Defibrillator Audit

• MIDCF

  Select

• Date of Inspection

  Date

• Inspection Completed By

• Have any incident reports involving the defibrillator been submitted since the last audit ?

  Yes

  No

• Has battery been tested or replaced?

  Yes

  No

  N/A

• Is the DEFIBRILLATOR located at RECEPTION ?

  Yes

  No

• Does the DEFIBRILLATOR appear to be in GOOD CONDITION ?

  Yes

  No

• Does the DEFIBRILLATOR STATUS INDICATOR display a GREEN TICK

  Yes

  No

BATTERY PACK

• Does the BATTERY PACK appear to be in GOOD CONDITION ?

  Yes

  No

FIRST RESPONDER KIT

• Is there a FIRST RESPONDER KIT located with the DEFIBRILLATOR ?

  Yes

  No

• Is the TAMPER SEAL intact ?

  Yes

  No

• Inside the FIRST RESPONDER KIT there should be the following items:
  - 1x CPR Barrier Mask
  - 1x Scissors
  - 1x Disposable Gloves
  - 1x Prep Razor
  - 1x Small Towel
  - 1x Moist Wipe

• Select all the items that are PRESENT in the FIRST RESPONDER KIT

  Select CPR Barrier Mask Scissors Disposable Gloves Prep Razor Small Towel Moist Wipe

  • CPR Barrier Mask
  • Scissors
  • Disposable Gloves
  • Prep Razor
  • Small Towel
  • Moist Wipe

• Select the item(s) that are MISSING from the FIRST RESPONDER KIT

  Select CPR Barrier Mask Scissors Disposable Gloves Prep Razor Small Towel Moist Wipe

  • CPR Barrier Mask
  • Scissors
  • Disposable Gloves
  • Prep Razor
  • Small Towel
  • Moist Wipe

ELECTRODE PAD

• Does the ELECTRODE PAD appear to be in GOOD CONDITION ?

  Yes

  No

• Is the ELECTRODE PAD CABLE CONNECTOR plugged in SECURELY ?

  Yes

  No

• Is the ELECTRODE PAD in date ?

  Yes

  No

• What is the EXPIRY DATE on the ELECTRODE PAD ?

  Date

• Is the EXPIRY DATE within the next 2 MONTHS ?

  Yes

  No