Da Form 5624 R For use of this form see tb 38 750 2 the proponent agency is otsg edition of jan 87 is obsolete control setting 9 10 location usapa v1 00 action not needed needed taken reverse of da form 5624 r aug 87 usapa v1 00 action needed action taken date and initials ok 12 charging time to maximum energy setting previous value sec sec to w sec
INSTRUCTIONS FOR COMPLETING DA FORM 5624 R DA FORM 5624 R MAY 2006 APD LC v1 00ES HOSPITAL AREA LOCATION Self explanatory MFR Name of manufacturer MDL Use the manufacturer s generic model identification rather than a catalog number SERIAL The serial number of the defibrillator ESN Equipment Control Number or locally assigned index The front and back of a blank DA Form 5624 R are shown in figures 2 3 and 2 4 a Purpose The DA Form 5624 R provides a record for the certification of energy output and performance inspection for defibrillators b Use Use the DA Form 5624 R for documenting energy output and defibrillator performance inspections
Da Form 5624 R
Da Form 5624 R
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Da Form 5624 R ≡ Fill Out Printable PDF Forms Online
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https://www.armyreal.com/forms/pdf/A5624_R.PDF
For use of this form see tb 38 750 2 the proponent agency is otsg edition of jan 87 is obsolete control setting 9 10 location usapa v1 00 action not needed needed taken reverse of da form 5624 r aug 87 usapa v1 00 action needed action taken date and initials ok 12 charging time to maximum energy setting previous value sec sec to w sec
https://daformfillable.com/wp-content/uploads/2024/07/DA-FORM-5624-R-DC-Defibrillator-Inspection-Record.pdf
INSTRUCTIONS FOR COMPLETING DA FORM 5624 R DA FORM 5624 R MAY 2006 APD LC v1 00ES HOSPITAL AREA LOCATION Self explanatory MFR Name of manufacturer MDL Use the manufacturer s generic model identification rather than a catalog number SERIAL The serial number of the defibrillator ESN Equipment Control Number or locally assigned index
Da Form 5624 R ≡ Fill Out Printable PDF Forms Online
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What Is DA Form 5624 R This is a military form that was released by the U S Department of the Army DA on May 1 2006 The form often mistakenly referred to as the DD Form 5624 R is a military form used by and within the U S Army As of today no separate instructions for the form are provided by the DA Form Details Get a DA 5624 R here Edit Online Instantly DC DEFIBRILLATOR INSPECTION RECORD
The DA Form 5624 R serves as a detailed inspection record for defibrillators within medical facilities It outlines the process for visual inspection performance tests and certification ensuring each unit meets all necessary specifications and safety standards Interested personnel should follow the guidelines for completing the form accurately DA Form 5624 R blocks 12 through 17 Medical Maintenance and Supply Procedures Figure 2 8 DA Form 5624 R block 11 Medical Maintenance and Supply Procedures Block 13 internal discharge of stored energy setting Medical Maintenance and Supply Procedures
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Figure 2-9. DA Form 5624-R, blocks 12 through 17. - Medical Maintenance and Supply Procedures
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Da Form 5624 R ≡ Fill Out Printable PDF Forms Online
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Da Form 5624 R ≡ Fill Out Printable PDF Forms Online
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DA Form 5624 R is used to record inspections of DC defibrillators The form comprises sections where details about the defibrillator inspection including date inspector information inspection results and any corrective actions are documented It serves to assess and document the condition and functionality of DC defibrillators Important fields in this form encompass DA Form 5624 R is locally reproduced on 8 1 2 by 11 inch paper 2 If you do encounter deficiencies attach the DA Form 5624 R to the number five copy of the DA Form 2407 requesting corrective action 3 Dispose of the attached DA Form 5624 R according to the disposition instructions of the number five copy of the DA Form 2407 Continue
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