Defibrillator Loan Form

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If you are a community group which wishes to borrow the defibrillator maintained by the Living Boat Trust for your event please complete the following form.

Before your event, at least one person from your group must complete this short online training session: https://rise.articulate.com/share/5hbr-vgXfKPJYy1L2bskjoNaZunfQ30S#/

For further information see the LBT website http://lbt.org.au or contact Deb (0427 554 265, debvanv66@gmail.com).

Community Group Name: *

Name of Contact Person responsible for the AED, case and contents while with your group. *

Contact Person Mobile phone: *

Contact Person Email:

Name of Event: *

Date(s): *

Location of event: *

Brief description of the event: *

Brief description of who will be at the event (E.g. older Huon residents, young men only, etc.), and why you’re booking the Mobile AED: *

Estimated number of people participating (including organisers): *

Pick up and Return - Name and contact details of person doing pick up and return of AED, case and contents (if not same as the contact person)

Preferred pickup date: *

YYYY

Preferred pickup time: *

Time

Preferred return date: *

YYYY

Preferred return time: *

Time

At least one person from your group and at the event has completed the online training package. Online training package: https://articulate.com/share/5hbr-vgXfKPJYyIL2bskjoNaZunfQ30S#/ *

Yes

Other:

If the AED, the case, or any of the case contents are used or damaged, I/We/Our Group will ensure this information is clearly passed onto the Living Boat Trust when we return the equipment. *

Yes

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