AED Inspection Form

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AED Inspection

Please indicate the below information with the condition that you are leaving the AED with - for example, if you've replaced pads or battery, indicate the new expiration date for these items.

This form is automatically emailed to the on-site contact for the AED unit so that they have a record of the information.
Person Completing Inspection:*
Business / Organization:*
On Site Contact:*
Phone:*
Email*
Address of AED Location*
Street Address Address Line 2 City State ZIP Code
Location of AED at Address:*
AED Brand:*
Other AED Brand:*
Be as specific/descriptive as possible.
Powerheart AED G3 Plus
Powerheart AED G3 Pro
(Has ECG Screen)
Powerheart AED G5
Cardiac Science Model:*
Defibtech Lifeline
Defibtech View
(Has ECG Screen)
Defibtech Model:*
Heartsine Samaritan 350P & 450P
HeartSine Models*
Heartstart OnSite AED
Heartstart FRX
HeartStart FR3
Philips Models*
Lifepak Express AED
Lifepak CR Plus
Lifepak 1000
Physio-Control Models*
Zoll AED Plus
Zoll AED Pro
Zoll Models*
AED Serial Number
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 time that the building is occupied?*
If kept in a locked office, select "No"
- Yes
- No
Is AED kept in a wall mounted cabinet?*
- Yes, cabinet is alarmed
- Yes, cabinet is not alarmed
- No, but AED is attached to a wall
- No
Does AED have a carrying case?*
- Yes
- No
Does AED have a rescue kit?*
If not attached to AED, please attach it if possible and indicate that it is attached to the AED.
- Yes, and rescue kit is attached to AED
- Yes, but it is not attached to AED
- No rescue kit
Does rescue kit include each of the following items?*
-Gloves
-Gauze or Towel
-CPR Pocket Mask or Barrier
-Razor
-Scissors or shears
- Yes, rescue kit is fully stocked
- No, rescue kit is missing items
What is missing from rescue kit?*
Adult Pads Expiration Date:*
Date Format: MM slash DD slash YYYY
Backup Adult Pads Expiration Date:
Date Format: MM slash DD slash YYYY
Pediatric Pads Expiration Date:
Date Format: MM slash DD slash YYYY
Battery Date:
Date Format: MM slash DD slash YYYY
AED is ready for use:*
Cardiac Science AEDs
- Yes: Rescue Ready indicator is green
- No: Rescue Ready indicator is red
AED is ready for use:*
Defibtech AEDs:
- Yes: Indicator light is green
- No: Indicator light is red
- No: Indicator light does not flash
AED is ready for use:*
HeartSine AEDs:
- Yes: Status Indicator flashes green
- No: Status Indicator flashes red
- No: Status Indicator not flashing
AED is ready for use:*
Philips AEDs:
- Yes: Status Indicator flashes green
- No: Status Indicator flashes red
- No: Status Indicator not flashing
AED is ready for use:*
Physio-Control AEDs:
- Yes: LCD screen reads "OK"
- No: LCD screen does not indicate "OK"
- No: LCD screen is blank
AED is ready for use:*
Zoll AEDs:
- Yes: Device displays green check
- No: Device displays red X
AED is ready for use:*
- Yes: Status Indicator flashes green
- No: Status Indicator flashes red
- No: Status Indicator not flashing
Device Notes:

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AED Inspection Form

AED Inspection

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