DAILY AND MONTHLY AED AND OXYGEN CHECK BRANCH: PERSON APPOINTED: AED LOCATION: MONTH: DAILY CHECK OF STATUS INDICATOR (For AED : flashing hourglass or blinking green light, depending on the model, For Oxygen Tank: level must be 50% or higher.) Date 1 2 3 4 5 6 7 8 9 10 11 12 13 Initial Date 14 15 16 17 18 19 20 21 22 23 24 25 26 Initial Date 27 28 29 30 31 Initial MONTHLY CHECK OF AED and OXYGEN TANK ITEMS: Available and in good condition? Yes/No Comments or concerns you need to address AED carry case 2 sets of defibrillator pads, in good condition and within the expiration date? Expiration Date: Expiration Date: Breathing barrier response pack Aspirin in response pack? (In the event of chest pain) Scissors in response pack? Razor in response pack? Towel in response pack? Battery within the expiration date? (Behind AED, do not remove battery) Expiration Date of battery 1: Expiration Date of battery 2 (optional): Status indicator is good? Oxygen level at 50% or Higher Mask and Tubing available for use ________________________________________ ___________________ _________________________________ Signature of person filling out monthly check Date of monthly check Fax each month on the 1st day of the month. Directly fax to Jackie Powell at: 972-560-3866 THIS FORM WILL NOT BE ACCEPTED UNTIL ALL FIELDS HAVE BEEN FILLED OUT If your AED is beeping or not flashing green at any time, please contact the Emergency Services Department immediately at 214-561-1508. Do not move the AED to another location unless it s an emergency!
DAILY AND MONTHLY AED AND OXYGEN CHECK
DAILY AND MONTHLY AED AND OXYGEN CHECK BRANCH: PERSON APPOINTED: AED LOCATION: MONTH: DAILY CHECK OF STATUS INDICATOR (For AED : flashing hourglass or blinking green ...
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