Application for assessment and registration of an automated external defibrillator

Use this form to apply to Automated External Defibrillator (AED) Deployment Registry (AEDDR) for assessment and registration of an AED under AEDDR 1410
You must complete one form and pay the applicable fee for each AED
Who should AEDDR contact if there is a query about this form?

1. Details of the Applicant/Registrant

2. Details of the workplace

3. Details for ambulance
If consent to public access is granted these details will be available as part of the public register.

4. Consent for public access
It is agreed that the information contained in items 3 and 5 will be available to the public both in written and mapping form both via the internet and smart phone applications at www.nearestdefib.com. It is further agreed that a member of the public is granted access to the AED in the event of a cardiac emergency.

5. Normal hours of public access (excluding public holidays)

6. Details of AED
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7. AED accessibility

8. AED reliability

9. AED ease of use

10. AED training

Signature
This form must be signed by a manager with appropriate delegation or a professional consultant with professional indemnity insurance cover of at least $5 million dollars.
 
I certify that the information in this form is true and correct
Signature
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For more information, including information about fees payable
Email: applications@aeddr.com
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