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Appendix 1 - Efficia Dfm100 Shift Checklist - Philips Efficia DFM100 Instructions For Use Manual

Defibrillator/monitor.
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Appendix 1 - Efficia DFM100 Shift Checklist

Inspect your Efficia DFM100, accessories, and supplies at the change of every shift, per AHA
guidelines. Place a check mark in the box as you check each item in the list below or place a dash (-)
or N/A if not applicable. Then, initial the list to indicate the check was performed for that shift.
Device Name or Serial Number:______________Unit or Department:________
Date:
Shift:
RFU Indicator - Hourglass
If blinking red X - Plug
into AC power or insert
charged battery
If solid red X - Insert
charged battery or plug into
AC power. If condition
persists, call for service
Case - clean, free from spills
and objects
Cables/connectors -
present and inspected
Paddles/Therapy cable -
present, inspected and
paddles release from tray
Multifunction pads -
present, sufficient supply;
check expiration date
Monitoring Electrodes -
present, sufficient supply;
check expiration date
Charged Batteries - one in
device, spares. Check
battery gauge
AC Power Cord - plugged
in, green light on
Printer Paper - present,
sufficient supply
USB Drive - present
SpO
Sensors - present,
2
sufficient supply*
NBP cuffs/tubing -
present, sufficient supply*
CO
sensor - present, clean
2
and free from spills*
CO
Sample line - present,
2
sufficient supply*
Initials
* - if option is installed
1
2
3
1
2
3
1
2
3
1
2
3
1
2
3
219

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