AED Use Report

To be completed when an AED has been used on any NC State University Campus.

Name*
Name of person who used the AED
First Last
Contact Phone number*
Contact Email address*
University Employee*
Was person who used the AED a University employee
- Yes
- No
Type of employee
- Faculty
- Staff
- Student
Building / Location*
List the location where the AED was used.

Buliding Location/Room
AED Manufacturer*
AED Model*
Responder(s)*
select all responders to the location
List other responders
Phone
This field is for validation purposes and should be left unchanged.