St. Vincent School

 2333 S. Figueroa St.

Incident Command Teams

 2024-2025

 

E.O.C. Emergency Operations Center

 

Incident Commander – Erika Avila Auzenne

2nd Commander – Myrna Mendez

 

Sweep Team

 

Captain –Judy Vasquez 

Alternate – Yvette Serrano

Team Member/South Exit – Ariel Guzman 

Team Member – Sonia Cortez

Team Member: Priscilla Alfaro

Team Member – Rudy Becerra- (Breezeway)

 

Hospital Center

 

Captain- Monique Garcia

Alternate- Maria Dominguez, Nurse Celia

Team Members- Cindy Del Rio,

Team Members-Wendy Lucatero

Team Member-Valeria Carrera

 










Cont. Incident Command Teams: 2024-2025



Student Control 


Captain –   Elise Munoz

Alternate – Irma Ticas

Team Members – Angela Diaz, Sr. Linda

Mrs. Corral, Miss Mel, Miss Lynn

Iris Magallanes, 

Alicia Zuniga, Silvia Zaragoza,

 

 

Parent Control

 

Captain / Gate 1 – Mrs. Cardenas

Team Member – Giselle Aranda

Alternate  Captain / Gate 2 – Alejandra Sanchez

Team Member – Rina Vega

 

Utility

 

Captain –  Sonia Cortez

Team Member – Priscilia Alfaro

Team Members - Adan Padilla, Juan Diaz, Rudy Becerra

 







Emergency Operations Center

 E.O.C.

 Team Members & Duties

  Incident Commander

Erika Avila

 2nd Commander

Myrna Mendez


 E.O.C. Emergency Operation Center

 

1.         Houses the command team.

 

2.         Serves as the nerve center for operations and collection point for critical information.

 

1.         Should access the overall condition of the school plant and make the    decision concerning activation of the incident command system.

 

2.         If activation is deemed necessary, commanders should organize emergency response teams.

 

3.         The Commander should assume overall management of the disaster throughout the incident until proclaimed over.

 

4.         The Commander should interface with emergency agencies as they arrive on campus.  Show a map of the school, indicate any injuries, and point out any hazards.

 

5.         The Commander should make all public statements to the press and disseminate information to the school community.


 Sweep Team


1.         Report to the Commander at the pre-designated E.O.C.

 

2.         At the direction of the Commander: Begin a search for missing and trapped personnel.

 

3.         When the sweep team approaches the search area, team members should separate by 5 to 10 feet and give a walkie-talkie to the designated member.

 

4.         The team should keep in constant contact with E.O.C.  

 

5.         The sweep team should assess injuries and place the (SEVERELY INJURED) sign on the door if needed.

 

6.         Then transport persons with minor injuries to the hospital site first.

 

7.         Then return to pick up the severely injured.

 

8.         After the room is clear, the team member in charge of the radio should place a (CLASSROOM CLEARED) sign on the door.


The decision to move injured victims from structures to the hospital Center may be a difficult one.  A severely injured person normally is not moved.  However, in the event of a major earthquake, a second moderate to major aftershock may occur, thereby causing more damage to the structure at the injured student/staff location.

 








 School Hospital Center


1. Report to the Commander at the pre-designated E.O.C.

 

2.        When directed by the commander, set up and maintain the Hospital Center at the pre-designated location.  The center is out of view from all students.  (see map).

 

3. Assess injured students/staff

 

4. ID the patient as soon as possible.  To ID on the tag write a person's name, and time of admission to the center.  Place ID tag on wrist or ankle.

 

5. 8th-grade students will maintain the treatment log.

 

6. The assigned person will communicate with the E.O.C. and parents of the injured.

 

 

 

 

The decision to move injured victims from structures to the hospital Center may be a difficult one.  A severely injured person normally is not moved.  However, in the event of a major earthquake, a second moderate to major aftershock may occur, thereby causing more damage to the structure at the injured student/staff location.

 

 

 

 

 

 

 

 

 Utility Team

 

1. The utility team captain, after reporting to the E.O.C., should immediately gather the utility team and proceed to the storage area.  All supplies should be rapidly taken to the Emergency Operations Center to be expedited. 

 

2. The E.O.C. Commander will direct the team leader regarding the necessity of utility shut-offs. Gas, Electricity, Water.

 

3. Sweep/shovel glass and other debris from walk/pathways utilized by disaster teams.

 

4. On the command of E.O.C. The team will help transport injured victims to the Hospital center by stretcher, or other means.

 

5. The assigned person will communicate with the E.O.C.

 

 

 

The decision to move injured victims from structures to the hospital Center may be a difficult one.  A severely injured person normally is not moved.  However, in the event of a major earthquake, a second moderate to major aftershock may occur, thereby causing more damage to the structure at the injured student/staff location.

 

 

 

 

Student Control

 

1. To assist in controlling the student body, team members should

position themselves at every corner of the student body.

 

2.        Members should identify students who are injured.  When injured students are identified, the captain shall immediately report anything serious to the E.O.C. those students should be taken to the hospital.

 

3.        Minor injuries will be treated by the Student Control personnel.

 

4.        Provide continuous emotional support to the students.

 

5.        8th-grade student helpers will dispense water as needed.

 

6.        8th-grade student helpers will escort students to the sanitation area as needed.

 

7.        Team members should make sure all students have their emergency cards on their person for quick release to parent or guardian.

 

8.        The Captain and team members will send parents or guardians to E.O.C. if needed.





Parent Control

 

1. Report to the E.O.C. at the pre-designated location, as indicated on the map.

 

2. Establish the Student Release Center at a pre-designated location, as indicated on the map.

 

3. Release students to parents or pre-authorized adults.

 

4. Maintain all records of releases.

 

5. Provide status report to E.O.C. commander when needed or requested.

 

 

Parent Control Areas

 

The parent-control areas should be guarded by all parent-control team members.  When adults arrive to pick up students they should be directed to the student control captain.

 

When students are leaving campus, the parent control member should take the student's emergency card, have the adult sign the card and write their destination.

 

 If a parent control team member does not recognize the adult he/she requests a photo I.D.  The team captain and commander should be notified to resolve any conflict or question.

 



 St. Vincent School

Disaster Procedures


Initial Response to Earthquake


Inside building


1. Drop down to knees with back to windows.


2. Duck and Cover under the desk, chair, or table if available. If not available drop where you are and assume classic “Earthquake Position” with arms covering the back of the head.


3. Evacuate at your discretion when shaking has stopped, and the outside area looks clear.


4. After evacuation, have students be seated in the Student Control area facing away from the school. Students should not see any emergency procedures that are taking place.


5. When small Emergency cards have been passed out, all teachers should report to the Incident Commander to hand in any remaining emergency cards. 


Any card handed to the Commander stating that a student is missing, trapped, or not accounted for during roll shall be termed a 

“HOT CARD”.


6. Once all teams have reported to the commander, the commander will deploy each team where they are needed.


7. Each team will be contacted by the commander periodically for a status report.


Initial Response to Earthquake


Auditorium


1. Drop, Duck, Cover, and Hold position until the shaking has stopped.


2. After evacuation, have students be seated in the Student Control area facing away from the school. Students should not see any emergency procedures that are taking place.


3. When small Emergency cards have been passed out, all teachers should report to the Incident Commander to hand in any remaining emergency cards. 


Any card handed to the Commander stating that a student is missing, trapped, or not accounted for during roll shall be termed a 

“HOT CARD”.


4. Once all teams have reported to the commander, the commander will deploy each team where they are needed.


5. Each team will be contacted by the commander periodically for a status report.







Initial Response to Earthquake


Outside of school building - School yard


Response by ALL persons (students, teachers, staff, parents)


1. Drop, Duck, Cover, and Hold position until the shaking has stopped.


2. After evacuation, have students be seated in the Student Control area facing away from the school. Students should not see any emergency procedures that are taking place.


3. When small Emergency cards have been passed out, all teachers should report to the Incident Commander to hand in any remaining emergency cards. 


Any card handed to the Commander stating that a student is missing, trapped, or not accounted for during roll shall be termed a 

“HOT CARD”.


4. Once all teams have reported to the commander, the commander will deploy each team where they are needed.


5. Each team will be contacted by the commander periodically for a status report.










Initial Response to Earthquake


Church


1. Drop, Duck, Cover, and Hold position until the shaking has stopped.


2. Students in grades TK–3rd exit the CHURCH through the west door. Students in grades 4th-8th will exit through the back door of the church.  The Student Control area will be on the west side of the church lawn facing the church towards the rectory.


3.  Teachers will take roll using the small emergency cards. When the roll is complete, all teachers should report to the Incident Commander to hand in any remaining emergency cards. 


Any card handed to the Commander stating that a student is missing trapped, or not accounted for during roll shall be termed a 

“HOT CARD”.


4. The administration will enter the church to remove all trapped or injured.


5. ALL INJURED WILL BE PLACED ON THE GRASS OF THE EAST SIDE OF THE CHURCH.


6. Parent Control teams will be on the sides of the Student control area.


7. Parents will be notified ASAP via School Messenger of our location.



FIRE DRILL PROCEDURES


1. Fire Drills will be performed once a month.


2. At the sound of the fire alarm, all students will exit the building in an orderly fashion in a rapid walk and form lines where posted.


3. Attendance will be taken by counting students to ensure all are present.


4. If a fire drill is activated during recess, students will STOP playing and form lines where posted.






















Lockdown Active Shooter Procedures


1. If you hear, (Code word PLEASE SECURE THE BUILDING) by walkie-talkie.

  • Everyone is to stay where they are.

  • Classroom teachers are to:


  • Quickly glance outside the room to direct any students in the hallway into your classroom immediately.

  • TK, 3rd and Kinder teachers will lock the door to the building.

  • Lock your door 

  • Lower blinds on windows and black shades on doors.

  • Place students against the whiteboard.

  • Turn out the lights.

  • Keep students SILENT.


  • PE classes being held outside should move to the auditorium and sit on the floor.

  • Any students in the lunch area should be directed to the auditorium.

  • If students are outside the building they should enter any building through the nearest door.

  • If students are in the bathroom inside the building they should move to a stall and lock the door. (Girls bathroom outside) office staff first checks for students, secures them in the office then locks the bathroom door. 

  • Anyone in the hallway moves to the nearest classroom immediately.

  • Nurses, cafeteria workers, and support staff should stay in the area they are in or move to the nearest safe place

  • ALL LIGHTS SHOULD BE TURNED OFF THROUGHOUT THE CAMPUS.

  • Stay in safe areas until directed by law enforcement or an administrator.

Never open doors during a lockdown or active shooter situation, even in the event of a fire alarm. All communication will take place via walkie-talkie.


  • The administration will announce via walkie-talkie when the lockdown active shooter situation has been lifted.



























Emergency Card Helpers


TK Mrs. Diaz

Kinder Miss Rina

1st Miss Ticas 

2nd Miss Monique

3rd Ms. Mel

4th Sr. Linda

5th Mrs. Corral

6th Ms. Lynn

7th Mr. Diaz

8th Miss Giselle





















Interfacing with Professionals

Police, Fire or Search and Rescue


The Incident Commander and the E.O.C. team should be the initial responding team to interface with the police, fire, or urban search & rescue team who comes on campus. The school commander shall give temporary authority to the second in command over each school response team while the commander is interfacing with the professional response team. 


The commander should have the following ready to give to the emergency response team.


  • A detailed map of campus.


  • A report of missing, injured, or trapped students.


  • Have ALL utilities on the Map (Electric panel, Gas, and Water sources.
















DISASTER PLAN

8TH GRADE TEAMS

(2024-2025)

 

 TEAM 1                                                                TEAM 2

 

Hospital Tent                                                 Help Utility / Sanitation

 

1.   8th grade student                              1.   8th grade student     

2.   8th grade student                    2.  8th grade student

3.   8th grade student                        3.  8th grade student

4.  8th grade student                         4.  8th grade student

5.   8th grade student                                       

6.  8th grade student      

           

                             

                                                                                               

E.O.C. Bench & Backpack   

 

 First Grade Helpers                                      Second Grade Helpers

  1. 8th Grade Student                                 1.   8th Grade Student

  2. 8th Grade Student                        2.    8th Grade Student 

  3. 8th Grade Student               3.   8th Grade Student

                                                           

                                                           

      

Kinder Helpers                                             TK Helpers

 

1.   8th Grade Student               1.  8th Grade Student

2.         8th Grade Student               2.  8th Grade Student

3.   8th Grade Student                      3.  8th Grade Student

4.  8th Grade Student                                                    

                                                                          

                                                                              


St. Vincent School Policy and Procedure for the Acquisition and Use of Automated External Defibrillators (AED’s)


This policy is to provide comprehensive guidance in the administration and maintenance of the Automated External Defibrillators (AED) Program.


Health and Safety Code Section 1797.196 (c) states when an AED is placed in a public or private K-12 school, the principal shall ensure that the school administrators and staff annually receive information that describes sudden cardiac arrest, the school's emergency response plan, and the proper use of an AED. The principal shall also ensure that instructions, in no less than 14-point type, on how to use the AED are posted next to every AED. The principal shall, at least annually, notify school employees as to the location of all AED units on the campus. 


Program Administration: The cloud-based device management program can assist with AED 

management and compliance. By using this program, St. Vincent School can monitor AED equipment and supplies for damage or expiration, as well as staff CPR/AED certification in one central location. St. Vincent School will also receive support services related to an AED usage event, such as medical oversight and AED replacement loaner device and refurbishment after use. 


St. Vincent School will report AED usage events within the cloud-based device management program as part of the post-event review process to be compiled in a final summation report. In addition, St. Vincent School will submit the Automated External Defibrillator (AED Program CPR/AED Emergency Response Site Plan (Attachment A) by October 15th.


St. Vincent school will complete the Daily/Monthly Readiness Status Checklist and the Annual Maintenance Checklist used for inspecting an AED unit. 


St. Vincent School will create an AED binder to be placed on top of each AED’s cabinet(s) and include the following inside the binder: 

  • Completed CPR/AED Emergency Response Site Plan (Attachment A)

  • St. Vincent Cardiac Emergency Response Team & Protocol

  • St. Vincent School Policy and Procedure for the Acquisition and Use of Automated External Defibrillators (AEDs) with corresponding attachments.


GUIDELINES: The following guidelines apply. 

I. Responsibilities 

  1. Principal (or designee)

1. Manage cloud-based program management tool for the St. Vincent School Automated External Defibrillator (AED) Program. 

2. Oversee the entire AED program through the cloud-based device management system, visibility, and access to all AEDs. 

3. Function as a liaison between the School and the School-approved vendor. 

4. Receive, prepare, and provide various AED reports, including postusage event reports, and send them to the appropriate departments. 

5. Maintain databases, files, and other records pertinent to the AED program. 


B. Principals and Non-School Site Administrators 

1. Ensure that all school or office site staff annually receive information on the following: 

• The school AED Program CPR/AED Emergency Response Site Plan and AED(‘s) location. This must be completed by October 15 (Attachment A)

 • AED Program information (including CPR/AED Resources, school specific type of AED, video demonstration link). See (Attachment B) sample.

2. Ensure that instructions on how to use the AED are posted next to every AED. The AED signage must be visible with clear instructions that are no less than 14-point type. Refer to (Attachment C) for sample.  


C. Local Administrator (Site Contact) – Principal, School Nurse, or Designee 

1. Perform equipment maintenance of AED and associated supplies, such as pads and first responder kit, check for expiration dates and damage every 30 days, specifically on the 1st of every month and no later than the 10th of every month. Report AED maintenance checks on the school-approved online platform (via online login if applicable)

2. Reorder outdated or damaged AED equipment supplies, as necessary. 

3. Allow school/site employees the opportunity to obtain CPR/AED certification that complies with the regulations adopted by the California Emergency Medical Services Authority (EMSA) and standards of the American Heart Association (AHA) or the American Red Cross (ARC). 

4. Designate volunteer emergency site responders and maintain responder training records and CPR/AED Emergency Response Site Plan form (Attachment A). 

5. Complete the Confidential Report of AED Incident Response form and immediately call the ADLA at (213) 637-7663. Report the AED usage event on the cloud-based device management system and comply with post-usage event processes from the School-approved vendor.


D. Volunteer Responder – Designated by the School Principal

1. Complete and receive certification for a basic CPR course that includes instruction on using the AED that complies with the regulations adopted by EMSA and standards of AHA or ARC.

2. Maintain competency recertification every two years as AHA or ARC requires. 

3. Respond to an emergency, using an AED and performing CPR, as necessary. 

4. Comply with AED post-usage event processes in accordance with this policy. 


II. AED: Equipment, Testing, and Training Records 


A. AED equipment is the property of St. Vincent School. 

1. Automated External Defibrillator device case contents include: 

a. Automated External Defibrillator Device with battery 

b. One set of defibrillator electrode pads 

2. First Responder Kit attached to AED Case includes: 

a. Mouth-to-Mouth Protective Barrier/Mask 

b. Scissors 

c. Two pairs of disposable gloves (non-Latex) 

d. Disposable razor 

e. Disposable towel 

f. Antiseptic towelette 

g. Equipment towelette 

h. Biohazard bag (or double bag) 

B. AED Equipment 

1. Monthly readiness check of AED 

a. The AED cloud-based program is managed by a District approved vendor for maintenance and testing. 

b. The principal (or designee) will perform a monthly inspection of the AED(s) and document the results online in the District-approved online platform (if applicable). 

c. The principal (or designee) will receive monthly automated email reminders sent on the 1st of each month to report the AED readiness check. An automated late alert email is sent on the 10th of each month if a person has not checked the AED OR self-reported via Wi-Fi for over 30 days. 

2. Reordering AED Supplies Online 

a. It is the responsibility of the principal (or designee) to reorder outdated or damaged AED supplies (i.e., battery, electrode pads, first responder kit) for their site(s) from their budget. 

b. The School-approved vendor will send an alert email about expiring supplies to the principal (or designee) weekly, every Monday, when any AED(s) they oversee have AED supplies expiring within 60 days. 

c. Replacement supplies must be ordered through the School-approved vendor. 

C. Testing of AED 

1. The AED does not require any manual calibration. The automatic self-tests will enable the AED to display a green flashing light indicating the AED is ready for use. Once connected to Wi-Fi, the self-reporting feature is an additional benefit to report that the AED has passed self-tests. The only time the AED needs to be physically maintained is when the battery or electrode pads need replacement at the end of their useful life. This does not replace the requirement for the Local Administrator (Principal, School Nurse, or Designee) to perform monthly visual inspections of the AED and document the results online. 

2. If the AED detects a problem, the unit will “chirp,” and the status indicator on the AED will not flash green (AED should flash green every 6 seconds). This information will be relayed to the District-Approved online platform and generate a support ticket if the AED has an active Wi-Fi connection. Otherwise, if “chirping” is heard any time of the month, record a check in the District-approved online platform and report the “chirp” to submit a support ticket.

D. Training Records 

1. The designated volunteer responder(s)’ training records will be maintained by the Principal (or designee) within the District-approved online platform. 

2. Weekly emails are sent every Tuesday when responder certifications are expiring within the next 60 days. 

III. After Use of AED 

A. The AED shall be kept at the school. The Principal, School Nurse, or Designee will notify the School-Approved vendor of the usage event by logging into the cloud-based device management system. 

B. The District-approved vendor will: 

1. Send a loaner AED via overnight or one-day air shipping directly to the deployed AED site. 

2. Include a pre-paid return label with instructions for the Site Contact to ship the used AED to them (for data retrieval cardiac tracing), utilizing the same box. 

3. Refurbish and resupply the deployed AED with new electrode pads, ensuring it is rescue-ready. 

4. Ship the refurbished AED with a prepaid label to return the loaner AED. 

5. Download the data as part of the post-usage event review process, and the data will be analyzed by the District-approved vendor’s California licensed physicians. 

6. Compile post-usage event data into a standard final summation report and send it to the School for events involving a student, employee, or visitor. 

7. File including EMS agency report. 

8. Follow-up: A District-approved vendor representative will call the site, if necessary, after an event is reported. 

C. The Principal will file the final report with the ADLA legal counsel. The Principal, School Nurse, or Administrative Designee will complete the confidential reports for all AED usage events. No copies of these reports are maintained at the school site. 

E. The Principal, School Nurse, or Administrative Designee will complete the Confidential Report of Automated External Defibrillator (AED) Incident Report (Attachment I) and send the document to the ADLA legal counsel. 

G. The principal (or designee) shall be responsible for organizing the post-incident review of the effectiveness of the site response. 


AUTHORITY: This is a policy of St. Vincent School. 

REFERENCES: 

    California Education Code sections 35160, 35179.6, 44277 

California Health and Safety Code section 1797.196 

California Code of Regulations, Health & Safety Code – HSC: Emergency Medical Services Chapter 3, Article 5, §1797.196 

California Code of Regulations, Education Code – EDC: Elementary and Secondary Education Chapter 2, Article 4.5, §35179.6 



RELATED RESOURCES: Attachment A- Automated External Defibrillator (AED) Program CPR/AED Emergency Response Site Plan 

Attachment B- Sample Automated External Defibrillator (AED)

Tri-Fold Information Pamphlet 

Attachment C- Sample Photograph of Required AED Signage 

Attachment D- Sample AED Inspection and Documentation on ArcH 

Attachment E- Sample Quick Response (QR) Codes on ArcH 

Attachment F- Sample AED Volunteer Responders and Training Records on Arch 

Attachment G- Sample Arch AED Superstore 

Attachment H- Sample AED Usage Event Reporting on Arch 

Attachment I- St. Vincent School Confidential Report of Automated External Defibrillator (AED) Incident Response


American Heart Association 

American Red Cross 

California Emergency Medical Services Authority



(Adapted from LAUSD, 2023)


















ATTACHMENT A

ST. VINCENT SCHOOL AUTOMATED EXTERNAL DEFIBRILLATOR (AED) PROGRAM CPR/AED EMERGENCY RESPONSE SITE PLAN MUST BE COMPLETED BY 

OCTOBER 15 


School Nurse:__________________________________________________ Date:___________ 

School Address: _______________________________City: ____________Zip Code: ________ Phone (      )___________________________________Extension:___________ 

AED Location(s): _______________________________________________________________

______________________________________________________________________________

CPR/AED Emergency Response Team Members Employee Number         CPR/AED Card Expiration Date 




















1. How will the first responder activate Emergency Medical Service (EMS)? 

______________________________________________________________________________


2. How will the first responder notify the CPR/AED Emergency Response Team Members? Indicate by phone, radio, bell, or intercom (e.g., “Code blue in room 20”) 

______________________________________________________________________________


3. Which Emergency Response Team members will be designated to bring the AED to the emergency site? ______________________________________________________________


The Local Administrator (Site Contact) will be responsible for documentation of the emergency. 

  • This document (Attachment A - CPR/AED Emergency Response Site Plan) must be reviewed and updated annually. 

  • Maintain the original copy of the CPR/AED Response Site Plan at your school or office site for 7 years. 

  • Create a binder for each AED on-site.


(Adapted fromLAUSD, 2023)




ATTACHMENT B 

Sample Information Pamphlet

 


(LAUSD, 2023)



ATTACHMENT C

Sample AED Signage

 



(LAUSD, 2023)





ATTACHMENT D 

Sample AED Inspection and Documentation on Arch

 





(LAUSD, 2023)



ATTACHMENT E

Sample Quick Response  (QR) Codes

 



(Adapted from LAUSD, 2023)




ATTACHMENT F 


Sample AED Volunteer Responders and Training Records on Arch

 








ATTACHMENT G

Sample Arch AED Superstore

 


(Adapted from LAUSD, 2023)



ATTACHMENT H

Sample AED Usage Event Reporting on Arch

 



(LAUSD, 2023)






ATTACHMENT I

ST. VINCENT SCHOOL

CONFIDENTIAL REPORT OF AUTOMATED EXTERNAL DEFIBRILLATOR (AED) INCIDENT RESPONSE 

This is a confidential report for transmission to and use by attorneys for the Archdiocese of Los Angeles. 

INSTRUCTIONS 

1. Complete this form Confidential Report of AED Incident Response within 24 hours.  

2. Complete and submit incident report within the cloud-based device management program.

3. Forward a copy to Archdiocese of Los Angeles Legal Counsel Email: legal@la-archdiocese.org Telephone: (213) 637-7511

4. No copy of AED Incident Response Report shall be retained by the school, or given to anyone, including the student or parent. 


Date:______Principal______________ Phone:______________Email Address:_____________

—----------------------------------------------------------------------------------------------------------------------------

  1. VICTIM INFORMATION Home Address 

____________________________________________________________________________

Last Name First Name                City     State           Zip Code


Gender Identity: Male____ Female____ Non-Binary____ Grade____ Date of Birth:__________

Student: ____         Employee____                     Visitor ____ 

—----------------------------------------------------------------------------------------------------------------------------

  1. AED INCIDENT SUMMARY 


Date of AED Incident Response: _________________ Time of incident: __________am/pm 

Exact location of incident: _______________________________________________________

Name of witness(s): ____________________________________________________________

Name of trained rescuer(s) responding:_____________________________________________

Emergency response site plan activated: Yes / No 

Was 911 called? Yes_____ No_____ If yes, name of person who called:___________________ 

Was CPR given before the AED arrived? ____Yes ____No 

If yes, name(s) of CPR rescuer(s): ________________________________________________

Description of Incident: _________________________________________________________

____________________________________________________________________________

AED usage event report filed (within 24 hours) Yes____ No___ Date:___________ Time: _____

____________________________________________________________________________

Name of person completing form Employee # Date

(Adapted from LAUSD, 2023)



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