AED Monthly Checklist - REC Main Entrance

• Location of AED: REC Main Entrance
  Address

• AED Type: Cardiac Science Powerheart G5

  Yes

  No

  N/A

• Model Number: G5S-80P1

  Yes

  No

  N/A

• Cayuga - Onondaga BOCES Tag #: CAY400735

  Yes

  No

  N/A

• AED Serial No.: D00000258258

  Yes

  No

  N/A

• Checked on

  Date

• Checked by

• Manufacturer Date: 10-4-2022

  Yes

  No

  N/A

• Is the AED secure in its container?

  Yes

  No

  N/A

• Check AED is on standby mode - green flashing light

• If AED is not on standby mode, verify AED operation

Verify AED Operation

• Open AED lid / Turn on AED

• Voice Prompts

• Wait for status indicator to change from RED to GREEN after five seconds

• Close AED lid / Turn off AED

• Wait for status indicator to change from RED to GREEN after five seconds

• Are the electrode pads in the AED container?

  Yes

  No

  N/A

• Check expiration date of electrode pads

• Electrode Pads Expiration Date:

  Date

• Is there an extra set of electrode pads?

  Yes

  No

  N/A

• Electrode Pads Expiration Date:

  Date

• Is there an extra set of electrode pads

  Yes

  No

  N/A

• Electrode Pads Expiration Date:

  Date

• Check expiration date of AED battery: 9-8-2026

  Yes

  No

  N/A

• The AED battery is expired if 4 years have passed since its installation.

• AED Battery Installation Date: 9-8-2022

  Yes

  No

  N/A

• Battery Status Indicator (remaining life/charge)

Check PPE/Ready Kit

• Gauze Pads/ Absorbent Towel

• Scissors

• Razor

• Gloves

• Resuscitation Mask

• Test AED container tamper alarm

• If electrode pads were expired, did you replace them?

  Yes

  No

  N/A

• Input the date the electrode pads were replaced:

  Date

• If AED battery was expired, did you replace it?

  Yes

  No

  N/A

• Input the date the AED battery was replaced:

  Date

• If the AED container tamper alarm was not working, did you change its battery?

  Yes

  No

  N/A

• Signature

  Sign