Cooper Cooper University Health Care – Community AED Donation Program

Organization(Required)

Mailing Address

Street Address Address Line 2 City State ZIP Code

Contact Name(Required)

Position(Required)

Email(Required)

Phone(Required)

Do you have a relationship with Cooper or have worked with Cooper in the past?(Required)

Yes

Does your organization currently have an AED?(Required)

Yes

Please briefly describe the reason you are requesting or need an AED device.(Required)

To be eligible for an AED, your organization must meet the following requirements:

Eligible applicants include but are not limited to private and public schools, businesses, places of worship, and community organizations.
The AED must be placed where it would be visible and easily accessible for emergency response.
Attend a training session provided by Cooper University Health Care, Center for Resuscitation Education and Community Engagement.
Have or work with Cooper University Health Care to implement a Cardiac Emergency Response Plan.
Develop an AED maintenance program to ensure the upkeep of the AED pads and battery.
- The donation recipient will be responsible for ensuring the AED is operational.
  - Current AED pads
  - Battery in good working order
Conduct a CPR/AED demonstration of the (CERP) Cardiac Emergency Response Plan and review annually.
Award recipients must notify local emergency medical services (EMS) when the AED is installed at a qualifying location.
Donation recipient must also agree to and sign Cooper release and liability form.
This donation is only for the organization requesting the AED. If your organization disbands, we request that you promptly return the AED unit to Cooper University Health Care.