AED Registration
This form should be used to register your AED with LaPorte County Emergency Medical Service
Name of Agency, Business or Organization *
Your answer
Address *
Your answer
Phone Number *
Your answer
Contact Person *
Your answer
Number of AED's *
Brand of AED(s)? i.e. LifePak 500 *
Your answer
When was the AED(s) purchased? *
Your answer
Location of AED(s) *
Your answer
Are AED(s) secured? If so, how? *
Your answer
How often is/are AED(s) checked? *
Who provides bio med service on the device(s)? *
Your answer
Number of American Heart Association trained CPR providers are at your location? *
Your answer
Who provides medical direction for your organization? *
Your answer
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