Equipment Maintenance Form

Your Name *

Clinic *

Today's Date * +

ALEX & YAG

ALEX - Maintenance *

	Yes	No
Tech Goggles Checked & are in Good Condition	Yes	No
Patient Goggles Checked & are in Good Condition	Yes	No
Slider Lens Checked for Pitting (hold up into light)	Yes	No
Slider Window Checked (replace if needed)	Yes	No
Laser Fiber Checked	Yes	No
Calport Clean	Yes	No
Water Level Checked	Yes	No
Distance Gauges Cleaned & PHOTO taken	Yes	No
Calibration Done (15mm 30J) & PHOTO taken	Yes	No
Filter (Lt side bottom) PHOTO taken & Cleaned	Yes	No

YAG - Maintenance *

	Yes	No
Tech Goggles Checked & are in Good Condition	Yes	No
Patient Goggles Checked & are in Good Condition	Yes	No
Slider Lens Checked for Pitting (hold up into light)	Yes	No
Slider Window Checked (replace if needed)	Yes	No
Laser Fiber Checked	Yes	No
Calport Clean	Yes	No
Water Level Checked	Yes	No
Distance Gauges Cleaned & PHOTO taken	Yes	No
Calibration Done (15mm 44J) & PHOTO taken	Yes	No
Filter (Lt side bottom) PHOTO taken & Cleaned	Yes	No

LVM SCREEN DETAILS
ALEX = HV>1800 BAD, HD>68 BAD, CP must be less than HD, TX<70BAD
YAG = HV >1100 BAD, HD>98 BAD, CP must be less than HD, TX<70BAD * 🛈

	Total Pulses	HV	HD	CP	TX
ALEX	Total Pulses	HV	HD	CP	TX
YAG	Total Pulses	HV	HD	CP	TX

YAG PHOTOS

YAG - Photo of Slider & DG Windows * 🛈

YAG - Photo of Tray on Top of Machine *

YAG Picture of Filters *

YAG LVM Screen (calibrate at 12mm 60j 70ms) * 🛈

Mesopen & Ultrasonic

Ultrasonic - Electrical Cord Straightened *

Yes

No

Photo of US Machine * 🛈

Photo of Mesopen Machine *

Supply Room

Photo of Shelf #1 *

Photo of Shelf #2 *

CRYO Canisters

On Machines *

Empty Cryo *

Full Cryo *

ALEX & YAG WINDOWS

*

	Total NEW Left in Inventory
Dual Windows	Total NEW Left in Inventory
ALEX Windows	Total NEW Left in Inventory
YAG Windows	Total NEW Left in Inventory

Mesopen Cartridges

Mesopen New Cartridges on Hand *

BLT Cream Qty *

Fire Extiguisher

Fire Extinguisher Checked and Working

Yes

No

Notes (if any)

Coolsculpting Cycles (If Relevant)

Large Cycles - Cool Advantage Plus (NEW)

Small Cycles - CoolAdvantage (NEW)

Small Petite Cycles - CoolAdvantage Petite

Flat Cycles - CoolSmoothPro

Touchscreen Photo Showing Usage

Touchscreen Photo Showing Usage Photo #2