Hospital. Enter the unit or activity, for example, 00 evacuation (EVAC) Hospital.
(4) Inspected by. Enter your name and code (assuming you are making the
(5) Type. Enter if the equipment is in the (A) critical-care area or (B)
(6) Results. Annotate whether the equipment measurements are within the
maximum limits identified.
Index number. Leave this block blank (local option).
(8) Nomenclature; model number. List the equipment nomenclature and
model number, for example,, Suction Apparatus, 9700.
(9) Test I-resistance (mΩ). Measure and record the ground resistance in
megohms (mΩ) from the grounding pin of the plug to the equipment's grounding test
point or to its chassis, for example, 90mΩ.
(10) Test II-current (A), grounded normal. Measure and record the leakage
current in microamperes (A) with the equipment in the "on" and "off" modes.
(11) Ground lifted-polarity; normal, reversed. Measure and record the
leakage current on the equipment in the ground-lifted; normal and reversed-polarity
f. Disposition Procedures.
Attach the completed form to the number-five copy of the completed DA
(2) Dispose of according to the normal disposition procedures used for the
DA Form 2407.
DA LABEL 175, DEFIBRILLATOR ENERGY OUTPUT CERTIFICATION
A completed DA Form Label 175 is shown in figure 2-2.
a. Purpose. The defibrillator energy-output-certification label provides a record
for the certification of energy output.
b. Use. DA Label 175 is used by medical units for documenting energy output
on all defibrillators.