AED Use Reporting Form

Following use of the AED (Automated External Defibrillator) for students/staff, please complete this form. While not mandatory, completion of this form will allow the Center to monitor the incidence and details of AED use in schools. This information will be used to plan programs and training, create educational resources, and provide support to school health professionals in the care of students/staff.

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* 1. School District Name

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* 3. Type of School

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* 4. Level

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* 5. Date / Time

Date
Time

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* 6. AED was used

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