Title Page
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Site conducted
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Location of Epi Pen
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Date & Time Conducted
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Name and Signature of Inspection Officer
Checklist
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Are there 2 Epi Pens, 1 for adult and 1 for Junior? (Green for Adult, Yellow for Junior)
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Is the epi pen seal still intact? (Seal on top of the pen)
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If seal is broken, check clear solution on the side of the pen, if solution is discolored then replace immediately
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Is the clear solution on the side of the pen discolored?
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If Yes, remove pen and replace with a new one.
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Are they housed and secured Properly?
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Are the Epi Pens visible and clear of obstruction?
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Is there proper signage?
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Expiry Date for Adult Epi Pen
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Expiry Date for Child Epi Pen
