DA Form 5624-R: DC Defibrillator Inspection Record – Ensuring life-saving medical equipment like DC defibrillators remains in peak condition is critical in military healthcare settings. The DA Form 5624-R, officially titled the DC Defibrillator Inspection Record, serves as the standardized U.S. Army document for documenting thorough inspections, performance tests, and certification of these vital devices.
This article explains the form’s purpose, how to complete it, its importance for compliance, and where to download the latest version. It is essential reading for Army biomedical equipment technicians, medical maintenance specialists, and facility managers across U.S. military installations.
What Is DA Form 5624-R?
DA Form 5624-R is a two-page Department of the Army form used to record visual inspections, performance testing, and certification results for DC defibrillators. It falls under the guidelines in TB 38-750-2 (Maintenance Management Procedures for Medical Equipment), with the Office of The Surgeon General (OTSG) as the proponent agency.
The current edition is dated May 2006 (previous editions are obsolete). It helps ensure defibrillators meet manufacturer specifications for safe and effective operation during cardiac emergencies.
Key Details:
- Form Number: DA Form 5624-R
- Title: DC Defibrillator Inspection Record
- Purpose: Document routine and detailed technical inspections
- Reference: TB 38-750-2 and AR 40-61 (Medical Logistics Policies)
Why Proper Defibrillator Inspection Matters in the U.S. Army?
Defibrillators deliver controlled electrical shocks to restore normal heart rhythm. In high-stakes military environments—from field hospitals to garrison clinics—equipment failure is not an option. Regular documented inspections:
- Ensure patient and operator safety
- Maintain compliance with Army medical logistics and maintenance standards
- Support readiness and accreditation requirements
- Track performance trends over time (e.g., energy output changes)
Results are recorded on DA Form 5624-R, and a DA Label 175 (Defibrillator Energy Output Certification) is typically attached to the device upon successful inspection.
Sections of DA Form 5624-R and How to Fill It Out
Header Information
- Hospital/Area/Location
- Manufacturer (MFR)
- Model (MDL)
- Serial Number
- ECN (Equipment Control Number or locally assigned index)
Visual Inspection (Items 1–5)
Inspect these areas and mark PASS (Y/N). If action is needed, describe it and note the completion date:
- General Instrument Condition
- Attachment Plug
- Line Cord and Strain Reliefs
- Paddle, Cables & Connectors
- Controls, Indicators & Meters
Performance Tests (After Battery Service)
Item 6: Output Energy — Test at various control settings (low, medium, high). Record delivered energy (in Watt-Seconds), previous values, and any change.
Item 7: Charge Time to maximum energy setting.
Items 8–11: Internal discharge, energy after 1 minute, tenth repeated discharge, synchronized operation.
Item 12: Other features (specify and test).
Certification
- Full Certification (meets all manufacturer specs) OR Provisional Certification (safe for use but repairs needed, with work order number)
- Date Inspected (YYYYMMDD)
- Next Inspection Due
- Inspected By (Print, Grade/Rank, Signature)
Pro Tip: Always perform performance tests after servicing batteries. Use calibrated Test, Measurement, and Diagnostic Equipment (TMDE).
Best Practices for Defibrillator Maintenance
- Follow manufacturer guidelines alongside Army technical bulletins.
- Maintain a schedule for periodic inspections (frequency often aligns with TB 38-750-2 or local policy).
- Keep completed DA Form 5624-R records on file for audits and trend analysis.
- Combine with broader AED/medical equipment checklists for comprehensive readiness.
Note: While DA Form 5624-R focuses on DC (manual) defibrillators, many facilities also maintain separate logs for Automated External Defibrillators (AEDs) per safety and manufacturer recommendations.
Download DA Form 5624-R PDF
Get the official, fillable version directly from the U.S. Army Publishing Directorate:
→ Download DA Form 5624-R PDF Here
This is the authoritative source for current Army forms. Always verify you have the latest edition on armypubs.army.mil.
Additional Resources
- AR 40-61: Medical Logistics Policies
- TB 38-750-2: Maintenance procedures for medical equipment
- Army Medical Logistics Center (AMLC) resources for maintenance guidance
Stay prepared. Keep your medical equipment inspection records accurate and up-to-date with DA Form 5624-R.