Templates
AED incident report form

AED incident report form

Document and analyze AED incidents effectively with our comprehensive AED incident report form, designed to streamline reporting and improve response strategies.

Use this template with Lumiform

The Lumiform application helps frontline teams uphold internal standards effortlessly.
  • Customize this template or build your own
  • Fill out templates via mobile app
  • Assign and track corrective actions
  • Get reports and analyse your data
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AED incident report form

Document and analyze AED incidents effectively with our comprehensive AED incident report form, designed to streamline reporting and improve response strategies.

Use this template with Lumiform

The Lumiform application helps frontline teams uphold internal standards effortlessly.
  • Customize this template or build your own
  • Fill out templates via mobile app
  • Assign and track corrective actions
  • Get reports and analyse your data
Prices start from ░░░ per month
Book a demo
Learn more
or Download template as PDF

The AED incident report form provides a structured framework to document critical details when an Automated External Defibrillator is used during a cardiac emergency. We created this template to help you capture essential information—from patient condition and AED performance to responder actions—ensuring comprehensive documentation for both compliance and emergency response improvement.

When a cardiac event occurs in your facility, this form guides you through proper documentation, helping protect your organization legally while providing valuable data for protocol refinement. Using an AED within the first three to five minutes of cardiac arrest can increase survival chances by up to 70 percent, making proper documentation of these life-saving interventions crucial.

Related categories

Preview of the template
Incident Details
Date and Time of Incident
Location of Incident
Name of Person Using the AED
Patient Condition
Was the Patient Conscious?
Was the Patient Breathing?
What was the Patient's Pulse?
What was the Patient's Skin Color?
AED Performance
Was the AED Turned On?
Did the AED Deliver a Shock?
Did the AED Prompt for CPR?

Frequently asked questions

Who is responsible for filling out the AED incident report form?

The primary responsibility typically falls to the person who operated the AED or the designated emergency response team leader. In workplace settings, safety officers or AED program coordinators should ensure form completion. Some organizations require dual verification, with the responder providing details while a supervisor or AED coordinator completes the official documentation.

How can I ensure my AED incident report form meets regulatory requirements?

Review your local health department guidelines and AED program requirements, as regulations vary by jurisdiction. Include all mandated fields such as device serial number, maintenance status, and patient information. Many organizations benefit from having their form reviewed by legal counsel familiar with emergency medical response regulations to ensure compliance with both local requirements and industry standards.

How can AED incident report data improve our emergency response?

Analyzing AED incident reports reveals valuable patterns in response times, procedural adherence, and equipment performance. This data helps identify training gaps, equipment issues, or facility layout problems affecting response effectiveness. Regular review of these reports allows you to refine protocols, adjust AED placement, and develop targeted training that addresses specific challenges identified from actual incidents.

How can AED incident data improve emergency response?

Analyzing AED incident data helps identify patterns and recurring issues, allowing you to refine your emergency response protocols and training programs. By understanding what works and what doesn’t, you can make informed decisions that will also improve the effectiveness of your emergency response efforts.

This template, developed by Lumiform employees, serves as a starting point for businesses using the Lumiform platform and is intended as a hypothetical example only. It does not replace professional advice. Companies should consult qualified professionals to assess the suitability and legality of using this template in their specific workplace or jurisdiction. Lumiform is not liable for any errors or omissions in this template or for any actions taken based on its content.