AED Use Report – Emergency Management & Mission Continuity

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

Type of employee

Building / Location*

List the location where the AED was used.

Buliding Location

AED Model

Responder(s)

select all responders to the location

List other responders

Was the AED easy to locate?*

Why was it hard to find the AED?

Did you experience any difficulty with the AED?*

Please describe the difficulty you had with the AED

Current status of the AED*

After use status of the AED Check all that apply!

Who Verified AED Condition / location?*

Name of person who inspected and replaced the AED

(if known)

First Last

Briefly describe your actions during the use of the AED*

Suggestions

Do you have any suggestions for us to improve the use of an AED?

Phone

This field is for validation purposes and should be left unchanged.