Defibrillator Inspection v1.0

• Client / Site Location

• Conducted on

  Date

• Conducted by

• Location
  Address

1. Routine Maintenance Items

• 1.1 Is there evidence that routine inspection are conducted? e.g. every 12 months NOTE: Ensure maintenance log has been filled out

  Yes

  No

  N/A
Equipment Make

• Type of Equipment

  Philips

  Defibtech

  Mediana

  Other

• List asset number

• Date of last inspection

  Date

• 1.2 Is the Active Status Indicator (ASI) is flashing green?

  Yes

  No

  N/A

• 1.3 Are the pads in good condition and within the expiry date?

  Safe

  At Risk

  N/A

• 1.4 Is the battery pack within expiry date?

  Safe

  At Risk

  N/A

2. Perform Self-test

• 2.1 Did the unit pass the self-test? NOTE: Refer to the specific operations manual for the self-test procedure

  Safe

  At Risk

  N/A

3. Competency

• 3.1 Are workers familiar with the use and maintenance of the defibrillator?

  Safe

  At Risk

  N/A

4. Signage

• 4.1 Are relevant signs displayed near equipment?

  Safe

  At Risk

  N/A

5. Information

• 5.1 Is the operator manual available with the device?

  Yes

  No

  N/A

• Add photos of unit and accessories

  Media

6. Additional Hazards

List any additional hazard identified

• Hazard details

• Take photo of issue

  Media

• Perform a self-test to ensure the defibrillator is functioning correctly. Refer to the operators manual.

  Functioning

  Error

• Signature below is confirmation that the defibrillator and related equipment, including pads and battery, were checked/ tested and were functioning correctly at the time of inspection. The defibrillator was taken out of maintenance mode and left in a ready state. The green Active Status Indicator (ASI) light was operating when the equipment was put back into service.

• Signature of auditor

  Sign