Defibrillator And Oxygen Kit Inspection

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Readiness for use check

• Is the defibrillator (serial number 1058) unit and oxygen bottle in position in amenities #3 First Aid room.

  satisfactory

  not satisfactory

  not applicable

• Is the defibrillator location sign displayed on the door to the first aid room?

  satisfactory

  not satisfactory

  not applicable

• Is the green light flashing on the defibrillator to indicate the unit is functioning correctly?

  satisfactory

  not satisfactory

  not applicable

• Are the defibrillator pads within the use-by date?

  satisfactory

  not satisfactory

  not applicable

• Has the defibrillator battery been replaced within the last 3 years?

  satisfactory

  not satisfactory

  not applicable

• Has the defibrillator had its annual certification by a qualified technician?

  satisfactory

  not satisfactory

  not applicable

• Has the oxygen dispenser had its annual inspection by a qualified technician?

  satisfactory

  not satisfactory

  not applicable

• Has the oxygen dispenser had the bodok seal replaced annually?

  satisfactory

  not satisfactory

  not applicable

• Is the oxygen bottle sufficiently full and in test?

  satisfactory

  not satisfactory

  not applicable

• Does the oxygen dispenser valve and regulator function as required?

  satisfactory

  not satisfactory

  not applicable

Any further comments

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