Get Da Form 5624

Filling out the Da Form 5624 online is a straightforward process that ensures proper documentation of defibrillator inspections. This guide will help you navigate each section of the form with clear instructions and support.

Follow the steps to complete the Da Form 5624 efficiently.

1. Press the ‘Get Form’ button to access the document and open it in your browser.
2. Begin by entering the hospital or area location in the designated field. This information is self-explanatory.
3. Next, input the manufacturer's name (MFR) and the generic model identification (MDL). Ensure you do not use a catalog number.
4. In the visual inspection section, for each item listed (1 through 5), perform a check and indicate pass/fail by selecting YES (Y) or NO (N).
5. Provide a brief description of any actions needed in the 'Description of action needed' field. Document when the action was completed in the specified date format (YYYYMMDD).
6. Proceed to the performance tests section. Indicate the output energy and control settings, along with the energy delivered. Record the previous value for reference.
7. Note the charge time at maximum energy settings and document this in the appropriate field. Also, reference the previous charge time for comparison.
8. Complete the subsequent fields for internal discharge function, energy delivered after one minute, output of tenth repeated discharge, and synchronized operation as applicable.
9. In the certification section, indicate whether you are providing full or provisional certification by checking the appropriate box. Enter the date inspected and the next inspection due date.
10. Lastly, print or type the name of the inspector and provide their signature. Ensure all fields are filled out before proceeding to save, download, print, or share the completed form.

Complete the Da Form 5624 online today to ensure thorough documentation of your defibrillator inspections.