• HeartSafe Designation Application

  • The HeartSafe program promotes and encourages community awareness of sudden cardiac arrest (SCA) and the potential lifesaving knowledge of cardiopulmonary resuscitation (CPR) and public access to automated external defibrillators (AEDs).

    In order to increase this awareness, the Southeast Health System, in partnership with the City of Dothan, the Dothan Fire Department, and the Dothan Area Chamber of Commerce, has developed an initiative to provide designations for cities, communities, workplaces and campuses. Criteria for each category were established through the assistance of the American Heart Association, medical personnel and other HeartSafe programs around the country.

    A “HeartSafe” designation demonstrates a commitment to promote and support:

    • Hands-only CPR and AED trained individuals
    • Public access to automated external defibrillators AED(s) through strategic placement
    • Emergency response action plan

    The included application details the requirements for becoming a HeartSafe Workplace and HeartSafe Campus. If you would like to become one of these HeartSafe Designations, please fill out the 2-page application.

  • HeartSafe designation requested

    Please select only one option
  •  

    HeartSafe Workplace requirements:

    • AED requirements:
      • Fixed locations (i.e. office buildings): minimum 1 AED in a publically accessible location and within a 3-minute round-trip walk of the furthest work area
      • Flexible locations (i.e. construction sites): minimum 1 AED per site that can travel throughout the site with work staff
    • Hands-Only CPR Trained employees: Minimum 10% of work staff, including regular employees, volunteers, contractors and student employees
    • Emergency action plan: A written emergency action plan that includes response to medical emergencies and maintenance of AED(s). This should also address unusual circumstances for specific business types (such as a workplace that might experience and influx of visitors). The Dothan Fire Department is available to help in writing your plan, if needed.
    • Recognition: Business is to display provided signage to show designation

    HeartSafe Campus requirements:

    • AED requirements:
      • Minimum 1 AED per building on campus in a publically accessible location and within a 3-minute round-trip walk of the furthest work area; or,
      • Ability to respond with an AED within 3 minutes
    • Hands-Only CPR Trained employees: Minimum 10% of work staff, including regular employees, volunteers, contractors and student employees
    • Emergency action plan: A written emergency action plan that includes response to medical emergencies and maintenance of AED(s). This should also address unusual circumstances for specific business types (such as a workplace that might experience and influx of visitors). The Dothan Fire Department is available to help in writing your plan, if needed.
    • Recognition: Campus is to display provided signage to show designation

     

  • A Comprehensive Program for Prevention of Sudden Cardiac Death Implementation Checklist

  • How long has an AED program been in place? * . Which AED(s) do you use? * .

  • Number of trained staff in CPR+AED * . 
    Training:      *      

  • Please complete this checklist for the current program in your agency/campus/community:

  • Emergency Response Plan (ERP) for cardiac arrest.
          
    **Please attach a copy of your current ERP, if available

  • Currently have * AED(s),* buildings,   *students, staff.
    **Please attach a list of the specific locations of all AEDs on site if not included in your ERP above

  • There is a designated emergency response team & CPR/AED training is updated:          

  • Currently have a system to track CPR/AED training/retraining and AED device maintenance.
          *      

  • Applicant Signature:

    Municipal Chief Elected Officer, Principal, Business Owner, CEO or Designee
  • Clear
  •  - -
    Pick a Date
  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof
  • Should be Empty: