AED Monthly Check

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Is the AED unit located in its designated area? Identify serial number of unit below.

  Yes

  No

  N/A

• Is the AED unit clean, undamaged and if applicable in its carry case or cabinet?

  Yes

  No

  N/A

• Is the AED rescue kit present and either stored on the carry case or cabinet or attached to the AED unit?

  Yes

  No

  N/A

• Does the AED rescue kit include: gloves, prep razor, scissors, towel, moist towelettes, CPR mask?

  Yes

  No

  N/A

• Are all electrode packages sealed and within the expiration date?

  Yes

  No

  N/A

• Does alarm on AED cabinet in working order? Note: Batteries should be replaced annually.

  Yes

  No

  N/A

• Is the Status Indicator showing a green check mark or the word 'OK'?

  Yes

  No

  N/A

• Are the electrodes attached to the unit?

  Yes

  No

  N/A

• Are the batteries within the expiration date?

  Yes

  No

  N/A

• Are you re-installing new electrodes or batteries?

  Yes

  No

  N/A

• If re-installing new electrodes or batteries, did you turn unit on to allow it to complete a full self-test to confirm a visible green check mark?

  Yes

  No

  N/A

Additional Photos

• Add media

  Media

• Add media

  Media

Signature

• Add signature

  Sign