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Public Access Defibrillator Loaner Program

Home Paramedic Services Public Access Defibrillator Loaner Program

About the Program

The Public Access Defibrillator (AED) Loaner Program allows the public to borrow an automated external defibrillator, at no cost, for short-term community and family events within Dufferin County.

These events could include:

  • Concerts
  • Golf tournaments
  • Festivals
  • Weddings
  • Church gatherings
  • Family reunions
  • Nature walks

Please review the Public Access Defibrillator (AED) Loaner Program Policy prior to completing an application.

Review the Public Access Defibrillator Loaner Program Policy

Booking A Defibrillator

  • Complete the request form below. Automated external defibrillators (AEDs) are available on a first-come, first-serve basis and subject to availability.
  • A valid photo identification is required at the time of pick up.
  • A liability release form must be signed by the borrower.
  • The borrower will be held responsible for the AED while on loan from Dufferin County Paramedic Service (DCPS). DCPS will run through CPR and how to use the AED with the borrower.

Defibrillator Loaner Program Application Form

Submit this form to borrow a defibrillator for your upcoming event in Dufferin County.

Contact Information

The primary contact person will be responsible for receiving the required training in advance of the event and will be responsible for the AED unit while on loan.
Primary Contact Person(Required)
Address(Required)
Secondary Contact Person(Required)

Details

Please request the dates you would like to check out and return the AED unit. Check out and returns are ONLY available Monday to Friday between 7:30 am and 4:30 pm.
Requested Check Out Date(Required)
Requested Return Date(Required)
MM slash DD slash YYYY
Event Location(Required)
Event Start Time(Required)
:
Event End Time(Required)
:
Does the venue have an AED on site?(Required)
Community, school or church, Sport or Athletic, Company, Event with guests at risk of cardiac arrest, etc.
Have you received an AED on loan from Dufferin County Paramedic Service before?(Required)

Information Collection

The information contained in this form is confidential. It contains personal health information that is subject to the provisions of the ‘Personal Health Information Protection Act, 2004’. This form and its contents should not be distributed, copied or disclosed to any unauthorized persons. If you have accessed this form in error, please contact the owner or sender immediately. All or part information from this referral form may be shared with other agencies to provide appropriate care. For questions please contact the Chief Paramedic at 519-941-9608 ext. 6001.

Defibrillator Loaner Program Liability Release Form

This form will be required to be completed by the primary contact person when picking up the AED.

PARTICIPATION IN THE PUBLIC ACCESS DEFIBRILLATOR LOAN PROGRAM (INCLUDING BORROWING AN AUTOMATIC EXTERNAL DEFIBRILLATOR)

In consideration of The Corporation of the County of Dufferin (the “County”) permitting me to participate in the Public Access Defibrillator (“AED”) Loan Program (the “Program”), and to borrow an AED, I, for myself, my heirs, executors, administrators, representatives, successors and assigns, hereby: (a) Release and discharge the County and its members of Council, directors, officers, employees, servants, agents and contractors (collectively the “Protected Persons”) from all claims, demands, actions, causes of action, suits and proceedings, whether involving negligence, actions or omissions, or any other basis (collectively the “Recourses”) for all liabilities, losses, damages (including property damages), injuries (including personal injuries, bodily injuries and death), costs (including legal costs) and expenses, including all effects and consequences thereof, and including all that are not now known or anticipated but which may arise in the future (collectively the “Harms”), relating in any way to my participation in the Program; (b) Indemnify the County and the Protected Persons against all Recourses by whomsoever made, brought, sustained or prosecuted, for the Harms, relating in any way to my participation in the Program, including my alleged acts or omissions; (c) Acknowledge that, for the purpose of making my promise to indemnify the County’s Protected Persons enforceable, the County is acting as the agent and trustee for its Protected Persons; (d) Acknowledge that I have received training on, and understand, the proper application and use of the borrowed AED; (e) Agree, at the County’s election, either to assume the defense of every Recourse brought in respect of a Harm, or to cooperate with the County in the defense, including providing the County with prompt written notice of any possible Harm and providing the County with all information and material relevant to the possible Harm; (f) Agree to use the AED solely for life saving; (g) Agree not to remove the AED from its sealed protective case unless it is required for life saving; (h) Waive all rights that I may have against the County and the Protected Persons in respect of all Recourses for the Harms, relating in any way to my participation in the Program; (i) Agree not to make, bring, sustain or prosecute any Recourse for any of the Harms, against any other person who might claim contribution or indemnification from the County or any of the Protected Persons, relating in any way to my participation in the Program; and (j) Agree that this Release will survive the termination of my participation in the Program.
I HAVE READ THE ABOVE, UNDERSTAND IT AND AGREE TO IT.(Required)
Name(Required)
MM slash DD slash YYYY
Address(Required)

Information Collection

The information contained in this form is confidential. It contains personal health information that is subject to the provisions of the ‘Personal Health Information Protection Act, 2004’. This form and its contents should not be distributed, copied or disclosed to any unauthorized persons. If you have accessed this form in error, please contact the owner or sender immediately. All or part information from this referral form may be shared with other agencies to provide appropriate care. For questions please contact the Chief Paramedic at 519-941-9608 ext. 6001.
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