Defibrillator Monthly Functional Check Log

Monthly functional check log for each defibrillator/AED, covering self-test result, pad condition, battery status, and corrective actions.

Check Details

• Month of Check
  Select the month the functional check was completed.
• AED / Defibrillator ID
  Enter the asset tag, room number, or other unique device identifier.
• Device Location
  Enter the current location of the device.

Functional Status

• Self-Test Result
  Record the device self-test result shown on the unit or indicator.
• Status Indicator
  Record the visible readiness indicator on the device.
• Audible Alarm or Error Message Observed?
  Select Yes if the device displayed an alarm, warning, or error message.
• Functional Issue Details
  Describe the issue observed and any immediate actions taken.

Pads and Battery

• Pads Present?
  Confirm that electrode pads are present with the device.
• Pads Expiration Date
  Record the expiration date if visible on the pad package.
• Pads Condition
  Record the condition of the pads and packaging.
• Battery Status
  Record the battery status shown by the device or indicator.

Corrective Actions and Sign-Off

• Corrective Action Required?
  Select Yes if any issue needs maintenance, replacement, or escalation.
• Corrective Action Details
  Describe the action needed, such as pad replacement, battery replacement, or service request.
• Checked By
  Enter the name or role of the person completing the check.
• I confirm this monthly functional check was completed accurately.
  Confirmation statement for audit trail and accountability.