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AED Location Form
 

Please use this form to report the location of an AED or to update previously reported information. If you have questions, please email aed@bostonems.org or contact Deputy Superintendent Claire McNeil, RN, EMT-P at 617-343-1115. This form is also available in PDF format to download and print.

* Required fields
General Information
Company Name: *
Address:
Street #
Street Address

* *
Section of City
5 or 9 Digit Zip Code

* *
 
Telephone:
Main Phone #
() - *    
Secondary #
() -    
 
AED Coordinator Information
AED Site Coordinator Name:
First Name
Last Name
* *
Department: *
Contact Person:
(if different from coordinator)
Email: *  
Telephone:
Tel #
() - *    
Fax #
() -    
Are you up to date with CPR training?
Do you or anyone in your organization wish to be CPR trained?
 
AED Location(s)
AED Location:
Add another location
Address (if different from address in the "General Information" section)

Exact location of AED/s (e.g. in lobby behind desk on left wall)

*
Floor Room/Suite AED Make Available 24/7?
* * * *

Are you reporting a new AED or updating information?

*

Other Information
Comments/Special Instructions


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