Defibrillator registration form


Location of defibrillator: This should include as much information as possible to identify the position of the defibrillator such as To the right hand side of the main entrance to - or - located behind reception etc):



Serial number of defibrillator: To include ambulance service asset number if appropriate:


Please state if owned by the ambulance service or community/ village/ charity etc):

Is your cabinet heated? *
Is your CPAD site accessible 24/7? *

Custodian contact details:

Custodian's role will be to ensure monthly checks are maintained on the defibrillator and will be the Trusts point of contact regarding deployment and recovery.


If you require any help or support please contact the office via

Please see our Records Management Policy for further information about how we store information within our secure internal database.

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The Data Protection Act 2018
As an NHS Trust we will not disclose your personal details to third parties without your explicit permission, unless there are exceptional circumstances such as; when it is in the public interest to investigate a serious crime, or to prevent serious risks to the public or NHS staff; or to protect children or vulnerable adults or where the law requires information to be shared through a formal court order. If the Trust does have to pass on any of your personal information to a third party it will follow the guidance and application of the Data Protection Act 2018. The Legal Basis for processing your personal data is with your explicit consent. You have the right to withdraw your consent at any point by informing the Community Collaboration Team at the above address and or the Data Protection Officer