LIFEPAK 500 Maintenance Checklist

LIFEPAK 500 Maintenance Checklist
®
LIFEPAK 500
AED Checklist
Month/Year:
DATE
INITIALS
1
2
3
4
Unit Serial Number:
5
6
7
8
Location:
9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Instruction and Recommended Corrective Action
Check defibrillator for damage or foreign substances.
If it appears that unit was tampered with, immediately
notify:______________________________________.
Adult electrode pads plugged into connector. If loose,
reconnect electrode pads to AED connector.
If
is visible on readiness display on handle.
is not visible refer to Troubleshooting Table.
Note USE BY date on electrode pads and battery.
Electrodes: _____________ Battery: ______________
If dates are passed notify: ______________________.
Extra set of electrode pads stored with AED (optional).
If missing notify: ______________________________
Spare battery stored with AED (optional).
If missing notify: ______________________________
Infant/child electrode pads* stored with AED (optional).
Expiration date: _______________________________
If missing notify: ______________________________
Other resuscitation equipment stored with AED:
____________________________________________
____________________________________________
If missing notify: _____________________________
NOTE: If corrective action is needed, leave box unchecked and complete troubleshooting log.
Troubleshooting Readiness Display
Replace battery
Notify: _______________________. Use AED if needed.
Service needed
Immediately notify: _______________________. Attempt of use AED in an emergency. If AED is inoperable retrieve
another AED, if possible, and continue CPR until EMS arrives.
Battery removed: no power to unit
If battery is not present notify:_____________________. If battery is present in unit, press ON and verify that OK
appears. If OK is visible, unit is now ready for use. If OK is still not visible, remove the battery to verify expiration
date and check pins, then reinsert until “click” is heard. Press ON and verify OK is present.
* Biphasic LIFEPAK 500 AEDs with a pink connector may be used on children up to 8 years old or 25kg (55 lbs) only with the Infant/Child Reduced Energy Defibrillation Electrodes.
®
Troubleshooting Log
Date/Time
LIFEPAK 500
AED Checklist
Action Taken
Signature Log
Initials
Print Full Name
©2004 Medtronic Physio-Control Corp. LIFEPAK is a registered trademark of Medtronic Physio-Control Corp.
MIN 3203813-001 / CAT. 26500-001704
Initials
Print Full Name
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