WEIGHING SCALE (ADULT) 1 OR CAMRY
WEIGHING SCALE (INFANT) 1 CAP DR-IFS-001
WEIGHING SCALE (INFANT) 1 DR HEMCO 20122947
WEIGHING SCALE (INFANT) 1 INMED 10501.19
WEIGHING SCALE (INFANT) 1 KINLEE/ EBSA-20 NA
NAME OF NOD INCHARGE
 OPERATING ROOM COMPLEX EQUIPMENT CHECKLIST
PLEASE CHECK FOR FUNCTIONALITY, CLEANLINESS, AND AVAILABILITY 5 MINUTES PRIOR TO RECEIVING OF ENDORSEMENTS. ANY INCURRED PROBLEMS OF THE ITEMS BELOW ARE SUBJECT FOR NOTIFICATION TO THE OR NURSE SUPERVISOR ASAP! LOOK OUTS DUE TO NOT CHECKING IS THE
ACCOUNTABILITY OF THE INCOMING SHIFT TO REPLACE FOR COMPLETENESS...THANK YOU!
INSTRUCTION: CHECK ( / ) IF COMPLETE ----- WRITE THE QUANTITY OF AVAILABLE EQUIPMENT IF INCOMPLETE
March 2024 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
NAME OF EQUIPMENT QTY. LOC. BRAND 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P
BAG VALVE MASK-ADULT 1 HD-BLUE
BAG VALVE MASK-PEDIA 1 HD-BLUE
RR
BAG VALVE MASK-ADULT 1 WHITE
BAG VALVE MASK-PEDIA 1 WHITE
BAG VALVE MASK-ADULT 1 SURGITECH
BAG VALVE MASK-NEONATE 1 DR SURGITECH
BAG VALVE MASK-NEONATE 1 OLD
BP APPARATUS-ADULT 1 RR BAXTEL STAND
BP APPARATUS-ADULT 1 DR BAXTEL-TABLE TOP
679365 / 656309 /
BP APPARATUS-ADULT 3 ORC 686300
BP APPARATUS-PEDIA 1 OR ERKA-STAND
DOPPLER 1 DR EDAN
DROPLIGHTS #1 & #2 2
DROPLIGHT W/ BLUE 3
ORC
DROPLIGHT TOP CARE 1 TOP CARE
DROPLIGHT TOP CARE (NEW) 6 TOP CARE
DR DROP LIGHT #1 1 PROVITA
DR
DR DROP LIGHT #2 1 PROVITA
LARYNGOSCOPE SET-NEONATE 1 DR OLTEN
LARYNGOSCOPE SET-ADULT 3 OR/RR/DR OLTEN
OXYGEN GAUGE 6 ORC
OXYGEN GAUGE (NEW) 6 ORC SHINE
OTHOSCOPE 1 ORC WELCHALLYN
PULSE OXYMETER 2 ORC HAND HELD
PULSE OXYMETER 4 ORC c/o NA
STETHOSCOPE-ADULT 4 ORC LITTMAN
STETHOSCOPE-PEDIA 1 DR LIT-RED
STETHOSCOPE-NEONATE 1 DR LIT-RED
THERMOMETER 3 ORC OMRON
WEIGHING SCALE (ADULT) 1 OR CAMRY
WEIGHING SCALE (INFANT) 1 CAP
WEIGHING SCALE (INFANT) 1 DR HEMCO
WEIGHING SCALE (INFANT) 1 INMED
WEIGHING SCALE (INFANT) 1 DR KINLEE EBSA-20

NAME OF NOD INCHARGE

 OPERATING ROOM COMPLEX EQUIPMENT CHECKLIST
PLEASE CHECK FOR FUNCTIONALITY, CLEANLINESS, AND AVAILABILITY 5 MINUTES PRIOR TO RECEIVING OF ENDORSEMENTS. ANY INCURRED PROBLEMS OF THE ITEMS BELOW ARE SUBJECT FOR NOTIFICATION TO THE OR NURSE SUPERVISOR
ASAP! LOOK OUTS DUE TO NOT CHECKING IS THE ACCOUNTABILITY OF THE INCOMING SHIFT TO REPLACE FOR COMPLETENESS...THANK YOU!

INSTRUCTION: CHECK ( / ) IF COMPLETE ----- WRITE THE QUANTITY OF AVAILABLE EQUIPMENT IF INCOMPLETE
March 2024 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
NAME OF EQUIPMENT QTY. LOC. BRAND 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P
BABY'S CRIB 2 DR
CABINET FOR LINENS 1 OR NARRA
CABINET FOR INSTRUMENTS 1 OR plywood+allum

DR CABINET 1 DR
DR TABLE- BLACK 1 DR BIKAKCILAR
DR TABLE- PINK 1 DR HEALTH WARD

E-CART - DR 1 DR
E-CART - OR 1 OR
E-CART - RR 1 RR
HIGH CHAIR 4
IV STAND NEW wt blue 3
IV STAND NEW PROCARE 10
MAYO TABLE 8 ORC

LONG TABLE WHITE 2 ZOOEY

MAYO TABLE SMALL 2
MAYO TRAY W/ STAND 5
MEDICINE RACK 4 OR SHOE RACK
OR LIGHT 4 OR SIM LED 7000

OR TABLE 4 OR AMTAI/STURDY

ORTHO BED 1 OR
OXYGEN HOLDER 12
OXYGEN HOLDER (NEW) 6
PATIENT BED 9
STAINLESS PAIL 2
ORC
SIDE TABLE 5
STRETCHER (OLD) 1
STRETCHER (NEW) 1
TROLLEY 1
WHEEL CHAIR ADULT 2
WHEEL CHAIR PEDIA 1
 NAME OF NOD INCHARGE
OPERATING ROOM COMPLEX EQUIPMENT CHECKLIST
PLEASE CHECK FOR FUNCTIONALITY, CLEANLINESS, AND AVAILABILITY 5 MINUTES PRIOR TO RECEIVING OF ENDORSEMENTS. ANY INCURRED PROBLEMS OF THE ITEMS BELOW ARE SUBJECT FOR NOTIFICATION TO THE OR NURSE SUPERVISOR
ASAP! LOOK OUTS DUE TO NOT CHECKING IS THE ACCOUNTABILITY OF THE INCOMING SHIFT TO REPLACE FOR COMPLETENESS...THANK YOU!

INSTRUCTION: CHECK ( / ) IF COMPLETE ----- WRITE THE QUANTITY OF AVAILABLE EQUIPMENT IF INCOMPLETE
March 2024 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
NAME OF EQUIPMENT QTY. LOC. BRAND 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P
BABY'S CRIB 2 DR
CABINET FOR LINENS 1 OR NARRA
CABINET FOR INSTRUMENTS 1 OR plywood+allum

DR CABINET 1 DR
DR TABLE- BLACK 1 DR BIKAKCILAR
DR TABLE- PINK 1 DR HEALTH WARD

E-CART - DR 1 DR
E-CART - OR 1 OR
E-CART - RR 1 RR
HIGH CHAIR 4
IV STAND NEW wt blue 3
MAYO TABLE 8
OR
LONG TABLE WHITE 2 ZOOEY
MAYO TABLE SMALL 2
MAYO TRAY W/ STAND 5
MEDICINE RACK 4 OR SHOE RACK
OR LIGHT 4 OR SIM LED 7000

OR TABLE 4 OR AMTAI/STURDY

ORTHO BED 1 OR
OXYGEN HOLDER 12
PATIENT BED 9
STAINLESS PAIL 2
SIDE TABLE 5 ORC

STRETCHER (OLD) 1
STRETCHER (NEW) 1
TROLLEY 1
WHEEL CHAIR ADULT 2
WHEEL CHAIR PEDIA 1
NAME OF NOD INCHARGE
 OR-DR COMPLEX EQUIPMENT MONTHLY INVENTORY and MONITORING SHEET (2023)

CALIBRATION

CALIBRATION

FUNCTIONAL

FUNCTIONAL
ACQUIRED
QUANTITY

LOCATION
NAME OF EQUIPMENT
REMARKS

NON-
DATE

DATE
BRAND MODEL SERIAL NUMBER

DUE
(HEAVY)
Fountain Med.
AUTOCLAVE 1 1 CSSR Equipment EZ-40D C1020008
AUTOCLAVE 2 1 CSSR GEMMY TC-406 103406-08 10/12/2022 10/12/2023
AUTOCLAVE 3 (BIG) 1 CSSR EMC III GLE-582 2436-300179 10/12/2022 10/12/2023
AUTOCLAVE 4 (NEW)-4/26/23 1 CSSR 4/26/23 SDL-D038 HWL-D0402
ANESTHESIA MACHINE 1 OR DRAGER FABULOUS PLUS XL ASJ-0079 10/12/2022 10/12/2023
ANESTHESIA MACHINE 1 OR MINDRAY WATO-EX-30 DY-12000893 12/21/2022 12/21/2023
ANESTHESIA MACHINE 1 OR OHMEDA
ANESTHESIA MACHINE-NEW 1 OR JULY,2023 DRAGER ATLAS A300 XSSC-0177
CAUTERY MACHINE 1 OR BERCHTOLD ELEKTROTOM530 1122004-1 11557 12/21/2022 12/21/2023
CAUTERY MACHINE 1 OR Geister ESU-x200NT 0725G-04116

CAUTERY MACHINE 1 OR NET A202105090002

DP2700
CAUTERY MACHINE 1 OR NET A202105090003
CV150 /
ENDOSCOPE SET 1 OR OLYMPUS SC-WV23-A1511
71450590791432
10/12/2022 10/12/2023
DEFIBRILATOR W/ MONITOR 1 RR PRICEPS/PHILIPS EFFICIA DFM100 CN32629331 10/12/2022 10/12/2023
FETAL MONITORING (CTG) 1 DR COMEN C21 K1210716001 12/21/2022 12/21/2023
INFANT WARMER 1 DR MEDICOR BABYLIFE BDT00148 12/21/2022 12/21/2023
LAPAROSCOPE SET #1 1 OR STORZ Xenon Nova 175 ZZ0667076 10/12/2022 10/12/2023
LAPAROSCOPE SET #2 1 OR TEKNO LIGHT XM 300 MF5 1543003 924839 12/21/2022 12/21/2023
OR MICROSCOPE 1 OR KARL KAPS 28880
PATIENT MONITOR 1 OR DRAGER VISTA 120 VISHNO056 10/12/2022 10/12/2023
PATIENT MONITOR 1 OR INFINIUM OMNI III OMN13-0910-50598 10/12/2022 10/12/2023
PATIENT MONITOR #16 W/ STAND 1 OR DRAGER VISTA120S SISND0023 10/12/2022 10/12/2023
PATIENT MONITOR #2 W/ STAND 1 RR DRAGER VISTA120S S3S3NC0066 10/12/2022 10/12/2023
PATIENT MONITOR #3 W/ STAND 1 RR DRAGER VISTA120S S3SNC0104 10/12/2022 10/12/2023
PATIENT MONITOR 1 1/19/23 FAZZINI E7210828042

PATIENT MONITOR 2 3 RR 1/19/23 FAZZINI E7210828059

PATIENT MONITOR 3 1/19/23 FAZZINI E7210828083

PROCTOSCOPE 1 OR WELCH ALLYN REFR-73210 6080

SUCTION MACHINE 1 OR GEMMY SU-305-P 15635 10/12/2022 10/12/2023
SUCTION MACHINE 1 OR CHEIRON VICTORIA V14900 10/12/2022 10/12/2023
SUCTION MACHINE 1 OR CHEIRON VICTORIA V14905 10/12/2022 10/12/2023
SUCTION MACHINE 1 OR HOSPIVAC CAMI 10540
SUCTION MACHINE (PORTABLE) 1 DR APEX VACMAXI YBA.03221 12/21/2022 12/21/2023
SUCTION MACHINE (PORTABLE) 1 DR 4/26/23 INDOPLAS MS801-1 1683
SUCTION MACHINE (PORTABLE) 1 OR 4/26/23 INDOPLAS MS801-1 1684
 CALIBRATION

CALIBRATION

FUNCTIONAL

FUNCTIONAL
ACQUIRED
QUANTITY

LOCATION
NAME OF EQUIPMENT
REMARKS

NON-
DATE

DATE
BRAND MODEL SERIAL NUMBER

DUE
(LIGHT)

BAG VALVE MASK-ADULT 1 HD-BLUE

BAG VALVE MASK-PEDIA 1 HD-BLUE
RR
BAG VALVE MASK-ADULT 1 WHITE
BAG VALVE MASK-PEDIA 1 WHITE
BAG VALVE MASK-ADULT 1 SURGITECH
BAG VALVE MASK-NEONATE 1 DR SURGITECH
BAG VALVE MASK-NEONATE 1 OLD
BP APPARATUS-ADULT 1 RR BAXTEL STAND 12/21/2022 12/21/2023
BP APPARATUS-ADULT 1 DR BAXTEL-TABLE TOP M18 693551 12/21/2022 12/21/2023
BP APPARATUS-ADULT 3 ORC BAXTEL 679365 / 686300

BP APPARATUS-PEDIA 1 OR ERKA-STAND 12/21/2022 12/21/2023

SONOTRAX BASIC 560042
DOPPLER 1 DR EDAN A
DROPLIGHTS #1 & #2 2
DROPLIGHT W/ BLUE 3 ORC
DROPLIGHT TOP CARE 1 TOP CARE
DROPLIGHT TOP CARE - NEW 6 4/26/23 TOP CARE
DR DROP LIGHT #1 1 PROVITA 2001 009
DR
DR DROP LIGHT #2 1 PROVITA 2001 011

LARYNGOSCOPE SET-NEONATE 1 DR OLTEN

LARYNGOSCOPE SET-ADULT 3 OR/RR/DR OLTEN
OXYGEN GAUGE -NEW 6 4/26/23 SHINE
OTHOSCOPE 1 ORC WELCHALLYN

PULSE OXYMETER 2 ORC HAND HELD

PULSE OXYMETER 4 ORC c/o NA OSPORT

STETHOSCOPE-ADULT 3 ORC LITTMAN

STETHOSCOPE-PEDIA 1 DR LIT-RED
STETHOSCOPE-NEONATE 1 DR LIT-RED
THERMOMETER 3 ORC OMRON
WEIGHING SCALE (ADULT) 1 OR CAMRY 10/12/2022 10/12/2023
WEIGHING SCALE (INFANT) 1 CAP DIIGITAL DR-IFS-001

WEIGHING SCALE (INFANT) 1 DR HEMCO HEMCO37-137 20122947 10/12/2022 10/12/2023

WEIGHING SCALE (INFANT) 1 INMED IWS-100 4-806031-50091 10/12/2022 10/12/2023
WEIGHING SCALE (INFANT) 1 DR 4/26/23 KINLEE EBSA-20
 CALIBRATION

CALIBRATION

FUNCTIONAL

FUNCTIONAL
ACQUIRED
QUANTITY

LOCATION
NAME OF EQUIPMENT REMARKS

NON-
DATE

DATE
BRAND MODEL SERIAL NUMBER

DUE
BABY'S CRIB 2 DR
CABINET FOR LINENS 1 OR

CABINET FOR INSTRUMENTS 1 OR

DR CABINET 1 DR
DR TABLE- BLACK 1 DR
DR TABLE- PINK 1 DR
E-CART - DR 1 DR
E-CART - OR 1 OR
E-CART - RR 1 RR
IV STAND NEW wt blue 3
IV STAND NEW 10 4/26/23 PROCARE
MAYO TABLE 8
ORC
LONG TABLE WHITE 2
MAYO TABLE SMALL 2
MAYO TRAY W/ STAND 5
MEDICINE RACK 4 OR
OR LIGHT 4 OR
OR TABLE 4 OR
ORTHO BED 1 OR
OXYGEN HOLDER 6
OXYGEN HOLDER -NEW 6 4/26/23

PATIENT BED 9
STAINLESS PAIL 2
SIDE TABLE 5 ORC

STRETCHER (OLD & NEW) 2

TROLLEY 1
WHEEL CHAIR ADULT 2
WHEEL CHAIR PEDIA 1
CHECKED BY: DATE:

OR-DR COMPLEX EQUIPMENT MONTHLY INVENTORY and MONITORING SHEET ( ISOLATION WARD) 2023

CALIBRATION

CALIBRATION

FUNCTIONAL

FUNCTIONAL
ACQUIRED
QUANTITY

LOCATION

NON-
DATE

DATE

DUE
NAME OF EQUIPMENT BRAND MODEL SERIAL NUMBER REMARKS

ANESTHESIA MACHINE 1 1SOL 12/28/15. Kontron/ORSA3 ABT 5100 99120391

PATIENT MONITOR 1 1SOL DRAGER VISTA120S SISND0034 12/12/2022 12/12/2023

DR LIGHT W/ TRANSFORMER 1 1SOL BOWIN

33070-
1SOL 11/23/18 WALLACH USA FETAL 2 EMR no TOCO
FETAL MONITORING (CTG) 1 M15202280006

OR BED 1 1SOL INFINIUM ATS

SUCTION MACHINE 1 1SOL CHEIRON Victoria V14908 12/12/2022 12/12/2023

SUCTION MACHINE (PORTABLE) 1 1SOL APEX VACMAXI YBA.03237 3/15/2022

VIDEO LARYNGOSCOPE 1 1SOL INSIGHTERS INSIGHT iS3-L CA 9204071

WEIGHING SCALE 1 1SOL INMED 12/12/2022 12/12/2023

DR TABLE- PINK 1
OR TABLE- BLACK 2
FOOT STOOL 2 1SOL

IV STAND 1 1SOL MANUAL

OXYGEN TANK 2
OXYGEN GAUGE 2
MAYO TABLE 2

MAYO TABLE with STAND 2

SIDE TABLE 2
CHECKED BY: DATE:
s
 LABOR AND DELIVERY ROOM EQUIPMENT CHECKLIST
PLEASE CHECK FOR FUNCTIONALITY, CLEANLINESS, AND AVAILABILITY 5 MINUTES PRIOR TO RECEIVING OF ENDORSEMENTS. ANY INCURRED PROBLEMS OF THE ITEMS BELOW ARE SUBJECT FOR NOTIFICATION TO CHIEF NURSE AND NURSE III ASAP! LOOK OUTS DUE TO
NOT CHECKING IS THE ACCOUNTABILITY OF THE INCOMING SHIFT TO REPLACE FOR COMPLETENESS...THANK YOU!
INSTRUCTION: CHECK ( / ) IF COMPLETE ----- WRITE THE QUANTITY OF AVAILABLE EQUIPMENT IF INCOMPLETE
January 2024 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
NAME OF EQUIPMENT QTY. BRAND 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P
BAG VALVE MASK-ADULT 1 SURGITECH
BAG VALVE MASK-NEONATE 1 SURGITECH
BAG VALVE MASK-NEONATE 1 OLD
BP APPARATUS-ADULT 1 BAXTEL-TABLE TOP
BP APPARATUS-ADULT 1 BAXTEL
DOPPLER 1 EDAN
DR DROP LIGHT #1 1 PROVITA
DR DROP LIGHT #2 1 PROVITA
DROP LIGHT TOP CARE 1 TOP CARE
FETAL MONITORING (CTG) 1 COMEN
INFANT WARMER 1 MEDICOR
INFANT WEIGHING SCALE 1 CAP
INFANT WEIGHING SCALE 1 HEMCO
LARYNGOSCOPE SET-NEONATE 1 OLTEN
LARYNGOSCOPE SET-ADULT 1 OLTEN
OXYGEN GAUGE 1 MEDICAL REGULATOR
OXYGEN GAUGE 1 JAPAN TECHNOLOGY
OXYGEN GAUGE 1 INDOPLAS
PULSE OXYMETER 4
STETHOSCOPE-NEONATE 1 LITTMAN-RED
STETHOSCOPE-ADULT 1 LITTMAN-BLACK
SUCTION MACHINE (PORTABLE) 1 INDOPLAS
SUCTION MACHINE (PORTABLE) 1 APEX

BABY'S CRIB 2
DR CABINET 1
DR E-CART 1
DR TABLE- BLACK 1 BIKAKCILAR
DR TABLE- PINK 1 HEALTH WARD
DR TABLE- BLUE 1
MAYO TABLE 1
MAYO TRAY W/ STAND 2
OXYGEN HOLDER 4
PATIENT'S BED 4
SIDE TABLE 1
TROLLEY 2
AM
PRINTED NAME AND INITIAL SIGN
PM
 NOTE: PLEASE WRITE AT THE BACK FOR ANY REMARKS, INDICATE DATE AND COMPLETE DATA OF EQUIPMENT/INSTRUMENTS….
LABOR AND DELIVERY ROOM EQUIPMENT CHECKLIST
PLEASE CHECK FOR FUNCTIONALITY, CLEANLINESS, AND AVAILABILITY 5 MINUTES PRIOR TO RECEIVING OF ENDORSEMENTS. ANY INCURRED PROBLEMS OF THE ITEMS BELOW ARE SUBJECT FOR NOTIFICATION TO CHIEF NURSE AND NURSE III ASAP! LOOK OUTS DUE TO
NOT CHECKING IS THE ACCOUNTABILITY OF THE INCOMING SHIFT TO REPLACE FOR COMPLETENESS...THANK YOU!
INSTRUCTION: CHECK ( / ) IF COMPLETE ----- WRITE THE QUANTITY OF AVAILABLE EQUIPMENT IF INCOMPLETE
January 2024 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
NAME OF EQUIPMENT QTY. BRAND 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P
ANESTHESIA MACHINE 1 OHMEDA
BAG VALVE MASK-ADULT 1 SURGITECH
BAG VALVE MASK-NEONATE 1 SURGITECH
BAG VALVE MASK-NEONATE 1 OLD
BP APPARATUS-ADULT 1 BAXTEL-TABLE TOP
BP APPARATUS-ADULT 1 BAXTEL
DOPPLER 1 EDAN
DR DROP LIGHT #1 1 PROVITA
DR DROP LIGHT #2 1 PROVITA
DROP LIGHT TOP CARE 1 TOP CARE
FETAL MONITORING (CTG) 1 COMEN
INFANT WARMER 1 MEDICOR
INFANT WEIGHING SCALE 1 CAP
INFANT WEIGHING SCALE 1 HEMCO
LARYNGOSCOPE SET-NEONATE 1 OLTEN
LARYNGOSCOPE SET-ADULT 1 OLTEN
OXYGEN GAUGE 1 MEDICAL REGULATOR
OXYGEN GAUGE 1 JAPAN TECHNOLOGY
OXYGEN GAUGE 1 INDOPLAS
PULSE OXYMETER 4
STETHOSCOPE-NEONATE 1 LITTMAN-RED
STETHOSCOPE-ADULT 1 LITTMAN-BLACK
SUCTION MACHINE (PORTABLE) 1 INDOPLAS
SUCTION MACHINE (PORTABLE) 1 APEX
WEIGHING SCALE 1 INMED
BABY'S CRIB 2
DR CABINET 1
DR E-CART 1
DR TABLE- BLACK 1 BIKAKCILAR
DR TABLE- PINK 1 HEALTH WARD
DR TABLE- BLUE 1
MAYO TABLE 1
MAYO TRAY W/ STAND 2
OXYGEN HOLDER 4
PATIENT'S BED 4
SIDE TABLE 1
TROLLEY 2
AM
PRINTED NAME AND INITIAL SIGN
PRINTED NAME AND INITIAL SIGN
PM
NOTE: PLEASE WRITE AT THE BACK FOR ANY REMARKS, INDICATE DATE AND COMPLETE DATA OF EQUIPMENT/INSTRUMENTS….
 RECOVERY ROOM EQUIPMENT CHECKLIST
PLEASE CHECK FOR FUNCTIONALITY, CLEANLINESS, AND AVAILABILITY 5 MINUTES PRIOR TO RECEIVING OF ENDORSEMENTS. ANY INCURRED PROBLEMS OF THE ITEMS BELOW ARE SUBJECT FOR NOTIFICATION TO
CHIEF NURSE AND NURSE III ASAP! LOOK OUTS DUE TO NOT CHECKING IS THE ACCOUNTABILITY OF THE INCOMING SHIFT TO REPLACE FOR COMPLETENESS...THANK YOU!
INSTRUCTION: CHECK ( / ) IF COMPLETE ----- WRITE THE QUANTITY OF AVAILABLE EQUIPMENT IF INCOMPLETE
January 2024 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
NAME OF EQUIPMENT QTY. BRAND 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P
BAG VALVE MASK-ADULT 1 HD-BLUE
BAG VALVE MASK-PEDIA 1 HD-BLUE
BAG VALVE MASK-ADULT 2 WHITE
BAG VALVE MASK-PEDIA 1 WHITE
BP APPARATUS-ADULT 1 BAXTEL STAND
BP APPARATUS-ADULT 1 BAXTEL
BP APPARATUS-PEDIA 1 SMART CARE
DR DROP LIGHT W/ BLUE 3
DEFIBRILATOR W/ MONITOR 1 PRICEPS/PHILIPS
OXYGEN GAUGE 3
PATIENT MONITOR #2 W/ STAND 1 DRAGER
PATIENT MONITOR #3 W/ STAND 1 DRAGER
PULSE OXYMETER 2 HAND HELD
PULSE OXYMETER 1 EDAN
STETHOSCOPE-PEDIA 1 LIT-RED
STETHOSCOPE-ADULT 1 LIT-BLACK
STETHOSCOPE-ADULT 1 LIT-BLUE
THERMOMETER 1 OMRON

MAYO TABLE 1
OXYGEN HOLDER 3
PATIENT BED 5
RR ECART 1

PRINTED NAME AND INITIAL AM

SIGN PM
NOTE: PLEASE WRITE AT THE BACK FOR ANY REMARKS, INDICATE DATE AND COMPLETE DATA OF EQUIPMENT/INSTRUMENTS….
 RECOVERY ROOM EQUIPMENT CHECKLIST

PLEASE CHECK FOR FUNCTIONALITY, CLEANLINESS, AND AVAILABILITY 5 MINUTES PRIOR TO RECEIVING OF ENDORSEMENTS. ANY INCURRED PROBLEMS OF THE ITEMS BELOW ARE SUBJECT FOR NOTIFICATION TO
CHIEF NURSE AND NURSE III ASAP! LOOK OUTS DUE TO NOT CHECKING IS THE ACCOUNTABILITY OF THE INCOMING SHIFT TO REPLACE FOR COMPLETENESS...THANK YOU!

INSTRUCTION: CHECK ( / ) IF COMPLETE ----- WRITE THE QUANTITY OF AVAILABLE EQUIPMENT IF INCOMPLETE
January 2024 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
NAME OF EQUIPMENT QTY. BRAND 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P
BAG VALVE MASK-ADULT 1 HD-BLUE
BAG VALVE MASK-PEDIA 1 HD-BLUE
BAG VALVE MASK-ADULT 2 WHITE
BAG VALVE MASK-PEDIA 1 WHITE
BP APPARATUS-ADULT 1 BAXTEL STAND
BP APPARATUS-ADULT 1 BAXTEL
BP APPARATUS-PEDIA 1 SMART CARE
DR DROP LIGHT W/ BLUE 3
DEFIBRILATOR W/ MONITOR 1 PRICEPS/PHILIPS
OXYGEN GAUGE 3

DRAGER
PATIENT MONITOR #2 W/ STAND 1

DRAGER
PATIENT MONITOR #3 W/ STAND 1
PULSE OXYMETER 2 HAND HELD
PULSE OXYMETER 1 EDAN
STETHOSCOPE-PEDIA 1 LIT-RED
STETHOSCOPE-ADULT 1 LIT-BLACK
STETHOSCOPE-ADULT 1 LIT-BLUE
THERMOMETER 1 OMRON

MAYO TABLE 1
OXYGEN HOLDER 3
PATIENT BED 5
RR ECART 1

PRINTED NAME AND AM

INITIAL SIGN PM
NOTE: PLEASE WRITE AT THE BACK FOR ANY REMARKS, INDICATE DATE AND COMPLETE DATA OF EQUIPMENT/INSTRUMENTS….
 OPERATING ROOM--1 & 2 EQUIPMENT CHECKLIST
PLEASE CHECK FOR FUNCTIONALITY, CLEANLINESS, AND AVAILABILITY 5 MINUTES PRIOR TO RECEIVING OF ENDORSEMENTS. ANY INCURRED PROBLEMS OF THE ITEMS BELOW ARE SUBJECT FOR NOTIFICATION TO CHIEF NURSE AND NURSE III ASAP! LOOK OUTS DUE TO NOT
CHECKING IS THE ACCOUNTABILITY OF THE INCOMING SHIFT TO REPLACE FOR COMPLETENESS...THANK YOU!
INSTRUCTION: CHECK ( / ) IF COMPLETE ----- WRITE THE QUANTITY OF AVAILABLE EQUIPMENT IF INCOMPLETE
January 2024 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
NAME OF EQUIPMENT QTY. LOC. BRAND 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P
ANESTHESIA MACHINE 1 OR DRAGER
PATIENT MONITOR 1 OR DRAGER
ANESTHESIA MACHINE 1 OR MINDRAY
PATIENT MONITOR 1 OR INFINIUM
PATIENT MONITOR #16 W/
STAND 1 OR DRAGER
BP APPARATUS-ADULT 1 BAXTEL
BP APPARATUS-PEDIA 1 ERKA-STAND
CAUTERY MACHINE 1 BERCHTOLD
CAUTERY MACHINE 1 GEISTER
CAUTERY MACHINE 1 NET
CAUTERY MACHINE 1 NET
DROPLIGHTS #1, #2, #3, #4 4
ENDOSCOPE SET 1 OLYMPUS
LAPARASCOPE SET #1 1 STORZ
LAPARASCOPE SET #2 1 TEKNO
LARYNGOSCOPE SET- ADULT 1 KAWE
OR LIGHT 4 SIM LED 7000
OR TABLE 4 AMTAI/STURDY
ORTHO BED 1
OR MICROSCOPE 1 KARL KAPS
OTHOSCOPE 1 WELCH ALLYN
PROCTOSCOPE 1 WELCH ALLYN
STETHOSCOPE-ADULT 1 LITTMAN-BLUE
SUCTION MACHINE 1 GEMMY
SUCTION MACHINE 1 CHEIRON
SUCTION MACHINE 1 CHEIRON
SUCTION MACHINE 1 HOSPIVAC
THERMOMETER 2 OMRON
WEIGHING SCALE 1 CAMRY

CABINET FOR LINENS 1 NARRA

CABINET FOR INSTRUMENTS 1 plywood+allum
MAYO TABLE 7
MAYO TABLE SMALL 1
MAYO TRAY W/ STAND 3
MEDICINE RACK 4 SHOE RACK
IV STAND PROCARE PROCARE
OR E-CART 1
OXYGEN HOLDER 4
STAINLESS PAIL 2
SIDE TABLE 4
 STRETCHER (OLD & NEW) 2
OPERATING ROOM/DR -- ISOLATION EQUIPMENT CHECKLIST
PLEASE CHECK FOR FUNCTIONALITY, CLEANLINESS, AND AVAILABILITY 5 MINUTES PRIOR TO RECEIVING OF ENDORSEMENTS. ANY INCURRED PROBLEMS OF THE ITEMS BELOW ARE SUBJECT FOR NOTIFICATION TO CHIEF NURSE AND NURSE III ASAP! LOOK OUTS DUE TO NOT
CHECKING IS THE ACCOUNTABILITY OF THE INCOMING SHIFT TO REPLACE FOR COMPLETENESS...THANK YOU!
INSTRUCTION: CHECK ( / ) IF COMPLETE ----- WRITE THE QUANTITY OF AVAILABLE EQUIPMENT IF INCOMPLETE
January 2024 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
NAME OF EQUIPMENT QTY. BRAND 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P
ANESTHESIA MACHINE 1 KONTRON/ORSA3
PATIENT MONITOR 1 DRAGER
DR LIGHT W/ TRANSFORMER 1 BOWIN
FETAL MONITORING (CTG) 1 WALLACH USA
OR BED 1 INFINIUM ATS
SUCTION MACHINE 1 CHEIRON
SUCTION MACHINE (PORTABLE) 1 APEX
VIDEO LARYNGOSCOPE 1 INSIGHTERS
WEIGHING SCALE 1 INMED
BAG VALVE MASK- PEDIA 1
DR TABLE- PINK 1
OR TABLE- BLACK 1
FOOT STOOL 2
IV STAND 1
OXYGEN TANK 2
OXYGEN GAUGE 2
AM
PRINTED NAME AND INITIAL SIGN
PM
NOTE: PLEASE WRITE AT THE BACK FOR ANY REMARKS, INDICATE DATE AND COMPLETE DATA OF EQUIPMENT/INSTRUMENTS….
OPERATING ROOM/DR -- ISOLATION EQUIPMENT CHECKLIST
PLEASE CHECK FOR FUNCTIONALITY, CLEANLINESS, AND AVAILABILITY 5 MINUTES PRIOR TO RECEIVING OF ENDORSEMENTS. ANY INCURRED PROBLEMS OF THE ITEMS BELOW ARE SUBJECT FOR NOTIFICATION TO CHIEF NURSE AND NURSE III ASAP! LOOK OUTS DUE TO NOT
CHECKING IS THE ACCOUNTABILITY OF THE INCOMING SHIFT TO REPLACE FOR COMPLETENESS...THANK YOU!
INSTRUCTION: CHECK ( / ) IF COMPLETE ----- WRITE THE QUANTITY OF AVAILABLE EQUIPMENT IF INCOMPLETE
January 2024 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
NAME OF EQUIPMENT QTY. BRAND 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P
ANESTHESIA MACHINE 1 KONTRON/ORSA3
PATIENT MONITOR 1 DRAGER
DR LIGHT W/ TRANSFORMER 1 BOWIN
FETAL MONITORING (CTG) 1 WALLACH USA
OR BED 1 INFINIUM ATS
SUCTION MACHINE 1 CHEIRON
SUCTION MACHINE (PORTABLE) 1 APEX
VIDEO LARYNGOSCOPE 1 INSIGHTERS
WEIGHING SCALE 1 INMED
BAG VALVE MASK- PEDIA 1
DR TABLE- PINK 1
OR TABLE- BLACK 1
FOOT STOOL 2
IV STAND 1
OXYGEN TANK 2
OXYGEN GAUGE 2
AM
PRINTED NAME AND INITIAL SIGN
 PRINTED NAME AND INITIAL SIGN
PM
NOTE: PLEASE WRITE AT THE BACK FOR ANY REMARKS, INDICATE DATE AND COMPLETE DATA OF EQUIPMENT/INSTRUMENTS….
OPERATING ROOM--1 & 2 EQUIPMENT CHECKLIST
PLEASE CHECK FOR FUNCTIONALITY, CLEANLINESS, AND AVAILABILITY 5 MINUTES PRIOR TO RECEIVING OF ENDORSEMENTS. ANY INCURRED PROBLEMS OF THE ITEMS BELOW ARE SUBJECT FOR NOTIFICATION TO CHIEF NURSE AND NURSE III ASAP! LOOK OUTS DUE TO NOT
CHECKING IS THE ACCOUNTABILITY OF THE INCOMING SHIFT TO REPLACE FOR COMPLETENESS...THANK YOU!
INSTRUCTION: CHECK ( / ) IF COMPLETE ----- WRITE THE QUANTITY OF AVAILABLE EQUIPMENT IF INCOMPLETE
January 2024 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
NAME OF EQUIPMENT QTY. LOC. BRAND 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P
ANESTHESIA MACHINE 1 OR DRAGER
PATIENT MONITOR 1 OR DRAGER
ANESTHESIA MACHINE 1 OR MINDRAY
PATIENT MONITOR 1 OR INFINIUM
PATIENT MONITOR #16 W/
STAND 1 OR DRAGER
BP APPARATUS-ADULT 1 BAXTEL
BP APPARATUS-PEDIA 1 ERKA-STAND
CAUTERY MACHINE 1 BERCHTOLD
CAUTERY MACHINE 1 GEISTER
CAUTERY MACHINE 1 NET
CAUTERY MACHINE 1 NET
DROPLIGHTS #1, #2, #3, #4 4
ENDOSCOPE SET 1 OLYMPUS
LAPARASCOPE SET #1 1 STORZ
LAPARASCOPE SET #2 1 TEKNO
LARYNGOSCOPE SET- ADULT 1 KAWE
OR LIGHT 4 SIM LED 7000
OR TABLE 4 AMTAI/STURDY
ORTHO BED 1
OR MICROSCOPE 1 KARL KAPS
OTHOSCOPE 1 WELCH ALLYN
PROCTOSCOPE 1 WELCH ALLYN
STETHOSCOPE-ADULT 1 LITTMAN-BLUE
SUCTION MACHINE 1 GEMMY
SUCTION MACHINE 1 CHEIRON
SUCTION MACHINE 1 CHEIRON
SUCTION MACHINE 1 HOSPIVAC
THERMOMETER 2 OMRON
WEIGHING SCALE 1 CAMRY

CABINET FOR LINENS 1 NARRA

CABINET FOR INSTRUMENTS 1 plywood+allum
MAYO TABLE 7
MAYO TABLE SMALL 1
MAYO TRAY W/ STAND 3
MEDICINE RACK 4 SHOE RACK
IV STAND PROCARE PROCARE
OR E-CART 1
OXYGEN HOLDER 4
 STAINLESS PAIL 2
SIDE TABLE 4
STRETCHER (OLD & NEW) 2
OPERATING ROOM/DR -- ISOLATION EQUIPMENT CHECKLIST
PLEASE CHECK FOR FUNCTIONALITY, CLEANLINESS, AND AVAILABILITY 5 MINUTES PRIOR TO RECEIVING OF ENDORSEMENTS. ANY INCURRED PROBLEMS OF THE ITEMS BELOW ARE SUBJECT FOR NOTIFICATION TO CHIEF NURSE AND NURSE III ASAP! LOOK OUTS DUE TO NOT
CHECKING IS THE ACCOUNTABILITY OF THE INCOMING SHIFT TO REPLACE FOR COMPLETENESS...THANK YOU!
INSTRUCTION: CHECK ( / ) IF COMPLETE ----- WRITE THE QUANTITY OF AVAILABLE EQUIPMENT IF INCOMPLETE
January 2024 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
NAME OF EQUIPMENT QTY. BRAND 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P
ANESTHESIA MACHINE 1 KONTRON/ORSA3
PATIENT MONITOR 1 DRAGER
DR LIGHT W/ TRANSFORMER 1 BOWIN
FETAL MONITORING (CTG) 1 WALLACH USA
OR BED 1 INFINIUM ATS
SUCTION MACHINE 1 CHEIRON
SUCTION MACHINE (PORTABLE) 1 APEX
VIDEO LARYNGOSCOPE 1 INSIGHTERS
WEIGHING SCALE 1 INMED
BAG VALVE MASK- PEDIA 1
DR TABLE- PINK 1
OR TABLE- BLACK 1
FOOT STOOL 2
IV STAND 1
OXYGEN TANK 2
OXYGEN GAUGE 2
AM
PRINTED NAME AND INITIAL SIGN
PM
NOTE: PLEASE WRITE AT THE BACK FOR ANY REMARKS, INDICATE DATE AND COMPLETE DATA OF EQUIPMENT/INSTRUMENTS….
OPERATING ROOM/DR -- ISOLATION EQUIPMENT CHECKLIST
PLEASE CHECK FOR FUNCTIONALITY, CLEANLINESS, AND AVAILABILITY 5 MINUTES PRIOR TO RECEIVING OF ENDORSEMENTS. ANY INCURRED PROBLEMS OF THE ITEMS BELOW ARE SUBJECT FOR NOTIFICATION TO CHIEF NURSE AND NURSE III ASAP! LOOK OUTS DUE TO NOT
CHECKING IS THE ACCOUNTABILITY OF THE INCOMING SHIFT TO REPLACE FOR COMPLETENESS...THANK YOU!
INSTRUCTION: CHECK ( / ) IF COMPLETE ----- WRITE THE QUANTITY OF AVAILABLE EQUIPMENT IF INCOMPLETE
January 2024 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
NAME OF EQUIPMENT QTY. BRAND 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P 8A 8P
ANESTHESIA MACHINE 1 KONTRON/ORSA3
PATIENT MONITOR 1 DRAGER
DR LIGHT W/ TRANSFORMER 1 BOWIN
FETAL MONITORING (CTG) 1 WALLACH USA
OR BED 1 INFINIUM ATS
SUCTION MACHINE 1 CHEIRON
SUCTION MACHINE (PORTABLE) 1 APEX
VIDEO LARYNGOSCOPE 1 INSIGHTERS
WEIGHING SCALE 1 INMED
BAG VALVE MASK- PEDIA 1
DR TABLE- PINK 1
OR TABLE- BLACK 1
FOOT STOOL 2
IV STAND 1
OXYGEN TANK 2
 OXYGEN GAUGE 2
AM
PRINTED NAME AND INITIAL SIGN
PM
NOTE: PLEASE WRITE AT THE BACK FOR ANY REMARKS, INDICATE DATE AND COMPLETE DATA OF EQUIPMENT/INSTRUMENTS….