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:

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