HeartSafe Community AED Registry
Did you know that AED electrode pads and batteries have expiration dates and need to replaced on a regular basis? AEDs that are part of the HearSafe Community AED Registry will have pads and batteries tracked and our team will notify you when it is time to replace the parts. Over 100 local businesses throughout the North Bay currently use our HeartSafe Community Registry.

We can also enroll your AED in the Pulse Point, an app used by 911 dispatchers and responders to locate the nearest AED in the case of a cardiac emergency.

For questions, contact healthquest@phcd.org | More info at phcd.org/heartsafecommunity.php
Connectez-vous à Google pour enregistrer votre progression. En savoir plus
Name of Business
Make and Model of AED
Serial #
AED Battery Expiration Date
Please list the expiration date on the battery of your AED. The expiration date will be clearly listed on the battery. If you need assistance locating this information, please contact Healthquest at healthquest@phcd.org or 707-766-9226.
JJ
/
MM
/
YYYY
Electrode Expiration Date (adult pad)
Please list the expiration date listed on the adult-sized electrode pad. Depending on the brand, AEDs can include up to two adult and two pediatric electrode pads. Each pad will have an expiration date clearly listed on the pad. If you need assistance locating this information, please contact Healthquest at healthquest@phcd.org or 707-766-9226.
JJ
/
MM
/
YYYY
Electrode Expiration Date (adult pad, spare)
Please list the expiration date listed on the second adult-sized electrode pad, if there are two adult pads. Depending on the brand, AEDs can include up to two adult and two pediatric electrode pads. Each pad will have an expiration date clearly listed on the pad. If you need assistance locating this information, please contact Healthquest at healthquest@phcd.org or 707-766-9226.
JJ
/
MM
/
YYYY
Electrode Expiration Date (pediatric pad)
Please list the expiration date listed on the pediatric-sized electrode pad, if there is one. Depending on the brand, AEDs can include up to two adult and two pediatric electrode pads. Each pad will have an expiration date clearly listed on the pad. If you need assistance locating this information, please contact Healthquest at healthquest@phcd.org or 707-766-9226.
JJ
/
MM
/
YYYY
Electrode Expiration Date (pediatric pad, spare)
Please list the expiration date listed on the second pediatric-sized electrode pad, if there are two. Depending on the brand, AEDs can include up to two adult and two pediatric electrode pads. Each pad will have an expiration date clearly listed on the pad. If you need assistance locating this information, please contact Healthquest at healthquest@phcd.org or 707-766-9226.
JJ
/
MM
/
YYYY
Physical Address Where AED is Located
Description of Location of AED Within Building
Ex.: On first floor to the right of the elevator
Do you want to register your AED with Pulse Point?
Effacer la sélection
Contact Information
Please provide the following contact information
Contact Person
Job Title
Email
Phone Number
Please include area code
Envoyer
Effacer le formulaire
N'envoyez jamais de mots de passe via Google Forms.
Ce contenu n'est ni rédigé, ni cautionné par Google. Signaler un cas d'utilisation abusive - Conditions d'utilisation - Règles de confidentialité
Google Forms