Defibrillator Monthly Check

• Site conducted

  Select

• Defibrillator Monthly Check

• Audit Completed by:

• AED Location

• Conducted on

  Date

• Is the AED unit located in its designated area?

  Yes

  No

  N/A

• Is the AED unit clean, undamaged and if applicable in its carry case or cabinet?

  Yes

  No

  N/A

• Is the AED rescue kit present and either stored on the carry case or cabinet or attached to the AED unit?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Are all electrode packages sealed and within the expiration date?

  Yes

  No

  N/A

• Is the Status Indicator showing a green check mark or the word 'OK'?

  Yes

  No

  N/A

• Are the electrodes attached to the unit?

  Yes

  No

  N/A

• Are the batteries within the expiration date?

  Yes

  No

  N/A

Auditors Signature

• Signature:

  Sign

AUDIT COMPLETION:

• When audit has been completed please select yes to submit.

  Yes