Sample AED/EAI/Naloxone Maintenance Check Sheet for Month of ______________________ Location of AED/EAI/Naloxone ______________________________ AED Information Epinephrine Auto-Injector /Naloxone Information Manufacturer: Brand: Lot: Dose Model #: Placement Date Expiration Date Serial #: Brand: Lot: Dose Pads Expiration Date: Battery Replaced on: Placement Date: Expiration Date: Date Cabinet AED Indicator light EAI Secure Naloxone Secure and Signature secure in place blinking in cabinet all components Fluid Clear useable This sample resource is located on the NYSSHSC website at: 8/15
Sample AED/EAI/Naloxone Maintenance Check Sheet for Month of ______________________ Location of AED/EAI/Naloxone ______________________________ AED Information Epinephrine Auto-Injector /Naloxone Information Manufacturer: Brand: Lot: Dose Placement Date Expiration Date Brand: Lot: Dose Placement Date: Expiration Date: Model #: Serial #: Pads Expiration Date: Battery Replaced on: Date Cabinet secure AED in place Indicator light blinking EAI Secure in cabinet Fluid Clear Naloxone Secure and all components useable Signature This sample resource is located on the NYSSHSC website at: 8/15
AED-EAI-Naloxone%20Maintenance%20Checklist.docx