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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)
Stop the bleed kit (broken seal)
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

Complete all four inspection steps in the links 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

To receive a confirmation of the report, you must enter your county e-mail address.

Additional comments, if any

Enter the verification code in the field below in order to submit the form.

If you cannot read the code, click the circle of arrows to retrieve a different one.