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AED Acquisition Form
To be completed prior to buying an AED
Complete this form prior to purchasing an AED
AED Owner
*
First
Last
Contact Phone Number
Monthly Inspector Name
*
This person will be responsible for the monthly checks of the AED.
First
Last
Email
*
Alternate Monthly Inspector Name
*
This person will be responsible for the monthly checks of the AED.
First
Last
Alternate Email
*
Department Head of Requester
*
Building Name
*
How Many Requested
*
1
2
3
4
5 (or more)
Desired Location(s)
*
Where would you like to store / mount the AED(s)
Trained Personel
Pursuant to state contract pricing a
minimum of 5 people
must be trained to use the AED. List those people here.
Phone
This field is for validation purposes and should be left unchanged.
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