Inspection Form

AED Inspection Form

AED unit custodians shall perform and document AED inspections for each unit designated to the custodian. Inventory management includes checking the emergency supply kit, AED battery and AED operation. Weekly tests should be conducted every Tuesday with monthly inspections on the first Tuesday of every month.

Select Inspection Date

Facility

Eight-digit serial #

The eight-digit serial number is located on the bottom of the AED (Ex. 31212345)

Enter the information below pertaining to the unit being inspected. All four inspection steps must be completed.

Step 1: Readiness display
OK Problem encountered
Check the readiness display and verify that no other symbols are present (other than the "OK" symbol).
Step 2: Use-by date
OK Problem Encountered
Check "Use By Date" on QUIK-PAK electrode packets (YYYY-MM-DD). Select "OK" or "Problem Encountered," then enter the date below.
Date
Step 3: Check defibrillator and wall case for the presence of: - First response kit (missing) - Damage(cracks, etc.) - Foreign substances If any of the above conditions are found indicate them in the comments box below.
Comments
Step 4: Location of AED unit
Indicate the exact location of the AED unit you inspected. (Ex. 4th floor next to elevator)

Complete all four inspection steps in the tabs above before completing the information below and submitting the form.

Name of AED unit custodian

If your name needs to be added to the custodian listing in the drop-down menu above, submit an e-mail to nas5@westchestergov.com.

County e-mail address

Enter your county e-mail address

Additional comments, if any

To submit this form, enter the random verification code in the field below:

Enter verification code