*QC: Defibrillator Monthly Check - draft

• Audit Title

• Conducted on

  Date

General Questions

• 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

• 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

• Remove the batteries and perform a test. Pass?

  Yes

  No

  N/A

AED Prep Kit Items

• AED Prep Kit - Gloves

  Yes

  No

  N/A

• AED Prep Kit - Combine Dressing - 10cmx10xm x1

  Yes

  No

  N/A

• AED Prep Kit - Resuscitation Face Shield x1

  Yes

  No

  N/A

• AED Prep Kit - Scissors - (Trauma Sheers) Flat x1

  Yes

  No

  N/A

• AED Prep Kit - Drying Towel / Towellette x1

  Yes

  No

  N/A

• AED Prep Kit - Surgical Razor x1

  Yes

  No

  N/A

• AED Prep Kit - St John Bag - Large

  Yes

  No

  N/A

Signature

• Club Trillium Centre Management Team Member

  Ally

  Tony

• Add signature

  Sign