Co-op FM AED Survey

• Client / Site

• Audit Title

• Conducted on

  Date

• Prepared by

• Location
  Address

Survey Questions

• Enter details of the AED location and take a photo of location and store frontage.

• Add media

  Media

• Please enter the name of the AED manufacturer. (Take a photo of the AED)

• Add media

  Media

• Please enter the model of the AED.

• Does the AED operate?

  Yes

  No

• Please enter the date on the pads.

  Date

• Please rate the condition of the AED.

  (AED) Red

  (AED) Amber

  (AED) Green

• Enter details of the AED provider.

• Enter any further comments.

Sign-off

• Signature of Regional Facilities Manager

• RFM Signature

  Sign