Automated External Defibrillator (AED) Inspection

Client / Site Information

• Client / Site

  Select
• Inspection Location
  Address

• AED Location

  Unit 100

  Resident Care Office

  Pool & Spa

  The Hahnemann Club

• Inspection date

  Date

• Inspection conducted by

AED Information

• Brand

  Cardiac Science

  Philips

  HeartSine

  Zoll

• Model

  G5

  G3

• Model

  Onsite

  FRx

• Model

  350P

  450P

• Model

  AED Plus

  AED Pro

  AED 3
Serial Number

• Is the AED more than 8 years old?

  Yes

  No

  Unknown

• Is the Status Indicator showing AED is working properly?

  Yes

  No

• Has the AED made any chirping or other noises?

  Yes

  No

Adult Pad(s)

• Is there an adult pad?

  Yes

  No

• Is the pad package sealed?

  Yes

  No

• What is the expiration date on the pads?

  Date

• Have the pads expired?

  Yes

  No

• Are there any spare adult pads?

  Yes

  No

• Is the pad package sealed?

  Yes

  No

• What is the expiration date on the pads?

  Date

• Have the pads expired?

  Yes

  No

Pediatric Pad(s) / Key

• Is this AED equipped to be pediatric capable?

  Yes

  No

• Is there a pediatric pad or key?

  Pediatric Pad

  Pediatric Key

• Is the pad package sealed?

  Yes

  No

• What is the expiration date on the pads?

  Date

• Have the pads expired?

  Yes

  No

• Are there any spare pediatric pads?

  Yes

  No

• Is the pad package sealed?

  Yes

  No

• What is the expiration date on the pads?

  Date

• Have the pads expired?

  Yes

  No

• Is key present and free of damage?

  Yes

  No

Battery

• What is the expiration date on the battery?

  Date

• Has the battery expired?

  Yes

  No

  N/A

• Is there a spare battery?

  Yes

  No

• What is the expiration date on the battery?

  Date

• Has the battery expired?

  Yes

  No

AED Physical Condition

• Is the AED unit located in its designated area?

  Yes

  No

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

  Yes

  No

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

  Yes

  No

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

  Yes

  No

AED Photos

• Additional Photos, if needed

  Media

Inspection Results

• Device (if the device fails, see comments below):

  PASS

  FAIL

• Why did the device fail? Actions needed?:

Comments, Issues & Recommendations

• undefined

Acknowledgement

• On-site Client Inspection contact

• On-site contact signature

  Sign

• Date completed

  Date

• Robert J. Dobberstein, Safety ES Partners, LLC, Owner

  Sign

• rob@safetyeducationalservices.com

• Cell: 585-281-1101

• Contact information for AED Sales, Accessories and Training:

• Philips AED supplies: www.sesaedcenter.com use code "SES10" for 10% discount.

• www.safetyeducationalservices.com