The Course Roster form plays a pivotal role in documenting the nuanced details of American Heart Association Emergency Cardiovascular Care Program courses, specifically within the Heartsaver First Aid CPR AED segment. It meticulously records various facets of the course, including but not limited to the lead instructor's details, whether they hold a status of BLS (Basic Life Support) Instructor, HS (Heartsaver) Instructor, or BLS TCF/RF, and the crucial renewal dates. This form also catalogs the specific components of the Heartsaver core that were covered, such as first aid, adult CPR AED, and optionally, child and infant CPR AED, along with any written exams. Further details encompass the course location, schedules, duration, the student to manikin ratio, number of cards issued, and information on assisting instructors or specialty faculty. The roster ensures that each course is aligned with AHA guidelines through a verification process signed off by the lead instructor, underscoring the commitment to accuracy and adherence to standards. By capturing such comprehensive data, this form not only facilitates administrative oversight and quality control but also supports the certification process for participants, thereby playing a crucial role in the broader mission of promoting lifesaving skills.
Question | Answer |
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Form Name | Course Roster Form |
Form Length | 2 pages |
Fillable? | No |
Fillable fields | 0 |
Avg. time to fill out | 30 sec |
Other names | heartsaver first aid roster, how to cpr roster form, heartsaver course roster, aha heartsaver roster 2020 |
American Heart Association Emergency Cardiovascular Care Program
Heartsaver First Aid CPR AED
Course Roster Form
Course Information
Lead Instructor___________________________________________
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Status: BLS Instr. HS Instr. |
BLS TCF/RF |
Heartsaver First Aid CPR AED Provider Course: |
Status Renewal Date: _______________________________________ |
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This course included the following Heartsaver Core components: |
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First Aid |
Training Center____________________________________________ |
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Adult CPR AED |
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Child CPR AED (optional) |
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Infant CPR (optional) |
Course Location____________________________________________ |
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Written Exam (optional) |
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Course Start Date/Time_______________ |
Course End Date/Time_________________ |
Total hours of Instruction __________ |
# of Cards Issued_________ |
Student/Manikin Ratio__________ |
Issue Date of cards________________ |
Assisting Instructors / Specialty Faculty (Attach copy of instructor card for instructors aligned with other than primary TC)
Name |
Instr. card Exp. Date |
Name |
Instr. card Exp. Date |
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I verify that this information is accurate and truthful, and that it may be confirmed. This course was taught in accordance with AHA guidelines.
____________________________________________ |
_______________________________________________ |
Signature of Lead Instructor |
Date |
Heartsaver First Aid 2010, page 1
DATE_________________ COURSE |
Heartsaver First Aid CPR AED |
INSTRUCTOR ________________________________ |
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FULL NAME |
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1st Aid |
Adult |
Child |
Infant |
Written |
Card |
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Job Title |
Department |
VUNet ID |
Skills |
CPR AED |
CPR AED |
CPR |
Exam |
Issued |
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PLEASE PRINT |
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(optional) |
Y orN |
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Heartsaver First Aid 2010, page 2