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Physical address of site:
Is there "enhanced" 9-1-1 coverage in the area?
Is there clear EMS access to the property?
Are their any "horizontal" barriers to action? (Examples of this would be crowded hallways, catwalks, secured doorways or work areas that may have potentially hazardous materials as in a manufacturin setting.)
Are there any vertical barriers to action? (ie, would an elevator or stairwell have to be used?)
Are there any areas that present unique access problems (security access coded doors, etc.?)
Is the proposed AED location accessible at all hours of operation?
If utilizing security personnel as members of the response team, are there internal policies addressing whether it is acceptable for them to leave their post to respond to medical emergencies?
Are there any areas where employees may be at a higher risk of cardiac arrest? (ie. Gym area, high stress area, area with electrical or chemical hazards)
Is there a "high visibility area" or a place near other emergency equipment (ie. First aid kit, Fire Extinguisher, etc.) that may improve the chances of prompt AED use during a cardiac arrest? (ie. Gym area, high stress area, area with electrical or chemical hazards) Yes No
Is there a telephone within close visual proximity of the AED location?
Is there a low risk area where the AED can be mounted to be less vulnerable to tampering, theft or damage?
How many people are employed at this site?
How many are usually onsite each day or shift?
What are the hours of operation?
If your company does have different shifts, please list (or estimate) each shift and the number of employees working during each one.
Are there areas of your company open to the public? If you answer yes, please comment on the number if public individuals you expect to be in these areas at peak times.
Is there an intercom or overhead paging system?
If yes, can all personnel access the paging system?
How many floors are present in the building?
Are there any other identified concerns for safety or that might delay a response, and if so, comment?
The rest of the questions are based upon the formula to determine if a site is a high risk location:
What is the average number of individuals at your location?
How many of these individuals are 50 or over?
Is the location:
A residential or 7 day a week commerical site
A non-residential or 5 day business site