Assessment Form - Canada EN Construction

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SITE ASSESSMENT FORM

GENERAL BUSINESS PARTNER INFORMATION

10%

Survey Completed By*

Please Enter Survey Completed By.

Completed By Email*

Please Enter Valid Completed By Email.

Completed By Title*

Please Enter Completed By Title.

Completed By Organization / Company*

Please Enter Completed By Organization / Company.

Date*

Please Select the Date.

Notes

SITE ASSESSMENT FORM

GENERAL CUSTOMER INFORMATION

20%

Organization Name*

Please Enter Organization Name.

Address

Postal Code*

Please Enter a Postal Code.

Site Contact (AED Coordinator)*

Please Enter Site Contact Title.

Title*

Please Enter Title.

Phone

Email*

Please Enter a Valid Email.

Industry

Notes

SITE ASSESSMENT FORM

FACILITY ASSESSMENT INFORMATION

40%

Locations of buildings?*

Please select any one option from Locations of buildings.

Site Name/Project Name*

Please Enter Site Name/Project Name.

Project Type*

Please select any one option from Project Type

Number of buildings?*

Please select any one option from Number of buildings.

Average number of floors in each building?*

Please enter number from Average number of floors in each building.

Estimated number of square feet for each building?*

Please select any one option from Estimated number of square feet for each building.

Number of workers on site (daily average)*

Please fill in the blank from Number of workers on site (daily average).

Are there any areas that are restricted access or behind locked doors?*

Please select any one option from Are there any areas that are restricted access or behind locked doors.

Site Hazards:*

Please select any one option from Site Hazards.

What type of fleet vehicles do you have?*

Please select any one option from What type of fleet vehicles do you have.

Barriers affecting emergency response:*

Please select any one option from Barriers affecting emergency response.

Notes

SITE ASSESSMENT FORM

GENERAL AED INFORMATION

60%

Are there AEDs onsite?*

Please select any one option from Are there AEDs onsite.

Is there anyone that is CPR certified onsite?

Items of interest:

Notes

SITE ASSESSMENT FORM

MEDICAL RESPONSE

80%

Has an ambulance service responded to the facility in the last 12 months?*

Please select any one option from Has an ambulance service responded to the facility in the last 12 months.

Notes

SITE ASSESSMENT FORM

MEDICAL RESPONSE PROGRAM

100%

Notes

SITE ASSESSMENT SUMMARY

Thank you for taking safety to heart.
Here is a summary of your site assessment.

Infi Health LLP

Completed on December 20th, 2022

Site Main Contact:
John Carter
john.c@abcorganisation.com

Site Location:
John Carter,
johncom.

Prepared For:
John Carter

Completed By:
John Smith, Zoll AED Specialist, johncom

SITE ASSESSMENT SUMMARY

GENERAL CUSTOMER INFORMATION

Organization Name:
Address:
Zip Code:
Site Contact (AED Coordinator):
Title:
Phone:
Email:
Industry:

Notes :

GENERAL BUSINESS PARTNER INFORMATION

Survey Completed By:
Completed By Email:
Completed By Title:
Completed By Organization / Company:
Date:

Notes :

FACILITY ASSESSMENT INFORMATION

Locations of buildings?:
Site Name/Project Name:
Project Type:
Number of buildings?:
Average number of floors in each building?:
Estimated number of square feet for each building?
Number of workers on site (daily average):
Are elevators operational?:
Stair-only access to floors?:
Vertical time between floors?:
Site Hazards:
Do you have any areas that are restricted access or behind locked doors?:
What type of fleet vehicles do you have:
Barriers affecting emergency response:

In addition to doing a site walk through, here are a few tips to help you plan approximately how many AEDs you might need:
- One AED Recommended:
- All areas of facility can be reached within 3 minutes from AED
- Facility has only one floor
- There are no areas inaccessible to responders
- Additional AEDs Recommended:
- Areas that are not within a 3-minute brisk walk of AED
- For every 3rd floor of a multi-floor building
- For every inaccessible work area/floor
- For every public lobby

Notes :

GENERAL AED INFORMATION

Are there AEDs onsite?:
If yes, on average how many AEDs are in each building?:
Are all the AEDs within a 90 second walk from any location within your facility?:
Where are the AEDs located?:
Is there signage near every AED?:
Is there a rescue accessory kit with every AED?:

AEDs should be located within a 3-minute reach from all areas of a facility to ensure maximum accessibility.¹ That means that from any areas of a facility, it should take a person no longer than three minutes to retrieve the AED and return to the victim. An able adult can usually briskly walk about 300 feet per minute.
- Be sure to consider:
- Locked doors or other inaccessible areas
- Obstacles that may delay responders from reaching the victim such as train tracks, elevators or restricted areas
- Areas where people might gather such as lobbies and lunch rooms
- Remote buildings, warehouses, inventory yards or other areas
- High risk areas such as loading docs and gyms

What other equipment are the AEDs located with?:
Is there anyone that is CPR certified onsite?
What is the brand of the AED(s) onsite?:
Items of interest:

According to the Heart & Stroke Foundation, up to 60,000 Canadians suffer a sudden cardiac arrest (SCA) each year - that's roughly one every 9 minutes. SCA is one of the leading causes of death in the country, often striking without warning and affecting people of all ages, including those without prior heart issues.²

Notes :

MEDICAL RESPONSE

Has an ambulance service responded to the facility in the last 12 months?:
If , list the types of emergencies that have occurred:
How long did it take for EMS to arrive? (Minutes):
Do you have an onsite emergency or medical response team?
If yes, are they trained in?:

Without intervention, a sudden cardiac arrest (SCA) victim’s chance of survival decreases by 10% every minute.³ EMS response times average 7 to 14 minutes.⁴ Being prepared with an AED and trained responders on-site can make the difference between life and death.

Notes :

MEDICAL RESPONSE PROGRAM

How do you handle replenishment of your AED supplies?:
What is used to track consumables like pads and batteries?:

Believe it or not, one in three AEDs are not ready for rescue.⁵
You would not want your AEDs to be one of those when a colleague, employee, customer, visitor, student – ANYONE – needs it most. Manage compliance and consumable replenishments so you and your devices will be ready at a moment’s notice. A life may depend on it.

How do you handle replenishment of your trauma first aid supplies?*
How re expiration dates tracked?:
How old are the AEDs? (Years):
When does the warranty expire?(Years):

If your AEDs are out of warranty or nearing their end of life, consider upgrading and standardizing models across your organization.

How often are the AEDs inspected?:

Effective January 1, 2026, Ontario requires that construction sites that:
- have an expected duration of three or more months
- have 20 or more workers on site at any time
Must have an on-site, Health Canada approved AED. The AED must be accessible and clearly marked, stored with required accessories and inspected at least quarterly. Additionally a worker trained in CPR/AED use must be present any time work is in progress.⁶

Notes :

CONFIDENTIALITY AND DISCLAIMER

This Site Assessment Form has been developed by ZOLL Medical for the express purpose of evaluating each workplace and for making recommendations on AED quantity and placement. The Customer further understands that any recommendation made under this AED Site Assessment is non-binding; the location and number of AED units is ultimately the Customer’s decision along with amendments for future changes at the assessed site. ZOLL Medical accepts no responsibility for the treatment of victims of Sudden Cardiac Arrest based on this assessment.

We hope this information is helpful
for your safety planning. We look
forward to working with you to ensure your facilities are Rescue Ready^®.

1 http://nejm.org/doi/citedby/10.1056/NEJM200010263431701
2 Lawrence, Stephanie. “Highs and lows: More cardiac arrests are
occurring and few survive. Heart & Stroke, Feb 01 2024.
https://www.heartandstroke.ca/what-we-do/media-centre/news-
releases/more-cardiac-arrests-are-occurring-and-few-survive

3 http://www.sca-aware.org/about-sudden-cardiac-arrest/myths-and
-facts
4 Mell HK, et al. [Editorial]. JAMA Surg. 2017;152:983–984.
5 Matske J, et al. Abstract 14999: Functional Assessment of Community-
Based Automated External Defibrillators. Circulation.
2018;134:A14999
6 Ontario. O.Reg. 157/25: Construction Projects. Government of Ontario, 2025

SITE ASSESSMENT SUMMARY

Thank you for taking safety to heart.
Here is a summary of your site assessment.

Infi Health LLP

Completed on December 20th, 2022

Site Main Contact:
John Carter
john.c@abcorganisation.com

Site Location:
John Carter,
johncom.

Prepared For:
John Carter

Completed By:
John Smith, Zoll AED Specialist, johncom

SITE ASSESSMENT SUMMARY

GENERAL CUSTOMER INFORMATION

Organization Name:	Smith, Zoll AED Specialist
Address:	Smith, Zoll AED Specialist
Zip Code:	Smith, Zoll AED Specialist
Site Contact (AED Coordinator):	Smith, Zoll AED Specialist
Title:	Smith, Zoll AED Specialist
Phone:	Smith, Zoll AED Specialist
Email:	Smith, Zoll AED Specialist
Industry:	Smith, Zoll AED Specialist

Notes : Smith, Zoll AED Specialist

GENERAL BUSINESS PARTNER INFORMATION

Survey Completed By:	Smith, Zoll AED Specialist
Completed By Email:	Smith, Zoll AED Specialist
Completed By Title:	Smith, Zoll AED Specialist
Completed By Organization / Company:	Smith, Zoll AED Specialist
Date:	Smith, Zoll AED Specialist

Notes : Smith, Zoll AED Specialist

FACILITY ASSESSMENT INFORMATION

Locations of buildings?:	Smith, Zoll AED Specialist
Site Name/Project Name:	Site Name/Project Name
Project Type:	Project Type
Number of buildings?:	Smith, Zoll AED Specialist
Average number of floors in each building?:	Smith, Zoll AED Specialist
Estimated number of square feet for each building?	Smith, Zoll AED Specialist
Number of workers on site (daily average):	Number of workers on site (daily average)
Are elevators operational?:	Are elevators operational?
Stair-only access to floors?:	Stair-only access to floors?
Vertical time between floors?:	Vertical time between floors?
Site Hazards:	Site Hazards
Do you have any areas that are restricted access or behind locked doors?:	Smith, Zoll AED Specialist
What type of fleet vehicles do you have:	Smith, Zoll AED Specialist
Barriers affecting emergency response:	Barriers affecting emergency response

In addition to doing a site walk through, here are a few tips to help you plan approximately how many AEDs you might need:
- One AED Recommended:
- All areas of facility can be reached within 3 minutes from AED
- Facility has only one floor
- There are no areas inaccessible to responders
- Additional AEDs Recommended:
- Areas that are not within a 3-minute brisk walk of AED
- For every 3rd floor of a multi-floor building
- For every inaccessible work area/floor
- For every public lobby

Notes :

GENERAL AED INFORMATION

Are there AEDs onsite?:	Smith, Zoll AED Specialist
If yes, on average how many AEDs are in each building?:	Smith, Zoll AED Specialist
Are all the AEDs within a 90 second walk from any location within your facility?*	Smith, Zoll AED Specialist
Where are the AEDs located?:	Smith, Zoll AED Specialist
Is there signage near every AED?:
Is there a rescue accessory kit with every AED?:

AEDs should be located within a 3-minute reach from all areas of a facility to ensure maximum accessibility.¹ That means that from any areas of a facility, it should take a person no longer than three minutes to retrieve the AED and return to the victim. An able adult can usually briskly walk about 300 feet per minute.
- Be sure to consider:
- Locked doors or other inaccessible areas
- Obstacles that may delay responders from reaching the victim such as train tracks, elevators or restricted areas
- Areas where people might gather such as lobbies and lunch rooms
- Remote buildings, warehouses, inventory yards or other areas
- High risk areas such as loading docs and gyms

What other equipment are the AEDs located with?:	Smith, Zoll AED Specialist
Is there anyone that is CPR certified onsite?	Is there anyone that is CPR certified onsite?
What is the brand of the AED(s) onsite?:	Smith, Zoll AED Specialist
Items of interest:	Items of interest

According to the Heart & Stroke Foundation, up to 60,000 Canadians suffer a sudden cardiac arrest (SCA) each year - that's roughly one every 9 minutes. SCA is one of the leading causes of death in the country, often striking without warning and affecting people of all ages, including those without prior heart issues.²

Notes : Smith, Zoll AED Specialist

MEDICAL RESPONSE

Has an ambulance service responded to the facility in the last 12 months?:	Smith, Zoll AED Specialist
If , list the types of emergencies that have occurred:	Smith, Zoll AED Specialist
How long did it take for EMS to arrive? (Minutes):	Smith, Zoll AED Specialist
Do you have an onsite emergency or medical response team?	Smith, Zoll AED Specialist
If yes, are they trained in?:	Smith, Zoll AED Specialist

Without intervention, a sudden cardiac arrest (SCA) victim’s chance of survival decreases by 10% every minute.³ EMS response times average 7 to 14 minutes.⁴ Being prepared with an AED and trained responders on-site can make the difference between life and death.

Notes : Smith, Zoll AED Specialist

MEDICAL RESPONSE PROGRAM

How do you handle replenishment of your AED supplies?:	Smith, Zoll AED Specialist
What is used to track consumables like pads and batteries?:	Smith, Zoll AED Specialist

Believe it or not, one in three AEDs are not ready for rescue.⁵
You would not want your AEDs to be one of those when a colleague, employee, customer, visitor, student – ANYONE – needs it most. Manage compliance and consumable replenishments so you and your devices will be ready at a moment’s notice. A life may depend on it.

How do you handle replenishment of your trauma first aid supplies?*	Smith, Zoll AED Specialist
How re expiration dates tracked?:	Smith, Zoll AED Specialist
How old are the AEDs? (Years):	Smith, Zoll AED Specialist
When does the warranty expire?(Years):	Smith, Zoll AED Specialist

If your AEDs are out of warranty or nearing their end of life, consider upgrading and standardizing models across your organization.

How often are the AEDs inspected?: Smith, Zoll AED Specialist

Effective January 1, 2026, Ontario requires that construction sites that:
- have an expected duration of three or more months
- have 20 or more workers on site at any time
Must have an on-site, Health Canada approved AED. The AED must be accessible and clearly marked, stored with required accessories and inspected at least quarterly. Additionally a worker trained in CPR/AED use must be present any time work is in progress.⁶

Notes : Smith, Zoll AED Specialist

CONFIDENTIALITY AND DISCLAIMER

This Site Assessment Form has been developed by ZOLL Medical for the express purpose of evaluating each workplace and for making recommendations on AED quantity and placement. The Customer further understands that any recommendation made under this AED Site Assessment is non-binding; the location and number of AED units is ultimately the Customer’s decision along with amendments for future changes at the assessed site. ZOLL Medical accepts no responsibility for the treatment of victims of Sudden Cardiac Arrest based on this assessment.

We hope this information is
helpful for your safety planning.
We look forward to working with you to ensure your facilities are Rescue Ready^®.

1 http://nejm.org/doi/citedby/10.1056/NEJM200010263431701
2 Lawrence, Stephanie. “Highs and lows: More cardiac arrests are
occurring and few survive. Heart & Stroke, Feb 01 2024.
https://www.heartandstroke.ca/what-we-do/media-centre/news-
releases/more-cardiac-arrests-are-occurring-and-few-survive

3 http://www.sca-aware.org/about-sudden-cardiac-arrest/myths-and
-facts
4 Mell HK, et al. [Editorial]. JAMA Surg. 2017;152:983–984.
5 Matske J, et al. Abstract 14999: Functional Assessment of Community-
Based Automated External Defibrillators. Circulation.
2018;134:A14999
6 Ontario. O.Reg. 157/25: Construction Projects. Government of Ontario, 2025