AED Inspection

Name of Person Completing Inspection

Business / Organization

Address of AED Location

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Location of AED

On Site Contact

Phone

Email

AED Brand

Other Manufacturer and Model

Powerheart G5

Powerheart G3

Powerheart G3 Pro

Cardiac Science AED Model

Lifeline

Lifeline View

Defibtech AED Model

samaritan PAD 350P, 360P, and 450P

Heartsine AED Model

HeartStart OnSite

HeartStart FRx

HeartStart FR3

Philips AED Model

LIFEPAK EXPRESS

LIFEPAK CR Plus

LIFEPAK 1000

LIFEPAK 500

Physio-Control AED Model

Zoll Aed Plus

Zoll Aed Pro

Zoll AED Model

Does AED have 3-Dimensional Signage?

A 3D sign is a triangular marker on the wall above the AED so that its location can be seen from either direction.

Yes
No

Is AED accessible at all times that the building is open?

If kept in a locked office, select "No"

Yes
No

Is AED kept in a wall mounted cabinet?

Yes, cabinet alarmed
Yes, cabinet not alarmed
No, but AED is attached to the wall
No

Does wall cabinet alarm work?

Yes, alarm functions properly
No

Does AED have a carrying case?

Yes
No

Does AED have a response kit?

Yes, attached to AED
Yes, not attached to AED
No response kit

Response kit contents:

How many adult pads does AED have?

None
One set
Two sets

Adult Pads Set 1 Expiration Date:

MM

DD

YYYY

Adult Pads Set 2 Expiration Date:

MM

DD

YYYY

Does AED have pediatric pads?

Yes
No

Pediatric Pads Expiration Date:

MM

DD

YYYY

Battery Inspection (Cardiac Science)

Open the lid. Battery indicator will show a percentage of battery life remaining. Close lid.

Green: more than 25% battery life
Green: less than 25% battery life
Red: replace battery

Rescue Ready:

Several seconds after closing the lid, the Rescue Ready status indicator is green. If indicator does not turn green, open lid again, wait for prompts to begin before closing lid. Indicator should turn green in several seconds.

Green: Ready for Rescue
Red: Not Ready for Rescue

Ready Light:

Ready light flashes green every few seconds.

Green: Ready for use
Not flashing, AED is chirping: Not ready for use
Not flashing, AED is not chirping: Battery is either dead or not installed. Not ready for use.

Battery Expiration Date:

Printed on battery underneath the bar code.

MM

DD

YYYY

Battery Expiration Date:

Printed on battery above the bar code.

MM

DD

YYYY

Battery Expiration Date:

Printed on battery under "PN"

MM

DD

YYYY

Active Status Indicator:

Indicator light flashes green every few seconds.

Green: Ready for use
Flashing red, AED is chirping: Not ready for use
Not flashing, AED is not chirping: Battery is either dead or not installed. Not ready for use.

Status Indicator:

Indicator light flashes green every 5-10 seconds.

Green: Ready for use
Flashing red, AED is chirping: Not ready for use
Not flashing, AED is not chirping: Battery is either dead or not installed. Not ready for use.

Status Indicator:

Check display on unit.

Green "✓"
Red "X"

Status Indicator:

Check LCD display on unit. If no LCD display, turn AED on, listen for "Battery OK. Self Test"

"OK"
Battery or Service (wrench) indicator displayed: Not OK

Notes:

AED Inspection

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