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HD
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Rely-A-Care Checklist
RELY-A-CARE
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Power & Function
Unit powers on
Yes
No
No error lights/alarms
Yes
No
Flow meter smooth
Yes
No
Oxygen output present
Yes
No
Noise level normal
Yes
No
Performance
O2 purity test done
PURITY %
FLOW (LPM)
Pass ≥87%?
Yes
No
Physical Condition
Exterior clean
No cracks or damage
Power cord intact
Handle / wheels secure
Labels / Serial # intact
Intake filter present
OVERALL CONDITION
Clean
Dirty
Missing
Unit Details
COMPANY
Select Company...
Drive
Dynarex
Rhythm Health
O2 Concepts
MICITECH
Enter Manual Name...
MODEL
LITER FLOW
Select Flow...
5 Liters
10 Liters
SERIAL # (Required)
SCAN
HOUR METER
Decision
Ready for reissue
Needs cleaning
Needs repair
Pull from service
Notes
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CHECKED BY
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