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HEARTSafe Workplace Designation Application Form Connecticut Department of Public Health Heart Disease and Stroke Prevention Program Cardiovascular disease is the leading cause of death in Connecticut and the nation and many sudden cardiac events happen in workplaces each year. Minimum one AED in a publicly accessible location within a 3-minute round-trip walk of the furthest work area. Other i.e. retail store manufacturing floor warehouse summer...

How to fill out heartsafe workplace form

How to fill out heartsafe workplace form:

1. Start by obtaining the heartsafe workplace form from the appropriate authority or organization.
2. Fill in the required information on the form, such as the name and address of the workplace, contact details, and the date of submission.
3. Provide details about the safety measures and equipment available in the workplace to handle cardiac emergencies, such as the presence of automated external defibrillators (AEDs) and trained personnel.
4. Include information about any training programs or certifications related to CPR and first aid that employees have received.
5. Indicate if there is a designated first aid room or area in the workplace.
6. Provide details on the emergency procedures that are in place in case of a cardiac event, including the contact information for emergency medical services.
7. Add any additional information or comments that may be relevant to the heartsafe workplace program.
8. Review the completed form for accuracy and completeness before submitting it.

Who needs heartsafe workplace form:

1. Employers who are committed to ensuring a safe working environment for their employees.
2. Organizations or entities that are required to comply with regulations or guidelines related to workplace safety and cardiac emergencies.
3. Workplaces where employees may be at risk of experiencing cardiac events and where the implementation of heartsafe workplace measures is deemed necessary.

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What is heartsafe workplace form?

HeartSafe Workplace Form is a document that organizations are required to submit to ensure that their workplace is equipped with the necessary emergency medical equipment and trained personnel to respond to cardiac emergencies.

Who is required to file heartsafe workplace form?

All employers, business owners, or organizations that operate a physical workplace are required to file the HeartSafe Workplace Form.

How to fill out heartsafe workplace form?

To fill out the HeartSafe Workplace Form, you will need to provide information about your organization, including the location and size of your workplace, the number of employees, and details about the emergency medical equipment and training programs in place.

What is the purpose of heartsafe workplace form?

The purpose of the HeartSafe Workplace Form is to ensure that workplaces are prepared to respond effectively to cardiac emergencies by having the necessary equipment and trained personnel.

What information must be reported on heartsafe workplace form?

The HeartSafe Workplace Form requires information such as the organization's name and address, the number of employees, details about the emergency medical equipment available (e.g., defibrillators), a description of relevant training programs, and the contact information of the person responsible for emergency response.