DC 5200 -Eyewash Station/AED Inspection - duplicate

• Site conducted

  Select

• Conducted on

  Date

• Prepared by:

AED (Safety Board)

• What is the AED serial number?

• Is the AED clean and undamaged?

  Yes

  No

  N/A

• Is the green light on the AED blinking?

  Yes

  No

  N/A

• Is the AED rescue kit in the case with the AED?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Are the electrode packets present, sealed, and within the expiration date?

  Yes

  No

  N/A

• Is the AED within the expiration date?

  Yes

  No

  N/A

Eyewash Station 1 (Receiving)

• Is the eyewash station at least half full?

  Yes

  No

  N/A

• Does the eyewash station work as intended?

  Yes

  No

  N/A

• Is the eyewash station free of damage or leaks?

  Yes

  No

  N/A

AED (Receiving Office)

• What is the AED serial number?

• Is the AED clean and undamaged?

  Yes

  No

  N/A

• Is the green light on the AED blinking?

  Yes

  No

  N/A

• Is the AED rescue kit in the case with the AED?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Are the electrode packets present, sealed, and within the expiration date?

  Yes

  No

  N/A

• Is the AED within the expiration date?

  Yes

  No

  N/A

Eyewash Station 2 (Chemical cage)

• Is the eyewash station at least half full?

  Yes

  No

  N/A

• Does the eyewash station work as intended?

  Yes

  No

  N/A

• Is the eyewash station free of damage or leaks?

  Yes

  No

  N/A

AED (Shipping Office)

• What is the AED serial number?

• Is the AED clean and undamaged?

  Yes

  No

  N/A

• Is the green light on the AED blinking?

  Yes

  No

  N/A

• Is the AED rescue kit in the case with the AED?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Are the electrode packets present, sealed, and within the expiration date?

  Yes

  No

  N/A

• Is the AED within the expiration date?

  Yes

  No

  N/A

Eyewash Station 3 (Shipping)

• Is the eyewash station at least half full?

  Yes

  No

  N/A

• Does the eyewash station work as intended?

  Yes

  No

  N/A

• Is the eyewash station free of damage or leaks?

  Yes

  No

  N/A

Eyewash Station 4 (maintenance)

• Is the eyewash station at least half full?

  Yes

  No

  N/A

• Does the eyewash station work as intended?

  Yes

  No

  N/A

• Is the eyewash station free of damage or leaks?

  Yes

  No

  N/A

• Are the float covers securely fastened?

  Yes

  No

  N/A

• Does the shower work?

  Yes

  No

  N/A

• Notes: