subject_line
Defibrillator Quality Check
Equipment Number
*
Year
*
2016
2017
2018
2019
2020
Month
*
January
February
March
April
May
June
July
August
September
October
November
December
Instrument Working Properly?
*
Yes
No
If Not, Action Taken?
*
Items Present:
*
1 CPR Mask
1 pair of Medical Scissors
1 Hand Sanitizer
1 pair of Gloves
1 Disposable Razor
1 set of Adult AED Pads (verify exp date)
1 set of Child AED Pads (verify exp date)
Date Check Performed
*
+
Signature of Nurse Performing Check
*
clear