Butte School District
Noninstructional Operations
AED Inspection Form 8450F-1
Inspected By:
Location of Inspection (Building):
Date of Inspection:
Use the following maintenance checklist when you check your unit.
Check the following Pass or Fail
Check the following |
PASS |
FAIL |
Comments |
---|---|---|---|
Is the green check showing that the unit is ready to use? |
FORMCHECKBOX |
FORMCHECKBOX |
|
Is the unit clean, undamaged, and free of excessive wear? |
FORMCHECKBOX |
FORMCHECKBOX |
|
Are there any cracks or loose parts in the housing? |
FORMCHECKBOX |
FORMCHECKBOX |
|
Verify that electrodes are within their expiration date. |
FORMCHECKBOX |
FORMCHECKBOX |
|
Verify electrodes are connected to the unit and sealed in their package. Replace if expired. |
FORMCHECKBOX |
FORMCHECKBOX |
|
Are all cables free of cracks, cuts and exposed or broken wires? |
FORMCHECKBOX |
FORMCHECKBOX |
|
Turn the unit on and off and verify the green check indicates ready for use. |
FORMCHECKBOX |
FORMCHECKBOX |
|
Batteries within expiration date. Replace if expired. |
FORMCHECKBOX |
FORMCHECKBOX |
|
Check for adequate supplies (mask, gloves, extra batteries) |
FORMCHECKBOX |
FORMCHECKBOX |
|
Alarm on AED Box operates correctly |
FORMCHECKBOX |
FORMCHECKBOX |
|
Cleaning the Unit
- After each use, clean and disinfect the unit with a soft, damp cloth using 90% isopropyl alcohol, or soap and water, or chlorine bleach and water mixture (30 ml/liter water).
- Do not immerse any part of the unit in water.
- Do not use ketones (MEK, acetone, etc.) to clean the unit.
- Avoid using abrasives (e.g., paper towel) on the display window or IrDa port.
- Do not sterilize the device.
SEND COMPLETED FORMS TO ENVIRONMENTAL HEALTH & SAFETY
ENVIRONMENTAL HEALTH & SAFETY USE ONLY
Work Order Number
Schedule Date
Completion Date
Action Required:
- 8100 - Transportation
- 8101 - Private Vehicle Transportation
- 8101P - Private Vehicle Transportation Continued
- 8101F-1 - Private Vehicle Transportation Continued
- 8102 - Transportation - School Activities
- 8102P - Transportation - School Activities - Continued
- 8104 - Student Behavior Code - School Buses
- 8104P - Student Behavior Code - School Buses Continued
- 8105 - Bus Emergencies
- 8105P - Bus Emergencies Continued
- 8105F - Bus Accident Notification Letter
- 8106 - School Bus Operation - Inclement Weather
- 8106P - School Bus Operation - Inclement Weather Continued
- 8107 - Transportation of Students
- 8107P - Transportation of Students Continued
- 8107F - Ineligible Transportee Application for Transportation
- 8110 - Bus Routes and Schedules New 4-24
- 8123 Driver Training and Responsibility
- 8125 - School Bus Emergencies
- 8125F - Bus Notification Letter (opens in new window)
- 8125P - Bus Emergencies - Bus Evacuation
- 8200 - Food Services
- 8210 - Procurement Policy for School Food Purchases
- 8230 | Nutrition
- 8420 - Districtwide Asbestos Program
- 8421 - Lead Renovation
- 8425 - Service Animals
- 8425F - Service Animals in District Facilities (opens in new window)
- 8425P - Service Animal Allowance Procedure
- 8430 - Records Management
- 8450 - Automatic External Defibrilators
- 8450F-1 AED Inspection Form
- 8450F-2 - AED & CPR Certification Log
- 8450F-3 - AED Incident Report
- 8450F-4 - AED Notification Letter
- 8450P - AED Program
This site provides information using PDF, visit this link to download the Adobe Acrobat Reader DC software.