Cardiac Smart- North West Organisations Application form

Section 1

Name of Organisation (this is the name that will appear on your plaque- please check spelling!)
Full Address of organisation
Name of Main Contact
Contact Number of main contact
Email address of main contact
How Many people do you have in your Organisation / No. of employees
No. of First Aiders
Have you previously received a cardiac smart award? If Yes please state which standard (bronze, silver or Gold) and which year you received it.
Which award level are you applying for? / Bronze (Please Fill out Section 2)
Silver (Please Fill out Section 2 and 3)
Gold (Please fill out Section 2, 3 and 4)

Section 2

To gain a bronze award you must fulfil all the bronze criteria. Please provide as much evidence as you can for each part. Failure to meet all the criteria will result in no Cardiac Smart award.

For CoS use only
  1. A Single AED in an accessible and obvious place (please evidence where)

  1. AED signposted and registered (Please provide name of contact in NWAs it was registered with)

  1. All first aiders on site trained in CPR and AED (Please evidence what training they have received)

Section 3- Silver award

To gain a Silver award you must fulfil all the bronze criteria in section 2andthe below Silver Criteria. Please provide as much evidence as you can for each part. If you do not meet the Silver award standard you will be considered for a bronze award.

For CoS use only
  1. AED/CPR trainer on site

  1. At least 50% of all staff trained in CPR/AED usage

Section 4- Gold Standard

To gain a Gold award you must fulfil all the bronze criteria in section 2, Silver Criteria in section 3 and the below Gold criteria. Please provide as much evidence as you can for each part. If you do not meet the Gold award standard you will be considered for a bronze or silver award.

For CoS use only
  1. Trainer offering external training to the community

  1. All staff trained in CPR and AED usage

Section 5 - Check list

Please Tick
Section 1 completed
If applying for bronze standard; section 2 completed
If applying for silver standard; section 2 and 3 completed
If applying for gold standard, section 2,3 and 4 completed
Photo Attached

Version 1- 08/09/2015