AED Incident Report Name Business LocationAddress City State Zip Code Phone Number Was Detroit CPR Notified via Phone? Yes NoPLEASE CONTACT IMMEDIATELY: 313-742-3751Date / Time Incident Type AED Used Damaged EquipmentAED Location AED Serial Number (if known) Narrative of What Happened Was the Collapsed Witnessed? Yes NoWho Witnessed? Was 911 notified? Yes NoWho Called 911? Was CPR Performed Before EMS Arrived? Yes NoWho Performed CPR? Was the AED retrieved and applied to the patient prior to EMS arrival? Yes NoWho Retreived the AED? Were shocks delivered with the AED prior to EMS arrival? Yes NoWho Delivered the Shock? How Many Shocks? Equipment Type AED Adult Pads Pediatric Pads AED Case AED Cabinet First Aid Kit AED Supply KitDamage Type: Submit Form
