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AED Registration
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This form has been modified since it was saved. Please review all fields before submitting.
In accordance with the Texas Administrative Code (Title 25, Part 1, Chapter 157, Subchapter C, Rule 157.41), a person or entity that acquires an AED shall immediately notify all local emergency medical service providers of the existence, physical location and type of device.
Reported installation must be within the City of Irving boundaries. The exact reported location/site address is required. Please use one form per AED installed.
Service Provider Information
AED Service Provider:
Contact Name:
Phone Number:
Email Address:
AED Information
Business/Organization:
*
Address:
*
City:
*
State:
Zip Code:
*
Installation Date:
*
Manufacturer:
Model:
Serial #:
AED Location Description:
*
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