UESI AED MONTHLY INSPECTION

• AED MONTHLY CHECK

• Life Support Equipment Maintenance<br>

  AED 1 MONTHLY CHECK

  AED 2 MONTHLY CHECK

  AED 3 MONTHLY CHECK

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Location of Unit:

  Commercial Bldg

  Nuclear Bldg

  Shop Office

  Missing

• Unit Model Number:

  M5066A

• Unit Serial Number:

  A07F03701

  A07E03119

  A15L03468

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

  Yes

  No

  N/A

• Does the AED rescue kit include: gloves, prep razor, scissors, bio-bag, towel, extra battery, extra pads, CPR mask?

  Yes

  No

  N/A

• Is the Status Indicator light flashing once every 3-4 seconds?

  Yes

  No

  N/A

• Are the electrode pads attached to the unit?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Date of installed electrode pads:

  2020/06

• Installed battery expiration date:

  2021-08

  2021-09

  2022-10

• Spare electrode pads expiration date:

  2020/06

• Spare battery expiration date:

  2021-08

  2021-09

  2022-10

• Are you installing new electrodes or batteries?

  Yes

  No

  N/A

• If installing new electrodes or batteries, did you turn unit on to allow it to complete a full self-test?

  Yes

  No

  N/A

• Press the "i" button, does the unit say "ready for use"?

  Yes

  No

  N/A

• Inspection card filled out?

  Yes

  No

  N/A

Signature

• Add signature

  Sign