AED registration form

Short URL: kingcounty.gov/aed/registration

Person opening the protective box holding an AED device

Congratulations on acquiring an AED. Before you register your AED, get medical direction on use from the Seattle or King County Medical Director or another licensed physician.

Next, register your AED with King County EMS by filling out the form below. This helps 911 dispatchers guide callers to the nearest AED in an emergency.

AED customer information

AED CUSTOMER INFORMATION

Department or division if applicable

DEPARTMENT/DIVISION IF APPLICABLE

Type of business

TYPE OF BUSINESS

Mailing address:

Mailing address for building

MAILING ADDRESS

City where building is located

CITY

State where building is located

STATE

Zip code where building is located

ZIP CODE

Check if this is a private residence.

Business phone with area code:

Area code number for the business AREA CODE

Phone number of the business

PHONE NUMBER

Phone extension of the business

PHONE EXTENSION

Site Coordinator information

AED site coordinator's first name

FIRST NAME

AED site coordinator's last name

LAST NAME

Email address of site coordinator

EMAIL ADDRESS

Phone number with area code:

Area code for site coordinator

AREA CODE

Phone number of site coordinator

PHONE NUMBER

Phone extension of site coordinator

PHONE EXTENSION

Alternative phone number with area code:

Alternative area code for site coordinator

AREA CODE

Alternative phone number of site coordinator

PHONE NUMBER

Alternative phone extension of site coordinator

PHONE EXTENSION

AED information

This is a new AED registration
This is an update or revision to a currently registered AED

Name of AED manufacturer

AED MANUFACTURER

Name of AED model

AED MODEL

AED serial number

AED SERIAL NUMBER

Street address of AED location:

Street address of the AED location

STREET ADDRESS

City of the AED location

CITY

State where the AED is located

STATE

Zip code of where the AED is located

ZIP CODE

Common name of building/office/location

Common name of building location

Placement of AED: Describe the location of the device at this address:

Describe the location of where the AED is located

Is the AED accessible to the public?
Yes No

Check if you do not want your registered AED listed in the Pulse Point app.

What are the days of the week that the AED is accessible at the site?

What days of the week is the AED available?

What are the hours that the AED is accessible at the site?

What hours of the day is the AED available?

Is the AED available 24/7?

Yes No

Are additional items placed with the AED?

Check if a Bleeding Control Kit is present.

Check if a Naloxone is present.

Check if a Epinephrine is present.

Optional AED information

Expiration date of AED battery:

Expiration date of AED electrodes:

Additional comments or instructions:

Please describe any other commons or instructions

How did you hear about AED registration requirements?

This website

Traditional media (television, radio, newspaper)

Social media (Facebook, Twitter, YouTube, etc.)

Online search (Google, Bing, Yahoo, etc.)

Word-of-mouth (heard from someone else)

CPR/AED training

AED manufacturer/distributor

Presentation

PulsePoint mobile app

AED program management company

AED company management name

To receive confirmation, please provide valid email address