Title Page
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Location of AED
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AED Type
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Model Number
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Cayuga - Onondaga BOCES Tag #
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AED Serial No.
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Checked on
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Checked by
AED Monthly Checklist
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Is the AED secure in its container?
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Check AED is on standby mode - green flashing light
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If AED is not on standby mode, verify AED operation
Verify AED Operation
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Open AED lid / Turn on AED
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Voice Prompts
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Wait for status indicator to change from RED to GREEN after five seconds
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Close AED lid / Turn off AED
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Wait for status indicator to change from RED to GREEN after five seconds
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Are the electrode pads in the AED container?
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Check expiration date of electrode pads
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Electrode Pads Expiration Date:
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Is there an extra set of electrode pads?
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Electrode Pads Expiration Date:
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Is there an extra set of electrode pads
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Electrode Pads Expiration Date:
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Check expiration date of AED battery
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The AED battery is expired if 4 years have passed since its installation.
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AED Battery Installation Date:
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Battery Status Indicator (remaining life/charge)
Check PPE/Ready Kit
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Gauze Pads/ Absorbent Towel
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Scissors
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Razor
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Gloves
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Resuscitation Mask
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Test AED container tamper alarm
IMPORTANT Maintenance
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If electrode pads were expired, did you replace them?
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Input the date the electrode pads were replaced:
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If AED battery was expired, did you replace it?
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Input the date the AED battery was replaced:
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If the AED container tamper alarm was not working, did you change its battery?
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Signature