Defibrillator Monthly Functional Check Log

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

Check Details

• Check Date
  Date the monthly functional check was completed.
• AED / Defibrillator ID
  Asset tag, room number, or other internal identifier for the device.
• Location
  Where the device is installed or stored.
• Inspected By
  Name or role of the person completing the check.

Functional Check

• Self-Test Result
  Select the result shown by the device self-test or readiness indicator.
• Readiness Indicator Status
  Confirm the status light or readiness indicator is normal.
• Pad Condition
  Confirm electrode pads are present, sealed, and not expired or damaged.
• Battery Status
  Confirm the battery is installed and shows acceptable status.
• Required Accessories Present
  Confirm any required accessories for this unit are present and usable, such as spare pads or rescue kit items.

Issues and Corrective Action

• Were any issues found?
• Issue Details
  Describe the issue, including the specific field that failed and any visible damage or missing items.
• Device Status After Check
  Indicate whether the device remains in service or has been taken out of service.
• Corrective Action Taken
  Record replacement, escalation, maintenance request, or other action taken.

Sign-Off

• Follow-Up Required
  Select whether maintenance, replacement, or supervisor review is needed.
• Follow-Up Notes
  Add any handoff details, work order numbers, or escalation notes.
• Inspector Signature
  Signature confirming the monthly functional check was completed.