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 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

• 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

• Add media

  Media

• Add signature

  Sign

• Select date

  Date